Prevalence of Onychomycosis in Patients with Psoriasis: Mycological, Pathological and Dermoscopical Study

Document Type : Original Article

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Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Onychomycosis, a common nail infection caused by dermatophytes, yeast, and molds, makes up roughly half of all nail conditions worldwide and is the most prevalent nail disorder globally. Clinically, nail psoriasis and onychomycosis can frequently be difficult to differentiate from one another and may exacerbate each other's progression.
The aim of the work: The purpose of this study was to use mycological, histological, and dermatoscopic techniques to evaluate the prevalence of onychomycosis in individuals with nail psoriasis.
Patients and Methods: A cross-sectional investigation was conducted on 30 patients. Patients with psoriasis and nail lesions who were not taking antifungal medication or affected by other dermatological conditions were recruited from the dermatology outpatient clinic between February 2021 and March 2023. A thorough clinical examination and history were conducted for each patient included. Additionally, nail samples were collected for dermoscopic examination, culture, direct microscopy with 20% KOH solution, and nail clipping with PAS stain.
Results: The 30 recruited patients ranged in age from 6 to 68 years old [mean ±SD 24.06±19.2], including 23 men and 7 women. Twenty percent of patients [six] had onychomycosis. Dermatophytes were isolated from 3.3% of patients, yeast from 16.6% of patients, and non-dermatophytic mold from 80% of patients. Histopathological results revealed fungal hyphae and spores in 16.6% of patients. The most prevalent dermoscopic sign in psoriatic patients with onychomycosis was spikes [83.3%] with statistical significance [P-value < 0.005] followed by subungual hyperkeratosis, while nail pitting was the most prevalent dermoscopic feature in nail psoriasis [89.7%].
Conclusion: This work paves the way for an accurate diagnosis of nail lesions by highlighting the importance of cooperation between mycology, histology, and dermoscopy in diagnosing onychomycosis in patients with nail psoriasis.

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