review · Dermatology Practical & Conceptual
Onychomycosis represents a substantial global health burden, comprising roughly half of all nail-related consultations. While dermoscopy is frequently employed to evaluate nail disorders, a proliferation of newly identified patterns has created confusion and inconsistency in onychoscopic terminology. A systematic review of thirty-three studies covering 2,111 patients examined the reported diagnostic signs and evaluated their performance. Key indicators include ruin appearance, longitudinal striae, and spikes along the proximal margin of onycholytic areas, all displaying high specificity. The aurora borealis pattern demonstrated the highest overall sensitivity and specificity. Establishing standardised terminology aids clinicians, students, and researchers in correctly identifying fungal nail disease. Furthermore, these specific dermoscopic features assist practitioners in distinguishing onychomycosis from conditions like nail trauma and psoriasis, as well as separating fungal melanonychia from serious malignancies such as nail melanoma.
Fungal nail infections are widespread and often clinically challenging to separate from other conditions such as trauma, psoriasis, or serious melanomas. Establishing a consistent, reliable terminology for dermoscopic signs gives practitioners clearer criteria for accurate diagnosis. This clarity ensures patients receive prompt and appropriate treatment while reducing the risk of misdiagnosing potentially dangerous nail diseases.
The standardised diagnostic criteria and performance metrics can inform the development of clinical decision-support tools, diagnostic training programmes, and dermatological imaging software. The primary users are clinical dermatologists, general practitioners, and medical educators. Because the findings synthesise existing clinical observation techniques from patient cohorts, translation into diagnostic protocols or educational aids is near-market, although digital software integration would require dedicated software validation.
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INTRODUCTION: Onychomycosis represents a global burden accounting for about 50% of nail consultations. Several studies have tried to assess the dermoscopic features of onychomycosis. With the multiplication of papers, several "new" dermoscopic signs keep being added leading to some inconsistency in onychoscopic terminology. OBJECTIVE: This study aimed to summarize the existing literature on the dermoscopic features of onychomycosis and propose a unified onychoscopic terminology. METHODS: The literature search was performed using PubMed and Scopus databases up to October 30, 2021 to identify eligible contributions. In total, 33 records (2111 patients) were included. RESULTS: The main dermoscopic signs of onychomycosis are "ruin appearance", "longitudinal striae" and "spikes" on the proximal margin of onycholytic areas, with a specificity of 99.38%, 83.78%, and 85.64% respectively. The "aurora borealis" sign had the highest sensitivity and specificity. CONCLUSIONS: The current review provides a framework for issues related to the onychoscopic terminology of onychomycosis and is intended to serve as an aid for students, teachers, and researchers. We proposed a unifying terminology to describe dermoscopic signs of onychomycosis. Dermoscopic signs of onychomycosis show good specificity and are useful in distinguishing nail psoriasis, trauma, and onychomycosis. It helps differentiate fungal melanonychia from nail melanoma, nevi, and melanocytic activation.
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DOI: 10.5826/dpc.1301a72
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