DERMOSCOPY EXAMINATION FOR EVALUATION OF NAIL MORPHOLOGY IN PATIENT WITH ONYCHOMYCOSIS

Abstract

Onychomycosis is a fungal infection of the nail caused by a dermatophyte, yeast or mold. Onychomycosis contributes as much as 30% of all superficial fungal infections and 50% of all abnormalities of the nail. Dermoscopy is a practical and noninvasive imaging method that allows in vivo evaluation of pigmented and unpigmented skin lesions. The utility of dermoscopy to support examination of abnormalities in the nail is still being developed. A woman, aged 45 years, with the chief complaint the nail of thumb and pinkie fingers of the right and left foot looking rough and the color change being brownish yellow and opaque since 1 year ago. Initially the blurred white color occurs at the tip of the thumb of the left foot, over time the blurred white patch extends towards the base of the nail, after which the nail becomes dark yellow, and then the nail becomes brittle and thickens. On physical examination, the unguium digiti I, V pedis sinistra, and udigiti I,V pedis dextra shows brownish yellow discoloration, while the number I pedis sinistra was found to have total onychodystrophy. The dermoscopic examination unguium digiti I pedis sinistra shows a ruin appearance, subungual hyperkeratosis, and spotted lines with a longitudinal configuration. Unguium digiti IV, V pedis sinistra, digiti v pedis dextra was found blackish brown pigmentation and a longitudinal spotting pattern. Unguium digiti IV pedis dextra shows longitudinal spotting lines. The patient received Itraconazol therapy with a pulse dose of 400 mg / day for 1 week in 1 month. Therapy will be evaluated in 3 months.