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Dermoscopic appearance of onychomycosis: A serie of 57 cases

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•Introduction :
–Onychomycosis is the most prevalent nail disease.amounting to about 50% of all onychopathies .The diagnosis is still a challenge  considering that the gold standard complementary test (direct microscopy and culture) may be false negative in up to 35% of the cases.
•Materiel and methodes :
–We have performed a dermoscopic study in a serie of 57 cases in our consultation for nail diseases. The Purpose of the study was  to Study of the sensitivity ,specificity and positive predictive value of dermoscopic signs in the diagnosis of onychomycosis ;it was a Cross-sectional study conducted in  our dermatology department at Hassan second University Hospital  Over a period of one year from June 2014 to June 2015 
•Results : 
–57 cases have been collected .Sex ratio F / M  was 1.6  (63,2%F ,36,8% M). The average age was 45 years.Mycological examination found  Trichophyton  in 44 cases (77%) (88%  T richophyton rubrum TR)  .Candida albicans CA in 14 cases (22%).Microsporum gypsum  1case (1%) .The dermoscopic signs of  onychomycosis with trichophyton  were Subungual hyperkeratosis  with ruins aspect  in 84%  Pachyonychia in 75% .Longitudinal white -yellow  streaks  in 63% .Onycholysis found in  54% .In addition the dermoscopic signs found  in candida’s onychomycosis were: Nail hyperkeratosis with  ruins aspect  found in 85.7% .Pachyonychia in  71.4% . In trichophyton  the  sensitivity of xanthonychia  was  90,7%, longitudinal yellow  streaks  was  81,4%, pachyonychia 83,7% . The specificity was higher  in melanonychia 85,7% ,beau ‘s lines  91,7%  . The Positive predictive value of melanonychia was 86,7%,dermatophytoma 84,2%, pachyonychia 83,7% .In  candida s,the sensitivity  of onychorrhexis was 80,0% ,subungual hyperkeratosis 73,3% . The specificity 100%  of paronychia, chloronychia 97,6%,leukonychia 95,2% the Positive predictive value was 100%  with paronychia 85,7% with chloronychie
•Discussion
•Onychomycosis is a disease  that the dermatologist is faced with great frequency, representing approximately 50% of nail affections.
•The clinical picture is a critical element for establishing the diagnosis, although it may be insufficient
•The dermoscopic signs may be useful in confirming the diagnostic suspicion of onychomycosis when it is not possible to perform tests that are more specific.
•Our study  shows the usefulness of dermoscopy as a diagnostic tool  for the diagnosis of onychomycosis.
•We recommend future studies with homogeneous groups of different clinical subtypes of onychomycosis and including patients with suspected traumatic onycholysis or other nail diseases.
•Our results are preliminary, there will be completed by  increase  the  number of patients  for more validation.
•Conclusion :
•By showing the importance of dermoscopy in the diagnostic investigation .It can be used to follow-up of onychomycosis treatment .We think that this study will contribute to daily dermatological practice, even though more studies are required to confirm our findings.
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