Comparative study of nail sampling techniques in onychomycosis.

Area of Science:

• Medical Mycology
• Dermatology
• Clinical Diagnostics

Background:

• Onychomycosis is a prevalent fungal nail infection.
• Accurate laboratory diagnosis is essential for effective treatment.
• Nail sampling techniques can impact diagnostic accuracy.

Purpose of the Study:

• To compare curettage and drilling techniques for nail sampling in onychomycosis diagnosis.
• To determine the optimal sampling site and method for improved diagnostic yield.
• To evaluate the sensitivity of different sampling methods and locations.

Main Methods:

• Sixty patients with distal and lateral subungual onychomycosis were enrolled.
• Nail samples were collected using curettage, horizontal drilling, and vertical drilling.
• Samples were obtained from three distinct sites on the infected nail.
• Potassium hydroxide (KOH) examination and fungal culture were performed.

Main Results:

• Horizontal drilling demonstrated higher culture sensitivity than curettage at all sites.
• The drilling technique, particularly vertical drilling from the proximal nail, yielded better results than curettage.
• Culture sensitivity increased with more proximal sample locations for both techniques.
• Trichophyton rubrum was the most frequently identified pathogen.

Conclusions:

• Vertical drilling from the proximal nail is the optimal method for onychomycosis diagnosis.
• Proximal sampling sites enhance the detection of fungal pathogens.
• Improved diagnostic accuracy through optimized nail sampling is critical for patient management.