Department of Dermatology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Center of Statistics and Applications, CEAUL, Lisbon University, Lisbon, Portugal.
J Eur Acad Dermatol Venereol. 2019 Apr;33(4):786-792. doi: 10.1111/jdv.15358.
Onychomycosis (OM) and traumatic onychodystrophy (OD) are common causes of toenail changes. A clinical diagnosis is often impossible without mycology. Dermoscopy is helpful in this setting but yet underexplored. Prospective comparative studies between OM and OD onychoscopic findings have not been previously performed.
We sought to determine distinguishing dermoscopic presentations of OM and traumatic OD.
We performed a prospective, observational study including patients presenting with ≥1 toenail onychodystrophy. All underwent onychoscopy, clinical and mycological examination. Based on these results, patients received a final diagnosis of OM or OD. Dermoscopic presentations of OM and OD patients were classified in patterns and compared.
In all, 110 cases of OM and 82 of traumatic OD were compared. Statistical analyses revealed that the distal pulverized and the irregular spiked macular dermoscopic patterns were predictors of an OM diagnosis. The regular macular, the non-classifiable, the total and partial homogeneous background dermoscopic patterns correlated with traumatic OD diagnosis.
We demonstrated that OM and traumatic OD have distinctive onychoscopic presentations. Dermoscopy may be an important ancillary tool to guide their differential.
甲真菌病（OM）和外伤性甲营养不良（OD）是常见的趾甲变化原因。如果没有真菌学检查，临床诊断通常是不可能的。在这种情况下，皮肤镜检查很有帮助，但尚未得到充分探索。OM 和 OD 甲下镜检查结果之间的前瞻性比较研究以前尚未进行过。
我们旨在确定 OM 和外伤性 OD 的甲下镜下表现的鉴别特征。
我们进行了一项前瞻性、观察性研究，纳入了至少有 1 个趾甲营养不良的患者。所有患者均接受了甲下镜检查、临床和真菌学检查。根据这些结果，患者接受了 OM 或 OD 的最终诊断。将 OM 和 OD 患者的甲下镜表现分类并进行比较。
共比较了 110 例 OM 和 82 例外伤性 OD。统计分析显示，远端粉碎和不规则刺状斑片状甲下镜表现是 OM 诊断的预测因素。规则斑片状、不可分类、全部分散和部分均匀背景甲下镜表现与外伤性 OD 诊断相关。
我们证明 OM 和外伤性 OD 具有独特的甲下镜下表现。皮肤镜检查可能是指导其鉴别诊断的重要辅助工具。
