CONTEXT

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.

AIMS

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.

SETTINGS AND DESIGN

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.

SUBJECTS AND METHODS

Participants underwent gross nail examination, dermoscopy, potassium hydroxide (KOH), and periodic acid-Schiff (PAS) examinations.

STATISTICAL ANALYSIS USED

Sensitivity, specificity, predictive value, and likelihood ratios (LRs) of the dermoscopic patterns were obtained using KOH and PAS results as the reference standard.

RESULTS

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.

CONCLUSIONS

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.

Human ; Dermoscopy ; Onychomycosis

Extramammary Paget Disease (EMPD) is a rare intraepithelial cancer often mistaken for inflammatory and infectious skin conditions, leading to diagnostic delays and increased morbidity. It constitutes 6.5% of cutaneous Paget Disease, predominantly affecting older individuals aged 50 to 80, with a higher prevalence in women. Notably, 10% to 30% of EMPD cases are linked to concurrent visceral malignancies, highlighting the importance of cancer screening.

This is a case of a 77-year-old Filipino male with a four-year history of a solitary, well-defined, irregularly-shaped, erythematous plaque with erosions on the perianal area. Despite two years of self-administered hydrocortisone cream, the lesion progressively expanded into an 8x4x2 cm plaque, accompanied by intermittent pruritus and stinging pain. On consultation, dermoscopy showed milky-red areas, telangiectasias, and hyperpigmentation. Histopathology revealed polygonal neoplastic cells with pleomorphic vesicular nuclei, conspicuous nucleoli, and pale eosinophilic cytoplasm above the basal epidermis. Immunohistochemistry was positive for CK7, GCDFP15, CEA, and EMA, and negative for CK20. Further imaging showed no evidence of concurrent malignancies, reinforcing the diagnosis of primary EMPD. While awaiting further evaluation by other specialties, he was managed with an eight-week course of topical Imiquimod 5% cream, resulting in a reduction in both erythema and lesion thickness.

Overall, this case highlights the importance of recognizing cutaneous cancers that mimic benign skin conditions. The application of diagnostic tools in dermatology, such as dermoscopy, histopathology, and immunohistochemical staining, is crucial for identifying key disease features and establishing an accurate diagnosis, enabling timely and appropriate intervention.

Human ; Male ; Aged: 65-79 Yrs Old ; Paget Disease, Extramammary ; Imiquimod ; Neoplasms ; Tumors

Angiokeratomas are present in approximately 0.16% of the population, with only 14% classified as the Fordyce type. Angiokeratomas of Fordyce are mainly found on the scrotum, with very rare occurrences on the glans penis or penile shaft. Currently, there are no established guidelines in the management of angiokeratomas. Since angiokeratomas are vascular in nature, lasers which target the chromophore oxyhemoglobin can be used, hence the use of the 578-nm yellow laser in this case.

This is a case of a 34-year-old Filipino male with a 22-year history of violaceous papules on the penile shaft gradually increasing in size, with complaints of bleeding from the lesions during coitus, significantly affecting the patient’s quality of life. Physical examination revealed few, well-defined, round, violaceous hyperkeratotic papules on the penile shaft, the largest measuring 4x4x4 mm. Dermoscopy revealed several, well-demarcated, round, erythematous to violaceous lacunae with whitish veil. Histopathology also revealed findings consistent with angiokeratoma.

Non-scrotal or penile angiokeratoma of Fordyce is a very rare benign vascular tumor that can adversely affect patients’ quality of life, particularly due to the potential discomfort brought about by bleeding during coitus. Traditional therapeutic modalities may lead to scarring, hence the emerging trend on the use of vascular lasers. After two sessions of yellow laser, our patient expressed satisfaction with the results with an improved overall quality of life. The effectiveness, minimal scarring potential, and relatively safe side effect profile of these vascular lasers make them a promising treatment option for angiokeratomas.

Human ; Male ; Adult: 25-44 Yrs Old ; Angiokeratoma