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Optical coherence tomography of onychomycosis: proposed terminology and a suggestion of practical usage

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Abstract

Onychomycosis is the most common cause of nail changes accounting for about half of all nail diseases. It is important to diagnose the fungal pathogen to prescribe adequate treatment, but as genus- and species-specific diagnostic tests can be time consuming and expensive, it is crucial to obtain representative tissue during nail scrapings. Optical coherence tomography (OCT) is a non-invasive imaging tool enabling real-time imaging of skin and tissue. Pilot studies using OCT have described morphological characteristics of onychomycosis, though diagnostic criteria of onychomycosis and other nail diseases are lacking. The aim of this study is to investigate the applicability of OCT to detect and localize fungal elements in nails with clinical signs of onychomycosis. OCT scans and nail scrapings were performed on all participants and only confirmed cases of onychomycosis were included in the data analysis. All scans were analyzed, and a set of morphological criteria based on known literature and deviations from healthy nail morphology were suggested. The suggested morphological features were: hyperreflective lines divided into sharply and diffusely demarcated; hyperreflective dots divided into singular and clustered patterns; irregular surface, divided into mild, moderate and severe degree; dark bands and disturbed architecture. The suggested OCT morphology is a refinement of previous studies, and though OCT cannot replace genus- or species-specific identification, it could be a useful assistance tool to increase diagnostic sensitivity of nail scrapings and laboratory tests as well as for monitoring treatment response.

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Authors and Affiliations

  1. Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, 4000, Roskilde, Denmark

    Jonas Olsen, Pernille Lindsø Andersen, Lotte Themstrup, Gregor Borut Ernst Jemec & Ditte Marie Lindhardt Saunte

  2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gregor Borut Ernst Jemec & Ditte Marie Lindhardt Saunte

  3. Department of Clinical Immunology, Naestved Hospital, Ringstedgade 77B, 4700, Naestved, Denmark

    Pernille Lindsø Andersen

Authors
  1. Jonas Olsen
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  2. Pernille Lindsø Andersen
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  3. Lotte Themstrup
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  4. Gregor Borut Ernst Jemec
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  5. Ditte Marie Lindhardt Saunte
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jonas Olsen, Pernille Lindsø Andersen and Lotte Themstrup. The first draft of the manuscript was written by Jonas Olsen and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Jonas Olsen.

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Olsen, J., Lindsø Andersen, P., Themstrup, L. et al. Optical coherence tomography of onychomycosis: proposed terminology and a suggestion of practical usage. Arch Dermatol Res 312, 51–58 (2020). https://doi.org/10.1007/s00403-019-01989-8

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  • DOI: https://doi.org/10.1007/s00403-019-01989-8

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