Intra-Operative Onychoscopy of Subungual Epidermoid Inclusions.

Area of Science:

• Dermatology
• Pathology
• Nail Medicine

Background:

• Subungual epidermoid inclusions (SEI) are uncommon epithelial growths beneath the nail.
• While typically small, SEI can enlarge, causing nail deformities like onycholysis and dystrophic nails.

Purpose of the Study:

• To report a case of SEI presenting with great toe onychodystrophy.
• To illustrate the characteristic onychoscopic features of SEI.
• To emphasize the utility of intra-operative onychoscopy in diagnosing SEI.

Main Methods:

• Case report of a female patient with symptomatic SEI.
• Clinical examination and onychoscopic evaluation of the great toe nail.
• Nail bed biopsy with histopathologic examination.
• Intra-operative onychoscopy during the biopsy procedure.

Main Results:

• The patient presented with onychodystrophy of the great toe nail.
• Onychoscopy revealed specific features indicative of SEI.
• Histopathology confirmed the diagnosis of SEI with central keratinization.

Conclusions:

• Intra-operative onychoscopy is a valuable tool for identifying SEI during nail bed biopsies.
• This technique can enhance diagnostic yield and reduce inadequate specimen collection.
• Early and accurate diagnosis of SEI is crucial for managing associated nail abnormalities.