Fungal infections

From dermoscopedia

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 Editor: Luc Thomas

 Author(s): Amélie Boespflug, Luc Thomas
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Nail fungal infections are common and are mostly due to dermatophytes[1], but are sometimes difficult to confirm by mycological examination. Dermoscopy has been shown to increase the sensitivity and specificity of the mycological examination with KOH preparation and fungal culture when associated to a localized abrasion of the proximal part of the lesion[2],[3].

Dermoscopy can help differenciate onychomycosis from traumatic onycholysis. Jagged proximal edge with spikes of the onycholytic area and longitudinalstreaks are more specific of onychomycosis, while linear edges without spikes are more specific of traumatic onycholysis, both lesions present subungual hyperkeratosis [4][5]. Onychomycosis can often also be associated to other nail disorders like onychomatricoma.

Nails can also be infected by Pseudomonas aeruginosa (P. aeruginosa) and Candida albicans (C. albicans). Dermoscopically these infections present a brown-green discolouration[6]



  1. Elewski BE, Rich P, Tosti A, Pariser DM, Scher R, Daniel RC, et al. Onchomycosis: an overview. J Drugs Dermatol. 2013;12:s96–103
  2. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples Diego Leonardo Bet, Ana Lucia dos Reis, Nilton Di Chiacchio, Walter Belda Junior An Bras Dermatol. 2015 Nov-Dec; 90(6): 904–906. doi: 10.1590/abd1806-4841.20154615
  3. Saliba AFN, Di Chiacchio N, Sampaio GAA, Queiroz NPL. O uso da onicoabrasão como método de auxílio na obtenção de amostras para o diagnóstico da onicomicose. Surg & Cosmet Dermatol. 2014;6:57–63.
  4. Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2013;27:509–513.
  5. Dermoscopy as a first step in the diagnosis of onychomycosis Ahu Yorulmazcorresponding author and Basak Yalcin
  6. Nail dermoscopy (onychoscopy) is useful in diagnosis and treatment follow-up of the nail mixed infection caused by Pseudomonas aeruginosa and Candida albicans Alicja Romaszkiewicz, Martyna Sławińska, Michał Sobjanek, Roman J. Nowicki Postepy Dermatol Alergol. 2018 Jun; 35(3): 327–329. Published online 2018 Jun 18. doi: 10.5114/ada.2018.76232