Dermoscopy of onycholysis due to nail psoriasis, onychomycosis and trauma: A cross sectional study in skin of color

Ankad, Balachandra S; Gupta, Aakash; Alekhya, Rallapalli; Saipriya, Morlawar

doi:10.4103/idoj.idoj_475_19

Cited by 17 publications

(42 citation statements)

References 19 publications

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“…Overall, 5 contributions were not in the English language, and 7 did not include information regarding the frequency of dermoscopic signs of onychomycosis. Consequently, 33 records were included in this review [2,3,[12][13][14][15][16][17][18][19][20][21]4,[22][23][24][25][26][27][28][29][30][31]5,[32][33][34][6][7][8][9][10][11]. The process of selecting relevant articles is illustrated in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

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Dermoscopy of Onychomycosis: A Systematic Review

Litaiem

Mnif

Zéglaoui

2023

Dermatol Pract Concept

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Introduction: Onychomycosis represents a global burden accounting for about 50% of nail consultations. Several studies have tried to assess the dermoscopic features of onychomycosis. With the multiplication of papers, several “new” dermoscopic signs keep being added leading to some inconsistency in onychoscopic terminology. Objective: This study aimed to summarize the existing literature on the dermoscopic features of onychomycosis and propose a unified onychoscopic terminology. Methods: The literature search was performed using PubMed and Scopus databases up to October 30, 2021 to identify eligible contributions. In total, 33 records (2111 patients) were included. Results: The main dermoscopic signs of onychomycosis are “ruin appearance”, “longitudinal striae” and “spikes” on the proximal margin of onycholytic areas, with a specificity of 99.38%, 83.78%, and 85.64% respectively. The “aurora borealis” sign had the highest sensitivity and specificity. Conclusions: The current review provides a framework for issues related to the onychoscopic terminology of onychomycosis and is intended to serve as an aid for students, teachers, and researchers. We proposed a unifying terminology to describe dermoscopic signs of onychomycosis. Dermoscopic signs of onychomycosis show good specificity and are useful in distinguishing nail psoriasis, trauma, and onychomycosis. It helps differentiate fungal melanonychia from nail melanoma, nevi, and melanocytic activation.

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Section: Resultsmentioning

confidence: 99%

“…The process of selecting relevant articles is illustrated in Figure 1. [4,7,11,16,17,23,[27][28][29][30][31][32]35], fungal culture [2,3,5,8,13,16,19,20,24,25,33,34], and/or histologic examination of nail plates [5,8,10,19,20,24].…”

Section: Resultsmentioning

confidence: 99%

Dermoscopy of Onychomycosis: A Systematic Review

Litaiem

Mnif

Zéglaoui

2023

Dermatol Pract Concept

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“…Nineteen studies reported dermoscopic features of 1,693 cases of onychomycosis. Commonly identified dermoscopic features of onychomycosis were spikes or spiked pattern (481, 28.4%) ( 10 – 18 ), jagged or spiked edges or jagged edge with spikes (188, 11.1%) ( 19 – 25 ), jagged proximal edge (175, 10.3%) ( 10 , 12 , 16 , 18 ), subungual hyperkeratosis (131, 7.7%) ( 15 , 19 , 20 , 25 , 26 ), ruins appearance, aspect or pattern (573, 33.8%) ( 15 , 19 , 22 , 24 , 27 , 28 ), and longitudinal striae (929, 54.9%) ( 10 – 18 , 20 – 23 , 27 ) ( Table 2 ). Other dermoscopic findings included distal irregular termination (331, 19.6%) ( 10 – 12 , 14 – 16 , 18 , 20 , 22 ) and aurora borealis pattern (293, 17.3%) ( 11 , 12 , 15 , 17 , 20 , 23 ).…”

Section: Resultsmentioning

confidence: 99%

“…Studies had a low risk of bias in terms of the index test (dermoscopy), reference standard (clear diagnosis of non-onychomycosis nails), flow, and timing. However, the risk of bias in the reference standard for one article was deemed high, as two cases with a positive potassium hydroxide result were not classified as onychomycosis as they primarily displayed features of other nail disorders ( 19 ). Studies had low applicability concerns with patient selection and reference standards, but two studies had high applicability concerns with the index test because they did not provide clear definitions or representative images for dermoscopic features ( 25 , 27 ).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of dermoscopy for onychomycosis: A systematic review

Lim

Hui²,

Ohn³

et al. 2022

Front. Med.

