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Giornale Italiano di Dermatologia e Venereologia 2000 October;135(5):563-7


language: Italian

Histological examination of the nail plate in the diagnosis of toe-nail mycosis

Papini M., Greco C., Boncio L., Morelli V., Guiducci A.

Università degli Studi di Perugia - Sede di Terni Sezione di Dermatologia Dipartimento delle Specialità Medico-Chirurgiche * Istituto di Anatomia Patologica


Background. The efficiency of the standard mycological tests for the diagnosis of onychomycosis is not satisfactory, particularly in non-dermatophyte infections. Aim of the study was to evaluate the usefulness of the histological examination of nail clipping specimens in improving direct microscopy and culture test diagnostic efficiency in toe-nail mycosis.
Methods. One hundred and twenty-five patients with suspected toe-nail mycosis were evaluated. Nail plate samples obtained by clipping were studied according to the standard techniques, i.e. microscopic examination of KOH clarified specimens and culture test in Sabouraud agar, and after histological preparation stained with periodic acid Schiff.
Results. Onychomycosis was clinically confirmed in 59 cases. Direct microscopy was positive in 48 samples and culture test in 60 specimens. The histological examination showed fungal invasion of the nail in 49 cases. In 2 patients, it was the unique positive investigation confirming the clinical diagnosis. Often, the aspects of fungal hyphae and/or spores could also suggest which group of pathogens might be responsible of the infection. The presence of a mixed infection, i.e. dermatophyte and either a mould or yeast, was observed in a few cases.
Conclusions. The results of this study confirm that histological examination of nail plate is useful to confirm or refuse the results of standard mycological tests. Moreover, histopathological observation of the fungal elements may help in evaluating mixed infection and in ascribing a pathogenic role to moulds and yeasts. This technique, which is reliable, economic and easy to perform, could greatly improve the diagnostic accuracy of toe-nail mycosis.

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