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Review
. 2021 Apr 15:8:637216.
doi: 10.3389/fmed.2021.637216. eCollection 2021.

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

Sophie Soyeon Lim  1 , Jungyoon Ohn  2   3 , Je-Ho Mun  2   3
Affiliations
Review

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

Sophie Soyeon Lim et al. Front Med (Lausanne). .

Abstract

Onychomycosis is a common fungal nail infection. Accurate diagnosis is critical as onychomycosis is transmissible between humans and impacts patients' quality of life. Combining clinical examination with mycological testing ensures accurate diagnosis. Conventional diagnostic techniques, including potassium hydroxide testing, fungal culture and histopathology of nail clippings, detect fungal species within nails. New diagnostic tools have been developed recently which either improve detection of onychomycosis clinically, including dermoscopy, reflectance confocal microscopy and artificial intelligence, or mycologically, such as molecular assays. Dermoscopy is cost-effective and non-invasive, allowing clinicians to discern microscopic features of onychomycosis and fungal melanonychia. Reflectance confocal microscopy enables clinicians to observe bright filamentous septate hyphae at near histologic resolution by the bedside. Artificial intelligence may prompt patients to seek further assessment for nails that are suspicious for onychomycosis. This review evaluates the current landscape of diagnostic techniques for onychomycosis.

Keywords: artificial intelligence; dermoscopy; diagnosis; diagnostic imaging; fungi; onychomycosis; pathology; reflectance confocal microscopy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Proximal subungual onychomycosis in a patient with systemic lupus erythematosus. (B) Abnormal plantar desquamation increases the likelihood of clinically diagnosing onychomycosis. Thus, the sole should also be examined while assessing onychomycosis. (C) KOH-test highlighting presence of fungal hyphae (×200 magnification). (D) Histopathology (nail clipping) with GMS staining showing numerous fungal hyphae in the nail plate (×400). The fungi are highlighted in black with GMS staining. (E,F) Dermoscopic examination of onychomycosis showing yellowish discoloration with spikes pattern and surface scales. Distal edge dermoscopy demonstrating subungual hyperkeratosis. (G,H) Dermoscopic examination of fungal melanonychia showing reverse triangular pattern, yellow streaks, black and yellow coloration, scales, and subungual hyperkeratosis.
Figure 2
Figure 2
A flowchart for diagnosing onychomycosis.
See this image and copyright information in PMC

References

    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) 43:641–8. 10.1067/mjd.2000.107754 - DOI - PubMed
    1. Gupta AK, Gupta G, Jain HC, Lynde CW, Foley KA, Daigle D, et al. . The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol. (2016) 30:1567–72. 10.1111/jdv.13677 - DOI - PubMed
    1. Svejgaard EL, Nilsson J. Onychomycosis in Denmark: prevalence of fungal nail infection in general practice. Mycoses. (2004) 47:131–5. 10.1111/j.1439-0507.2004.00968.x - DOI - PubMed
    1. Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol. (2003) 149(Suppl. 65):1–4. 10.1046/j.1365-2133.149.s65.4.x - DOI - PubMed
    1. Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Takwale A, Shemer A, et al. . Global perspectives for the management of onychomycosis. Int J Dermatol. (2019) 58:1118–29. 10.1111/ijd.14346 - DOI - PubMed

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