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. 2019 Jul 29;94(3):344-347.
doi: 10.1590/abd1806-4841.20198301.

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

Flávia Trevisan  1 , Betina Werner  2 , Rosangela Lameira Pinheiro  3
Affiliations

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

Flávia Trevisan et al. An Bras Dermatol. .

Abstract

Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis.

Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis.

Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis.

Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.

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Conflict of interest statement

Conflict of interest: None.

Figures

Figure 1
Figure 1
Divisions of the nail. 1- Plate. 2- Nail transition zone (NTZ), demarcated with the dotted line. Here, blurred definition is seen in the right of the image. Linearity is irregular. 3- Subungual region. PAS + fungal structures can be seen on the plaque and the subungual region (Periodic Acid-Schiff, X20)
Figure 2
Figure 2
Nail plate with onychomycosis by T. rubrum. A - Clefts (arrows) and onychocariosis (circle in detail) (Periodic Acid-Schiff, X10). B - Nail granular parakeratosis (Periodic Acid-Schiff, X40)
Figure 3
Figure 3
Subungual region on nails with onychomycosis by T. rubrum. A - Thickness of the subungual region. Two serous lakes are visible in this image (+) (Periodic Acid-Schiff, X10). B - Neutrophil grouping with hyphae in the vicinity (*) (Periodic Acid-Schiff, X100). C - Bacteria (Periodic Acid-Schiff, X100). D - Marked subungual parakeratosis. The layers of cells stacked in the subungual region and a very irregular NTZ are visible (Periodic Acid-Schiff, X40).
See this image and copyright information in PMC

References

    1. Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. J Cutan Med Surg. 2017;21:525–539. - PubMed
    1. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, et al. A large-scale North-American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000;43:641–648. - PubMed
    1. Bertanha L, Chiacchio ND. Nail clipping in onychomycosis. An Bras Dermatol. 2016;91:688–690. - PMC - PubMed
    1. Stephen S, Tosti A, Rubin AI. Diagnostic applications of nail clippings. Dermatol Clin. 2015;33:289–301. - PubMed
    1. Fillus Neto J, Tchornobay AM. How the Nail Clipping helps the dermatologist. An Bras Dermatol. 2009;84:173–176. - PubMed