Histologic Evaluation of Nail Clippings for Diagnosing Onychomycosis

Suarez, Sylvia M.; Silvers, David N.; Scher, Richard K.; Pearlstein, Hillard H.; Auerbach, Robert

doi:10.1001/archderm.1991.01680090081008

Cited by 96 publications

(44 citation statements)

References 4 publications

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“…In recent years, the use of nail clipping specimens has been suggested as a good alternative to either incisional or punch biopsy [11, 12, 13, 14, 15, 16]. Our present experience confirms that histological examination of nail clippings can give results as good as those obtained from biopsy, but in a faster, more economical and painless manner.…”

Section: Discussionsupporting

confidence: 78%

“…However, this procedure is often painful and can cause permanent alteration of the nail plate [7, 8, 9, 10, 11]. The histological examination of nail samples obtained by clipping might provide results comparable to those obtained by the standard punch biopsy, but in a rapid and painless manner [12, 13, 14, 15, 16]. In this study, the standard direct microscopy and culture techniques were systemically supplemented with histological examination of nail clipping samples to evaluate how useful the latter investigation is in improving the diagnosis of onychomycosis.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Histological Examination for the Diagnosis of Onychomycosis

Gianni¹,

Morelli

Cerri³

et al. 2001

Dermatology

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Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. Objective: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. Patients and Methods: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. Results: Direct microscopy was positive in 102 (59.3%) nail specimens. The culture test was positive in 90 cases (52.9%), showing a dermatophyte in 45, a yeast in 23 and a mould in 22 samples. The histological examination was positive in 94 (54.6%) samples. In 4 cases, it was the only investigation confirming the clinical diagnosis of nail mycosis. In most of the cases, the morphological aspect of the hyphae and/or spores suggested also to which group of pathogens (dermatophytes, yeasts or moulds) the mycetes observed in the histological sections could be ascribed. The concurrent presence of a dermatophyte and a mould was evidenced in a few specimens. The control histological examination at the end of the treatment showed negative results or residual non-vital hyphae and/or spores. Conclusions: Results of the present study indicate that the histological examination of nail clipping specimens is a relatively inexpensive, rapid and easily performed procedure. It is useful to confirm or refute the results of routine microscopy and culture tests. Moreover, nail histopathological observation may help in ascribing a pathogenic role of non-dermatophyte isolates and evaluating the effectiveness of antifungal treatment.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Usefulness of Histological Examination for the Diagnosis of Onychomycosis

Gianni¹,

Morelli

Cerri³

et al. 2001

Dermatology

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“…1,7,10 Pretreatment with agents to soften the nail plate have been described, including potassium hydroxide (KOH), 5% trichloroacetic acid and 10% formalin, 10% Tween40, and chitin-softening solutions containing mercuric chloride. 1,12,14,16,17 NaOH at 10% concentration has been used in clinical practice for chemical matrixectomy of ingrown toenails. [18][19][20] Treatment of nail specimens with a strong base such as NaOH causes alkaline hydrolysis of disulfide bonds that bind keratin intermediate filaments in the nail, leading to softening.…”

Section: Discussionmentioning

confidence: 99%

“…We have determined that this strategy enables improved histomorphologic examination of the nail plate for presence of fungal forms without compromised sensitivity due to secondary colonization or contamination and requires much less pretreatment time, 2 hours compared with 2 days, significantly affecting turn-around time. 16 Low concentrations (\1%) of NaOH may be safely discarded down the drain. High-concentration (20%) NaOH requires separate hazardous waste disposal and is incompatible with other hazardous waste streams, including formalin or alcohol and xylene, and requires separate disposal.…”

Section: Discussionmentioning

confidence: 99%

An improved method of surgical pathology testing for onychomycosis

Nazarian

Due

Deshpande

et al. 2012

Journal of the American Academy of Dermatology

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“…5,6 Gelatin-coated slides have been reported to enhance adherence of nails. 2,6 Our experience with the use of casein (Elmer's Glue) is that the adhesive produces higher backgrounds during staining, and it does not prevent the plate from curling away from the glass slide during drying. Plastic embedding has also been described.…”

Section: Discussionmentioning

confidence: 99%