Usefulness of Histological Examination for the Diagnosis of OnychomycosisGianni C. · Morelli V. · Cerri A. · Greco C. · Rossini P. · Guiducci A. · Braidotti P. · Calcaterra R. · Papini M.
Departments of aDermatology and bPathology, S. Paolo Hospital, University of Milan, and Departments of cDermatology and dPathology, Terni Hospital, University of Perugia, Italy
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.
Claudia Gianni, MD
Department of Dermatology, University of Milan, San Paolo Hospital
Via A. di Rudinì, 8
I–20142 Milan (Italy)
Fax +39 02 89 129 995, E-Mail firstname.lastname@example.org
Received: Received: October 30, 2000
Accepted: January 21, 2001
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 2, Number of References : 32
Dermatology (International Journal for Clinical and Investigative Dermatology)
Founded as ‘Dermatologische Zeitschrift’ by Oskar Lassar (1893–1907); Continued by Erich Hoffmann (1908–1938), continued as ‘Dermatologica’ (1939–1991), by Wilhelm Lutz (1939–1958), Rudolf Schuppli (1959–1985)
Official Organ of the Swiss Society for Dermatology and Venereology; Official Organ of the Belgian Royal Society for Dermatology and Venereology
Vol. 202, No. 4, Year 2001 (Cover Date: 2001)
Journal Editor: J.-H. Saurat, Geneva.
ISSN: 1018–8665 (print), 1421–9832 (Online)
For additional information: http://www.karger.com/journals/drm