Onychoscopy in a Colombian population with a diagnosis of toenail onychomycosis: an evaluation study for this diagnostic test.

BACKGROUND: Onychoscopy is a technique that uses a dermatoscope for the evaluation of specific features of different skin conditions that are not visible to the naked eye. There are few studies establishing parameters for the diagnosis of onychomycosis based on onychoscopy. Determining the sensitivity and specificity of a potentially new diagnostic test for onychomycosis requires an evaluation study of this new diagnostic test, as there are limited studies reporting onychoscopy results. AIM: To determine the sensitivity, specificity, positive predictive value and negative predictive value of onychoscopy findings in a Colombian population with onychomycosis. METHODS: We assessed outpatients with a diagnosis of toenail onychomycosis confirmed by potassium hydroxide preparation or fungal culture. Onychoscopy was performed using a dermatoscope, and digital images collected using a smartphone. RESULTS: The onychoscopy findings were: longitudinal striae, distal spiked pattern, distal irregular termination, linear edge and ruins aspect, while some patients were confirmed as having traumatic onycholysis. A statistically significant association was found between the clinical symptoms of onychomycosis and both the clinical feature of dyschromia and the onychoscopy feature of longitudinal striae. CONCLUSION: We suggest that this technique is an alternative method that should be used in patients with onychopathies because it has the potential to differentiate onychomycosis from traumatic onycholysis and another nail involvement.

[Differences of spectral Doppler in psoriatic arthritis and onychomycosis]. / As diferenças do Doppler espectral, na artrite psoriática e onicomicose.

OBJECTIVE: To evaluate the use of the spectral Doppler (SDoppler) to quantify inflammatory activity and to detect nail echotextural differences in patients with psoriatic arthritis and onychomycosis. METHODS: Two patients, one with psoriatic arthritis but with no joint pain nor nail clinical change and the other with onychomycosis and rheumatoid arthritis were included. The gray scale ultrasound study, showed changes in the regular presence of echotexture at the nail insertion, thickening of the nail bed and loss of trilaminar nail pattern. The spectral Dopplerresistance index (RI), detects the inflammatory process in nail entheses. RESULTS: Seven distal interphalangeal (DIP) joints in both patients were evaluated in two planes, getting nine RI. In the patient with psoriatic arthritis the author found: loss of normal trilaminar nail plate aspect, and nail beds and DIP joint capsules preserved. The spectral Doppler showed RI<1, with mean±SD=0.50±0.75 in the microcirculation at nail entheses, with characterization of a bone erosion in the third left DIP joint, with RI=0.38 and 0.63 in transverse and longitudinal planes, respectively. The patient with onychomycosis showed the following changes: hypoechogenicity at nail insertion; loss of nail shape, and spectral Doppler in nail entheses with RI>1, with mean±SD=1.71±0.98. CONCLUSION: The use of ultrasound can detect changes in the nail beds in these diseases. Future studies will further characterize these changes.

As diferenças do Doppler espectral, na artrite psoriática e onicomicose / Differences of spectral Doppler in psoriatic arthritis and onychomycosis

Objetivo Utilizar o Doppler espectral (DE) para quantificar atividade inflamatória e detectar diferenças ecotexturais ungueais em pacientes com artrite psoriásica e onicomicose. Métodos Foram incluídos dois pacientes, um com artrite psoriásica, mas sem dores nas articulações e sem alterações clínicas ungueais; e outro paciente com onicomicose e artrite reumatoide. O exame de ultrassom, pela escala cinza, demonstrou alterações na presença regular da ecotextura na inserção da unha, aumento da espessura do leito ungueal e perda do padrão trilaminar da unha. O Doppler espectral, através do índice de resistência (IR), detecta o processo inflamatório nas enteses ungueais. Resultados Sete articulações interfalângicas distais (IFD) nos dois pacientes foram avaliadas em dois planos, obtendo nove IR. O autor encontrou no paciente com artrite psoriásica: perda normal do padrão trilaminar da unha; leitos ungueais e cápsulas articulares das IFDs preservados. O Doppler espectral evidenciou IR<1, com média±DP igual a 0,50±0,75 em microcirculação nas enteses ungueais e caracterizou erosão óssea ativa em 3a IFD esquerda, com IR igual a 0,38 e 0,63 em planos transversal e longitudinal, respectivamente. O paciente com onicomicose mostrou as seguintes alterações: hipoecogenicidade na inserção ungueal; perda do formato da unha e o Doppler espectral nas enteses ungueais com IR>1, com média±DP igual a 1,71±0,98. Conclusão O uso do ultrassom pode detectar alterações nos leitos ungueais nessas doenças. Futuros estudos poderão melhor caracterizar essas mudanças. .

Objective To evaluate the use of the spectral Doppler (SDoppler) to quantify inflammatory activity and to detect nail echotextural differences in patients with psoriatic arthritis and onychomycosis. Methods Two patients, one with psoriatic arthritis but with no joint pain nor nail clinical change and the other with onychomycosis and rheumatoid arthritis were included. The gray scale ultrasound study, showed changes in the regular presence of echotexture at the nail insertion, thickening of the nail bed and loss of trilaminar nail pattern. The spectral Dopplerresistance index (RI), detects the inflammatory process in nail entheses. Results Seven distal interphalangeal (DIP) joints in both patients were evaluated in two planes, getting nine RI. In the patient with psoriatic arthritis the author found: loss of normal trilaminar nail plate aspect, and nail beds and DIP joint capsules preserved. The spectral Doppler showed RI<1, with mean±SD=0.50±0.75 in the microcirculation at nail entheses, with characterization of a bone erosion in the third left DIP joint, with RI=0.38 and 0.63 in transverse and longitudinal planes, respectively. The patient with onychomycosis showed the following changes: hypoechogenicity at nail insertion; loss of nail shape, and spectral Doppler in nail entheses with RI>1, with mean±SD=1.71±0.98. Conclusion The use of ultrasound can detect changes in the nail beds in these diseases. Future studies will further characterize these changes. .