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BackgroundDermoscopy is a non-invasive adjuvant diagnostic tool that allows clinicians to visualize microscopic features of cutaneous disorders. Recent studies have demonstrated that dermoscopy can be used to diagnose onychomycosis. We performed this systematic review to identify the characteristic dermoscopic features of onychomycosis and understand their diagnostic utility.MethodsWe searched the Medline, Embase, Scopus, and Cochrane databases from conception until May 2021. Studies on the dermoscopic features of onychomycosis were screened. The exclusion criteria were as follows: fewer than 5 cases of onychomycosis, review articles, and studies including onychomycosis cases that were not mycologically verified. Studies on fungal melanonychia were analyzed separately. We adhered to the MOOSE guidelines. Independent data extraction was performed. Data were pooled using a random effects model to account for study heterogeneity. The primary outcome was the diagnostic accuracy of the dermoscopic features of onychomycosis. This was determined by pooling the sensitivity and specificity values of the dermoscopic features identified during the systematic review using the DerSimonian-Laird method. Meta-DiSc version 1.4 and Review Manager 5.4.1 were used to calculate these values.ResultsWe analyzed 19 articles on 1693 cases of onychomycosis and 5 articles on 148 cases of fungal melanonychia. Commonly reported dermoscopic features of onychomycosis were spikes or spiked pattern (509, 30.1%), jagged or spiked edges or jagged edge with spikes (188, 11.1%), jagged proximal edge (175, 10.3%), subungual hyperkeratosis (131, 7.7%), ruins appearance, aspect or pattern (573, 33.8%), and longitudinal striae (929, 54.9%). Commonly reported features of fungal melanonychia included multicolor (101, 68.2%), non-longitudinal homogenous pigmentation (75, 50.7%) and longitudinal white or yellow streaks (52, 31.5%).ConclusionThis study highlights the commonly identified dermoscopic features of onychomycosis. Recognizing such characteristic dermoscopic features of onychomycosis can assist clinicians diagnose onychomycosis by the bedside.

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“…Nail dermoscopy is a fundamental method in differentiating nail psoriasis from other nail disorders when clinical findings are not apparent [7,8]. A few studies [9][10][11][12][13][14][15][16], including ours [17], have described both classical and novel dermoscopic features of nail psoriasis. The diagnosis of nail psoriasis can easily be made when characteristic dermoscopic features are detected [7].…”

Section: Introductionmentioning

confidence: 99%

Dermoscopic Features of Nail Psoriasis: Revisited

Yorulmaz¹,

Aksoy²

2022

Skin Appendage Disord

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Introduction: Nail psoriasis poses a diagnostic challenge in a context of clinical findings that are not evident. We aimed at exploring dermoscopic findings of nail psoriasis and assessing the relationship between these features with disease severity and the risk of arthritis. Methods: We enrolled 35 patients (26 men, 9 women) with severe nail psoriasis (Nail Psoriasis Severity Index [NAPSI] score of more than 50). A complete clinical evaluation, including musculoskeletal assessment and videodermoscopic examination of all nails, was carried out for each patient. Results: Splinter haemorrhage was the most common finding (94.3%), followed by distal onycholysis (88.6%) and pitting (74.3%). The presence of subungual hyperkeratosis (SUH) and the absence of mottled lunula were associated with disease severity (p < 0.05). Both SUH and nail plate crumbling (NPC) were observed more in patients with arthritis. The presence of a combination of SUH and NPC was associated to a 15-fold increase in the risk of arthritis (%95 confidence intervals: 1.55–145.2, p < 0.05). Discussion/Conclusion: This study presents preliminary evidence for the use of dermoscopy as a first step in the diagnosis of nail psoriasis. Dermoscopy is an indispensable tool in the primary evaluation of patients with nail psoriasis, which provides predictive information about the course of the disease.

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Dermoscopy of onycholysis due to nail psoriasis, onychomycosis and trauma: A cross sectional study in skin of color

Cited by 17 publications

References 19 publications

Dermoscopy of Onychomycosis: A Systematic Review

Dermoscopy of Onychomycosis: A Systematic Review

Diagnostic accuracy of dermoscopy for onychomycosis: A systematic review

Dermoscopic Features of Nail Psoriasis: Revisited

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