Nail digital dermoscopy (Onychoscopy) in the diagnosis of onychomycosis
Nail digital dermoscopy (Onychoscopy) in the diagnosis of onychomycosis
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DOI：
10.1111/j.1468-3083.2011.04323.x
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发表时间：
2013-04-01
影响因子：
9.2
通讯作者：
Rech, G.
中科院分区：
文献类型：
--
作者：
Piraccini, B. M.;Balestri, R.;Rech, G.
远端甲下甲真菌病和创伤性甲松解是趾甲异常最常见的原因，没有真菌学检查往往无法鉴别诊断。目的识别和描述远端甲下甲真菌病的皮肤镜特征，以便于其诊断和与创伤性真菌学阴性甲松解症的鉴别，并确定这些皮肤镜特征的敏感性和特异性。方法我们进行了一项回顾性研究，在门诊咨询指甲疾病的皮肤科博洛尼亚大学。对2010年12月1日至2011年6月30日期间因单个趾甲松解而接受整体摄影、视频皮肤镜和真菌学检查的57例连续患者的皮肤镜数字图像进行了评价和比较。数字皮肤镜图像的趾甲松解的大趾甲进行了评估，存在特殊的皮肤镜特征。假定的皮肤镜诊断与真菌学结果进行了比较。结果评价视频皮肤镜图像，使我们能够确定三个经常出现的特殊皮肤镜特征，其中两个只存在于远端甲下甲真菌病（锯齿状近端边缘与甲松解区和纵向条纹的尖峰）和一个只在创伤性甲松解（线性边缘无甲松解区的尖峰）。结论：我们发现独特的皮肤镜体征是唯一的远端甲下甲真菌病和创伤性甲松解。这些迹象的检测是简单的，可以在选定的情况下，有助于避免真菌学。
Background Distal subungual onychomycosis and traumatic onycholysis are the most common causes of toenail abnormalities, and differential diagnosis is often impossible without mycology. Objectives To identify and describe dermoscopic signs specific for distal subungual onychomycosis that could facilitate its diagnosis and differentiation from traumatic mycologically negative onycholysis and to determine the sensitivity and specificity of these dermoscopic features. Methods We performed a retrospective study at the Outpatient Consultation for Nail Diseases of the Department of Dermatology of the University of Bologna. Dermoscopic digital images of 57 consecutive patients who underwent global photography, videodermoscopy and mycological examination for onycholysis of a single toenail between 1 December, 2010 and 30 June, 2011, were evaluated and compared. Digital dermoscopic images of onycholysis of the great toenail were evaluated for the presence of peculiar dermoscopic features. The presumptive dermoscopic diagnosis was compared with results of mycology. Results Evaluation of videodermoscopic images allowed us to identify three recurring peculiar dermoscopic features, two of which were present only in distal subungual onychomycosis (jagged proximal edge with spikes of the onycholytic area and longitudinal striae) and one only in traumatic onycholysis (linear edge without spikes of the onycholytic area). Conclusions We found distinctive dermoscopic signs that are exclusive to distal subungual onychomycosis and to traumatic onycholysis. Detection of these signs is simple and can, in selected cases, help to avoid mycology.