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Utility of Histopathologic Analysis in the Evaluation of Onychomycosis

Jeffrey M. Weinberg Clinical Research Center, Department of Dermatology, St Luke’s–Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY.

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Evelyn K. Koestenblatt Department of Dermatology, New York Medical College, Metropolitan Hospital Center, New York, NY.

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Maureen B. Jennings New York College of Podiatric Medicine, New York, NY. Dr. Jennings is now in private practice, Fort Lee, NJ.

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Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before initiation of antifungal therapy. Potassium hydroxide preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent studies have suggested that nail plate biopsy with periodic acid–Schiff stain may be a very sensitive technique for the diagnosis of onychomycosis. In this article, we review the literature on the utility of histopathologic analysis in the evaluation of onychomycosis. Many of these studies indicate that biopsy with periodic acid–Schiff is the most sensitive method for diagnosing onychomycosis. We propose that histopathologic examination is indicated if the results of other methods are negative and clinical suspicion is high; therefore, it is a useful complementary technique in the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 95(3): 258–263, 2005)

Corresponding author: Jeffrey M. Weinberg, MD, Department of Dermatology, St Luke’s–Roosevelt Hospital Center, 1090 Amsterdam Ave, Ste 11D, New York, NY 10025.