Noninvasive Assessment of Mycotic Nail Tissue Using an Ultraviolet Fluorescence Excitation Imaging System

Ortner, Vinzent Kevin; Franco, Walfre; Hædersdal, Merete; Philipsen, Peter Alshede

doi:10.1002/lsm.23285

Cited by 2 publications

(2 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In situ hybridization would be the ideal method to both identify the fungus on a species level and to prove its localization in the nail; some research has been carried out [ 17 ], but this method is not yet available for routine diagnosis. Other sophisticated methods such as immunohistochemistry, immune adsorption, immunochromatography (approved in Japan) and ultraviolet excitation are not yet available for routine diagnosis [ 18 , 19 ] ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Single-Digit Onychomycosis

Haneke

Stovbyr²

2023

JoF

View full text Add to dashboard Cite

Onychomycoses are a group of fungal nail infections commonly classified either according to the pathogenic fungus, to the duration of the disease or to the mode of fungal invasion. Most cases are diagnosed clinically, although there is a general consensus that the pathogen should be identified prior to initiating a treatment. However, this is often difficult as the classical mycologic methods of direct microscopy and culture frequently remain negative. We came across a particular subset of onychomycoses, which posed extreme diagnostic and therapeutic challenges. Over a period of 15 years, 44 patients were seen in specialized nail clinics with a single nail dystrophy that was examined and treated in vain by many practitioners and dermatologists prior to their consultation. Of the forty-four cases, thirty-nine patients had a fingernail affected and five had a toenail affected. The nail was almost completely onycholytic, the nail bed visibly keratotic, the proximal nail fold smooth and shiny and slightly swollen. All patients except five brought the results of negative mycologic cultures. Thirty-four patients had received antifungal therapy, mostly topical, as a single nail would not qualify for systemic treatment according to most national and international guidelines. The diagnosis was finally confirmed by histopathology of the nail plate showing an invasive onychomycosis in all cases. After nail avulsion and combined topical and systemic antifungal therapy, thirty-six patients were cured, three were lost from follow-up, and five showed improved nails but not a complete clinical and mycologic cure. A single-digit nail disease raises the suspicion of a tumor or a trauma; although, in rare cases, diseases normally affecting several nails may only affect a single nail. Such a case should prompt the clinician to ask for a previous trauma to this digit and to intensify the search for a specific pathogen. This study also underlines the importance of histopathology for the diagnosis of onychomycoses.

show abstract

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Single-Digit Onychomycosis

Haneke

Stovbyr²

2023

JoF

View full text Add to dashboard Cite

show abstract

“…Preliminary investigation of ultraviolet fluorescence excitation imaging (u-FEI) detected significant difference in autofluorescent signal intensity of healthy and mycotic nail samples [ 39 ]. Average and maximum fluorescence values were 10.2% and 23.9% higher in onychomycosis versus healthy nails.…”

Section: Visual Methods Of Diagnosismentioning

confidence: 99%

Diagnosing Onychomycosis: What’s New?

Gupta

Hall

Cooper

et al. 2022

JoF

View full text Add to dashboard Cite

An overview of the long-established methods of diagnosing onychomycosis (potassium hydroxide testing, fungal culture, and histopathological examination) is provided followed by an outline of other diagnostic methods currently in use or under development. These methods generally use one of two diagnostic techniques: visual identification of infection (fungal elements or onychomycosis signs) or organism identification (typing of fungal genus/species). Visual diagnosis (dermoscopy, optical coherence tomography, confocal microscopy, UV fluorescence excitation) provides clinical evidence of infection, but may be limited by lack of organism information when treatment decisions are needed. The organism identification methods (lateral flow techniques, polymerase chain reaction, MALDI-TOF mass spectroscopy and Raman spectroscopy) seek to provide faster and more reliable identification than standard fungal culture methods. Additionally, artificial intelligence methods are being applied to assist with visual identification, with good success. Despite being considered the ‘gold standard’ for diagnosis, clinicians are generally well aware that the established methods have many limitations for diagnosis. The new techniques seek to augment established methods, but also have advantages and disadvantages relative to their diagnostic use. It remains to be seen which of the newer methods will become more widely used for diagnosis of onychomycosis. Clinicians need to be aware of the limitations of diagnostic utility calculations as well, and look beyond the numbers to assess which techniques will provide the best options for patient assessment and management.

show abstract

Noninvasive Assessment of Mycotic Nail Tissue Using an Ultraviolet Fluorescence Excitation Imaging System

Cited by 2 publications

References 32 publications

Post-Traumatic Single-Digit Onychomycosis

Post-Traumatic Single-Digit Onychomycosis

Diagnosing Onychomycosis: What’s New?

Contact Info

Product

Resources

About