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

Area of Science:

• Dermatology
• Ophthalmology

Background:

• Onychomycosis is the most common nail disorder.
• Clinical diagnosis is straightforward, but confirmatory fungal cultures are time-consuming and require lab facilities.
• Onychoscopy offers a rapid, cost-effective alternative for improving diagnostic accuracy.

Purpose of the Study:

• To identify common onychoscopic patterns associated with onychomycosis.
• To correlate these patterns with established clinical subtypes of the fungal nail infection.

Main Methods:

• The study involved 60 patients with clinically diagnosed onychomycosis confirmed by KOH mount.
• Onychoscopy was performed using a DermLite II hybrid m device with polarized light at 10× magnification.
• Data on onychoscopic patterns and clinical subtypes were collected and analyzed.

Main Results:

• Common onychoscopic findings included longitudinal striae (77.6%), distal irregular termination/"ruin pattern" (82.7%), chromonychia (62.1%), and jagged edges with spikes (65.5%).
• Significant associations were found between clinical subtypes and chromonychia (p=0.000), jagged edges with spikes (p=0.015), and distal irregular termination (p=0.016).

Conclusions:

• Onychoscopy serves as a valuable complementary diagnostic tool for onychomycosis.
• It can potentially decrease reliance on traditional methods like direct microscopy and fungal cultures.
• The technique enhances clinical diagnostic capabilities for this prevalent nail condition.