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Routine histologic examination for the diagnosis of onychomycosis: an evaluation of sensitivity and specificity

Machler, B.C.; Kirsner, R.S.; Elgart, G.W.

Cutis 61(4): 217-219

1998

ISSN/ISBN: 0011-4162
PMID: 9564595
Document Number: 493647
The use of routine histological examination of nail clippings in differentiating onychomycosis from psoriatic onychodystrophy was investigated. 23 distal nail clipping specimens (12 specimens from patients in the USA with onychodystrophy of unknown cause and 11 control specimens from nails with known cause) were evaluated by routine histology and periodic acid-Schiff (PAS) staining. Of the dystrophic cases, 4 were demonstrated to be onychomycosis (due to Trichophyton rubrum) by the presence of hyphae on histological evaluation and by culture, whereas only 3 of these cases yielded positive results on KOH examination. Eight cases of onychodystrophy were due to psoriasis. Yeast forms of Candida sp. were detected on one case of psoriatic onychodystrophy that demonstrated yeast growth on culture. In this study, routine histological examination with PAS staining was equal to culture and superior to KOH preparation in leading to the correct diagnosis of dermatophyte infection. In addition, the diagnosis of psoriasis of the nail plate was detected accurately by routine histological examination. It is concluded that routine histological examination with PAS staining is a rapid, simple and reliable test in the evaluation of onychodystrophy.

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