Diagnosis of onychomycosis clinically by nail dermoscopy versus microbiological diagnosis

Nada, Essam; Taieb, Moustafa A El; El-Feky, Mohamed A; Ibrahim, Hassan; Hegazy, Eisa M.; Mohamed, Alaa E; El-Amir, Mostafa I

doi:10.1007/s00403-019-02008-6

Cited by 20 publications

(34 citation statements)

References 19 publications

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“…In this study, males (78.3%) outnumbered females; this was similar to the findings of Yorulmaz et al (5). However, a female preponderance of onychomycosis has been reported in few other studies (6)(7)(8). Male preponderance in this study may be due to the fact that the majority of patients were agricultural workers (26.7%), followed closely by semiskilled workers (drivers, shopkeepers, masons, mechanics, cooks, or barbers) at 23.3%; both of these are male-dominated occupations in this part of India.…”

Section: Discussionsupporting

confidence: 92%

Onychoscopy: a quick and effective tool for diagnosing onychomycosis in a resource-poor setting

Hazarika¹,

Chauhan²,

Divyalakshmi³

et al. 2021

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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44 to 100% for potassium hydroxide (KOH) mount, and about 81 to 91.6% for biopsy. Currently, there is no consensus on the most appropriate combination of tests that can increase the sensitivity and specificity of diagnosis. The sensitivity values reported for test combinations are 57% for biopsy and KOH, and 98.3% for biopsy and culture (2).Onychoscopy is dermoscopic examination of the nail apparatus, which includes the nail plate surface and the free edge, nail matrix, nail bed, periungual folds, and hyponychium. It forms a link between naked eye examination and nail histopathology, opening the potential to prevent biopsy (3).Piracini et al. were the first to use dermoscopy to support the diagnosis of fungal infection of nails. Their retrospective study of 57 patients sought to identify and describe dermoscopic signs specific for distal subungual onychomycosis that could differentiate it from traumatic mycologically negative onycholysis (4).Very few studies are available in the literature on onychoscopic findings of onychomycosis in Indian patients. The aim of this study was to identify common onychoscopic patterns of onychomycosis prevalent in this part of India, explore their correlation with clini-cal subtypes of onychomycosis, and contribute to knowledge of the use of onychoscopy as a simple, quick, and reliable diagnostic aid for clinical diagnosis of onychomycosis in the outpatient department setting. Materials and methodsThis was an outpatient-based, observational, cross-sectional study conducted for 6 months using the STROBE checklist, after obtaining institutional ethical clearance. Patients were recruited after providing informed written consent (in Hindi or English) for inclusion in the study as well as separate consent for photography.The aim of the study was to identify common onychoscopic patterns in nails affected by onychomycosis and to describe their correlation to the clinical subtypes of onychomycosis. The inclusion criteria were all treatment-naive patients presenting to the dermatology outpatient department for the first time and clinically diagnosed with onychomycosis. Children below 18 years, patients already partially treated for onychomycosis, patients with clinical diagnosis of onychomycosis but negative on KOH mount were excluded from the study.Nail clippings of all patients were taken for KOH mounting. Only patients with a positive KOH mount were recruited for the study. Images of the affected nail were obtained with a Canon PowerShot G1x® camera. Onychoscopy was performed with DermLite II hybrid m, 3Gen, polarized mode, 10× magnification. An IPhone camera was used to capture the images. The image from the most clinically dystrophic nail unit, whether fingernail

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Section: Discussionsupporting

confidence: 92%

Onychoscopy: a quick and effective tool for diagnosing onychomycosis in a resource-poor setting

Hazarika¹,

Chauhan²,

Divyalakshmi³

et al. 2021

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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“…Traditionally, mycological diagnosis was made using KOH examination or fungal cultures. The sensitivity and specificity of these tests were estimated to be 52.5-81.8% and 72.0-100%, respectively for KOH, and 57.0-59.0% and 82.0-100%, respectively, for fungal culture [12,14,15]. However, the two tests require the use of specific equipment and are time-consuming, particularly culture, which requires at least 4 weeks' incubation.…”

