Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India

Abstract

<jats:p>Background: Nail disorders comprise approximately10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy.&#x0D; Objective: To study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones.&#x0D; Methods: An open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded.&#x0D; Results: The study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases.&#x0D; Limitations: The study was only observational and did not compare the results to biopsy and culture.&#x0D; Conclusions: Onychoscopy may be used as an important diagnostic tool when evaluating nail disorders. It should be used to aid in the diagnosis of various nail disorders and to avoid unnecessary and time-consuming investigations.</jats:p>

Onychoscopic evaluation of various nail disorders at a Tertiary care center

“…Onychomycosis was the most common nail disorder observed in our study and this was concordant with Puri et al 4 , Bhat YJ et al 5 and Kumar et al 6 with 25%, 34.18% and 34.2% prevalence respectively, while Rathod et al 3 found onychomycosis as the second most common disorder after nail psoriasis.…”

“…In our study, there was a male preponderance [M:F = 1.46:1] which was similar to the findings of other Indian studies by Puri et al 4 , Rathod et al 3 and Bhat YJ et al 5 This could be because of better accessibility of males to health care facilities.…”

“…A bulk [89(79.6%)] of patients belonged to rural areas in our study which was comparable to the study by Bhat YJ et al 5 where 151 (63.71%) patients belonged to rural areas. Place of study mainly serving the rural population could explain the dominance of rural patients in the study.…”

“…In nail psoriasis, the most common observation in our study was onycholysis (84.4%) followed by pits (81.3%), splinter hemorrhages (71.9%) and subungual hyperkeratosis (68.8%). However, pits were the commonest findings in studies by Rathod et al(64.5%), 3 Bhat YJ et al 5 (85.71%) and Wanniang et al(84%) 14 while splinter haemorrhage was the commonest in the study by Yorulmaz et al(73.1%). 15 Depending on the part of nail unit involvement, nail psoriasis had a myriad of clinical and dermoscopic manifestations.…”

“…15 Pseudo-fiber sign corresponded to arterial and venous ends of capillaries seen in 34.3% cases in a study by Yorulmaz et al 15 However, we failed to observe pseudo-fiber sign owing to the less magnification provided by our dermoscope. Salmon spots, also known as 'oil drop sign' (9.3%) were seen as dull red to orange-red globules in the nail plate while Bhat YJ et al 5 and Polat et al 18 observed salmon spots in 42.9% and 47.5% cases.…”