Confocal microscopy for healthy and pathological nail

Area of Science:

• Dermatology
• Medical Imaging
• Optical Engineering

Background:

• Nail diseases present diagnostic challenges for dermatologists, often necessitating invasive nail biopsies.
• There is a growing need for advanced, non-invasive imaging techniques for nail disorder diagnosis.
• Confocal microscopy is an emerging high-resolution imaging technology with potential applications across various body surfaces, including nails.

Purpose of the Study:

• To systematically review the literature on confocal microscopy for studying healthy and pathological nails.
• To evaluate the current applications and future potential of confocal microscopy in nail diagnostics.
• To explore its role in non-invasive in vivo examination and ex vivo surgical assistance.

Main Methods:

• A systematic literature review was conducted focusing on confocal microscopy use in nail studies.
• Studies examining both healthy and pathological nail conditions using confocal microscopy were included.
• The review assessed the technique's suitability for in vivo and ex vivo nail examination.

Main Results:

• Confocal microscopy allows non-invasive in vivo examination of the nail unit, including up to the nail bed.
• The technique's suitability is enhanced by nail plate transparency, aiding corneocyte identification.
• Potential diagnostic roles include onychomycosis, melanonichia, and drug penetration studies.

Conclusions:

• Confocal microscopy is a promising non-invasive tool for diagnosing various nail diseases such as psoriasis and lichen planus.
• Future applications may include intra-operative ex vivo examination for precise tumor margin delineation.
• This technique could significantly reduce the need for nail biopsies in clinical practice.