Section: Discussionmentioning

confidence: 99%

Prospective, comparative evaluation of a deep neural network and dermoscopy in the diagnosis of onychomycosis

Kim

Han²,

Yang

et al. 2020

PLoS ONE

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Background Onychomycosis is the most common nail disorder and is associated with diagnostic challenges. Emerging non-invasive, real-time techniques such as dermoscopy and deep convolutional neural networks have been proposed for the diagnosis of this condition. However, comparative studies of the two tools in the diagnosis of onychomycosis have not previously been conducted. Objectives This study evaluated the diagnostic abilities of a deep neural network (http://nail. modelderm.com) and dermoscopic examination in patients with onychomycosis. Methods A prospective observational study was performed in patients presenting with dystrophic features in the toenails. Clinical photographs were taken by research assistants, and the ground truth was determined either by direct microscopy using the potassium hydroxide test or by fungal culture. Five board-certified dermatologists determined a diagnosis of onychomycosis using the clinical photographs. The diagnosis was also made using the algorithm and dermoscopic examination. Results A total of 90 patients (mean age, 55.3; male, 43.3%) assessed between September 2018 and July 2019 were included in the analysis. The detection of onychomycosis using the algorithm (AUC, 0.751; 95% CI, 0.646-0.856) and that by dermoscopy (AUC, 0.755; 95% CI, 0.654-0.855) were seen to be comparable (Delong's test; P = 0.952). The sensitivity and specificity of the algorithm at the operating point were 70.2% and 72.7%, respectively. The sensitivity and specificity of diagnosis by the five dermatologists were 73.0% and 49.7%, respectively. The Youden index of the algorithm (0.429) was also comparable to that of the dermatologists' diagnosis (0.230±0.176; Wilcoxon rank-sum test; P = 0.667).

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“…[72][73][74][75] Dermoscopy may aid in distinguishing onychomycosis from other dystrophic nail disorders by revealing features unique to onychomycosis 71,76,77 such as jagged edges with spikes in the proximal margin and longitudinal striations and colour changes in the onycholytic nail area. 72,73,78 Dermoscopy or nail plate videodermoscopy provides a quick, simple, differential diagnostic tool that can increase accuracy in diagnosing onychomycosis. 62,71,79 Additionally, it is possible to use dermoscopy to identify the ideal location to obtain samples for subsequent mycological examination.…”

Section: Diagnosismentioning

confidence: 99%

“…It is a non‐invasive imaging method that requires knowledge of the anatomy, physiology, and pathogenesis of nail fungal infections 71 . The enhanced specificity and sensitivity of dermoscopy in diagnosing onychomycosis have been documented 72–75 . Dermoscopy may aid in distinguishing onychomycosis from other dystrophic nail disorders by revealing features unique to onychomycosis 71,76,77 such as jagged edges with spikes in the proximal margin and longitudinal striations and colour changes in the onycholytic nail area 72,73,78 .…”

Section: Diagnosismentioning

confidence: 99%

“…The enhanced specificity and sensitivity of dermoscopy in diagnosing onychomycosis have been documented 72–75 . Dermoscopy may aid in distinguishing onychomycosis from other dystrophic nail disorders by revealing features unique to onychomycosis 71,76,77 such as jagged edges with spikes in the proximal margin and longitudinal striations and colour changes in the onycholytic nail area 72,73,78 . Dermoscopy or nail plate videodermoscopy provides a quick, simple, differential diagnostic tool that can increase accuracy in diagnosing onychomycosis 62,71,79 .…”

Section: Diagnosismentioning

confidence: 99%

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Nondermatophyte mould onychomycosis

Gupta

Summerbell

Venkataraman

et al. 2021

Acad Dermatol Venereol

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Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.

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Diagnosis of onychomycosis clinically by nail dermoscopy versus microbiological diagnosis

Cited by 20 publications

References 19 publications

Onychoscopy: a quick and effective tool for diagnosing onychomycosis in a resource-poor setting

Onychoscopy: a quick and effective tool for diagnosing onychomycosis in a resource-poor setting

Prospective, comparative evaluation of a deep neural network and dermoscopy in the diagnosis of onychomycosis

Nondermatophyte mould onychomycosis

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