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A modified approach to the histologic diagnosis of onychomycosis.
J Am Acad Dermatol 2007; 57(5):849-53JA

Abstract

BACKGROUND

Histologic examination of nail clippings with periodic acid-Schiff staining is the most sensitive diagnostic test for onychomycosis; however, difficulties in processing nail plates limit its use. In onychomycosis, fungi are most concentrated in the subungual hyperkeratosis rather than in the nail plate. We hypothesized that the diagnosis of onychomycosis could be effectively made from histologic examination of subungual hyperkeratosis alone. Specimens of subungual hyperkeratosis, unlike nail plates, can be processed in the same routine manner as skin specimens, allowing for the diagnosis of onychomycosis to be made more quickly and at lower cost.

OBJECTIVE

We investigated whether the diagnosis of onychomycosis could be effectively made from histologic examination of subungual hyperkeratosis alone.

METHODS

We selected all nail specimens submitted during an 8-month period to the New York University Dermatopathology Section for evaluation of onychomycosis that had subungual hyperkeratosis associated with the nail plate. Nail specimens were divided into two components: a subungual hyperkeratosis component and a nail plate component. The subungual hyperkeratosis was processed separately in a routine fashion and embedded in paraffin and examined. We determined the percentage of cases of onychomycosis in which hyphae were present in the subungual component.

RESULTS

Sixty-six cases of onychomycosis were diagnosed histologically during the study period. Ninety-seven percent of these cases had hyphae in the subungual component. In 3% of cases, hyphae were present in the nail plate component but not in the subungual component.

LIMITATIONS

This modified approach to diagnosing onychomycosis can only be utilized when an adequate amount of subungual hyperkeratosis is submitted.

CONCLUSIONS

The diagnosis of onychomycosis can be effectively made from histologic examination of subungual hyperkeratosis alone in most cases. This method circumvents the need to process nail plates in the vast majority of cases of onychomycosis (97%), resulting in a more efficient, less costly, and technically easier way of diagnosing onychomycosis. Submitting ample amounts of subungual hyperkeratosis is essential to increasing the diagnostic yield of nail clippings.

Authors+Show Affiliations

Section of Dermatopathology, New York University School of Medicine, New York, New York 10016, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17939937

Citation

Chang, Anwell, et al. "A Modified Approach to the Histologic Diagnosis of Onychomycosis." Journal of the American Academy of Dermatology, vol. 57, no. 5, 2007, pp. 849-53.
Chang A, Wharton J, Tam S, et al. A modified approach to the histologic diagnosis of onychomycosis. J Am Acad Dermatol. 2007;57(5):849-53.
Chang, A., Wharton, J., Tam, S., Kovich, O. I., & Kamino, H. (2007). A modified approach to the histologic diagnosis of onychomycosis. Journal of the American Academy of Dermatology, 57(5), pp. 849-53.
Chang A, et al. A Modified Approach to the Histologic Diagnosis of Onychomycosis. J Am Acad Dermatol. 2007;57(5):849-53. PubMed PMID: 17939937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A modified approach to the histologic diagnosis of onychomycosis. AU - Chang,Anwell, AU - Wharton,Jacqueline, AU - Tam,Sam, AU - Kovich,Olympia I, AU - Kamino,Hideko, PY - 2007/02/11/received PY - 2007/05/03/revised PY - 2007/05/11/accepted PY - 2007/10/18/pubmed PY - 2007/11/9/medline PY - 2007/10/18/entrez SP - 849 EP - 53 JF - Journal of the American Academy of Dermatology JO - J. Am. Acad. Dermatol. VL - 57 IS - 5 N2 - BACKGROUND: Histologic examination of nail clippings with periodic acid-Schiff staining is the most sensitive diagnostic test for onychomycosis; however, difficulties in processing nail plates limit its use. In onychomycosis, fungi are most concentrated in the subungual hyperkeratosis rather than in the nail plate. We hypothesized that the diagnosis of onychomycosis could be effectively made from histologic examination of subungual hyperkeratosis alone. Specimens of subungual hyperkeratosis, unlike nail plates, can be processed in the same routine manner as skin specimens, allowing for the diagnosis of onychomycosis to be made more quickly and at lower cost. OBJECTIVE: We investigated whether the diagnosis of onychomycosis could be effectively made from histologic examination of subungual hyperkeratosis alone. METHODS: We selected all nail specimens submitted during an 8-month period to the New York University Dermatopathology Section for evaluation of onychomycosis that had subungual hyperkeratosis associated with the nail plate. Nail specimens were divided into two components: a subungual hyperkeratosis component and a nail plate component. The subungual hyperkeratosis was processed separately in a routine fashion and embedded in paraffin and examined. We determined the percentage of cases of onychomycosis in which hyphae were present in the subungual component. RESULTS: Sixty-six cases of onychomycosis were diagnosed histologically during the study period. Ninety-seven percent of these cases had hyphae in the subungual component. In 3% of cases, hyphae were present in the nail plate component but not in the subungual component. LIMITATIONS: This modified approach to diagnosing onychomycosis can only be utilized when an adequate amount of subungual hyperkeratosis is submitted. CONCLUSIONS: The diagnosis of onychomycosis can be effectively made from histologic examination of subungual hyperkeratosis alone in most cases. This method circumvents the need to process nail plates in the vast majority of cases of onychomycosis (97%), resulting in a more efficient, less costly, and technically easier way of diagnosing onychomycosis. Submitting ample amounts of subungual hyperkeratosis is essential to increasing the diagnostic yield of nail clippings. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/17939937/A_modified_approach_to_the_histologic_diagnosis_of_onychomycosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(07)00881-X DB - PRIME DP - Unbound Medicine ER -