CONTEXT<p>Accurate diagnosis of onychomycosis is important since misdiagnosis can lead to inappropriate therapy, delayed diagnosis of other nail conditions, and antifungal resistance. Dermoscopy is an emerging diagnostic tool, particularly valuable in the resource-poor settings.p>AIMS<p>The study aimed to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO) at a tertiary hospital.p>SETTINGS AND DESIGN<p>An observational, prospective, and cross-sectional study was conducted among 22 clinically diagnosed DSO patients using convenience sampling at a tertiary hospital from November 2019 to September 2021.p>SUBJECTS AND METHODS<p>Participants underwent gross nail examination, dermoscopy, potassium hydroxide (KOH), and periodic acid-Schiff (PAS) examinations.p>STATISTICAL ANALYSIS USED<p>Sensitivity, specificity, predictive value, and likelihood ratios (LRs) of the dermoscopic patterns were obtained using KOH and PAS results as the reference standard.p>RESULTS<p>Fifty-one nails were submitted but 2 were lost during the processing, leaving 49 nails for analysis. The most common pattern was jagged edge with spikes (65.3%). Individual patterns yielded only low-to-moderate sensitivity (32.4%–73.5%). However, combining all patterns increased sensitivity to 91.2% (95% confidence interval: 76.3–98.1). Ruin appearance showed the highest specificity (100%) and positive predictive value (100%). LRs were not significant enough to draw the conclusions.p>CONCLUSIONS<p>Dermoscopy may serve as an on-site, adjunct tool in the diagnosis of DSO, especially when the combination of patterns is considered. Ruin appearance maybe particularly useful in ruling in DSO. However, confirmation using mycological and histopathological tests remains essential.
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Human ; Dermoscopy ; Onychomycosis

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.p>OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).p>CONCLUSIONS<p style="text-align: justify;" data-mce-style="text-align: justify;">Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.p>
Dermoscopy ; Onychomycosis ; Potassium Hydroxide