Direct examination (KOH) by pressing: a novel method for the diagnosis of onichomycosis
DOI:
https://doi.org/10.29176/2590843X.1575Keywords:
Aged; Biopsy; Colombia; Diagnosis; Onychomycosis; Potassium hydroxide.Abstract
Introduction: Onychomycosis is the most common nail disease and represents around 50-60% of nail disorders. A PAS-stained biopsy is considered the gold standard for diagnosis. The objective of the study was to determine the diagnostic performance using KOH by pressing to evaluate the presence of onychomycosis compared to the gold standard.
Materials and methods: 102 nail plates, 51 clinically healthy and 51 clinically diseased, were taken, and two methods were performed: KOH by pressing and nail biopsy by distal cut with PAS staining, independently evaluated by two experienced dermatopathologists. Sensitivity, specificity negative predictive value, positive predictive value, validity (likelihood ratios), efficiency (proportion of correctly diagnosed patients), and reproducibility (Kappa index) were calculated.
Results: In the 102 samples evaluated, 3 of the 5 clinical subtypes were found: superficial white (1.8%), distal subungular (47.2%), and total dystrophic (50.9%). The direct examination (KOH) test by pressing presented a sensitivity of 67.3%, a specificity of 74.5%, a positive predictive value of 75.5%, and a negative predictive value of 66.0% (p <0.001). The likelihood ratios were also calculated: LR+ 2.63; 95% CI: 1.56-4.44; and LR- 0.44; CI 95%:0.29-0.67. The efficiency was 70.58%. The concordance between the two tests was moderate (Kappa index: 0.414).
Conclusion: The direct examination method (KOH) by pressing is a useful and easy diagnostic tool to perform with results obtained in a maximum period of 72 hours, which allow a diagnostic approach in onychomycosis, with the possibility of rapid decision-making
Author Biography
Heliana Botello, Universidad de Caldas: Manizales, Caldas, CO
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