Background: Onychomycosis is the most common nail pathology, involving various pathogens such as dermatophytes, moulds and yeasts.Objective: The objective of this study was to observe the prevalence of onychomycosis, analyse the most appropriate diagnostic test, and assess the distribution of pathogens based on age, sex, quarter of the year, duration of symptoms and previous treatment.Methods: Retrospectively, mycological culture and PCR data and results were collected from 121 patients.Results: Of the 121 samples, 57% (69/121) tested positive when both microbiological study techniques were combined. The prevalence of onychomycosis was higher when PCR was performed (52.1%) compared to microbiological culture (33.1%). Among the 81 samples negative by microbiological culture, 31 were positive by PCR. Similarly, of the 58 samples negative by PCR, eight were positive by microbiological culture. Diagnostic accuracy data (with 95% confidence intervals) for PCR, using microbiological culture as the gold standard, were as follows: sensitivity of 0.8, specificity of 0.62, positive predictive value of 0.51 and negative predictive value of 0.86. The most frequently identified pathogen was Trichophyton rubrum, and the hallux nail plate was the most commonly affected location. However, no statistically significant associations were found between sex, age, quarter of the year and affected area with culture and PCR results.Conclusion: Combining microbiological culture and PCR can increase the detection rate of onychomycosis and help avoid false‐negative results.

Background: Several clinical signs in dermatoscopy are very characteristic of onychomycosis and can be a quick complement for the diagnosis of onychomycosis.Objectives: The aim of this study was to evaluate the diagnostic accuracy of dermatoscopy compared to microbiological culture and polymerase chain reaction (PCR), as well as the clinical signs associated with onychomycosis.Methods: The clinical signs of 125 patients were assessed cross‐sectionally using dermatoscopy, and a positive or negative result was assigned. A sample was then taken for PCR and microbiological culture.Results: Of the 125 patients, 69.6% (87/125) had positive results when both laboratory tests were combined. When they were not combined, the prevalence was lower at 48% (60/125) with PCR and at 43.2% (54/125) with culture. Furthermore, 76.8% (96/125) were classified as positive with dermatoscopy with a sensitivity of 1, a specificity of 0.76, positive predictive value of 0.91 and negative predictive value of 1 (with 95% confidence intervals). Of the 96 dermatoscopy‐positive samples, 36 were negative with PCR (p < 0.001), 42 were negative with culture (p < 0.001) and nine were negative when both tests were combined (p < 0.001). Clinical signs that were significantly associated with the presence of onychomycosis were subungual hyperkeratosis (dermatoscopy: p = 0.004, odds ratio (OR) = 2.438; PCR + microbiological culture: p = 0.004, OR = 3.221), subungual detritus (p = 0.033, OR = 3.01, only with dermatoscopy) and dermatophytoma (dermatoscopy: p = 0.049, OR = 3.02; PCR + microbiological culture: p = 0.022, OR = 2.40).Conclusions: The results suggest that dermatoscopy is a good tool for the diagnosis of onychomycosis but should be used as a complementary test or for screening patients to be sampled for laboratory testing. The combination of the three tests can lead to a reduction of false‐positive and false‐negative clinical and laboratory results. This allows for early diagnosis and specific treatment based on test results.

Background: Onychomycosis (ONM) is the most prevalent nail unit pathology, and its severity and monitoring are often based on the visual judgement of clinicians.Objective: The objective of this study is to assess the reliability of the Onychomycosis Severity Index (OSI) classification when utilized by three clinicians with varying levels of clinical experience: an experienced podiatrist (with 5 years of experience), a moderately experienced podiatrist (with 2 years of experience) and an inexperienced podiatrist (a recent graduate familiar with the OSI classification but lacking clinical experience). Additionally, we compared the severity assessments made through visual inspection with those determined using the OSI by different clinicians.Methods: We evaluated reliability using the intraclass correlation index (ICC), analysing 50 images of ONM.Results: The OSI demonstrated a very high level of reliability (ICC: 0.889) across clinicians, irrespective of their experience levels. Conversely, a statistically significant increase in severity was observed when comparing visual assessments with the OSI (p < .001) for ONM severity evaluation.Conclusion: The OSI proves to be a reproducible classification system, regardless of the clinical experience of the practitioner employing it.

A plantar wart is a benign hyperplasia that appears on the feet due to the human papillomavirus (HPV). One method used for the treatment of recalcitrant plantar warts, those lasting over 2 years or persisting after at least two treatment attempts, is the cantharidin (1%), podophyllin (5%), and salicylic acid (30%) formulation, also known as the CPS formulation. Although this method is in use, there are few studies on it. This study's objective was to ascertain its cure rate. For this retrospective observational study, we reviewed the medical records of patients treated with the CPS formulation at a podiatric clinic specializing in plantar wart treatment. Our sample size was 48 subjects. The CPS formulation had a cure rate of 62.5%. Out of the cured patients, 86.67% (26/30) required one or two applications. There was no observable correlation ( p > 0.05) between wart resolution and virus biotype, evolution time, patient's morphological and clinical attributes, location, number of warts, or preceding treatments. The CPS formulation presents a relatively high efficacy rate for treating recalcitrant HPV plantar warts. Still, additional studies are necessary to evaluate its safety and efficiency.

Background: There are multiple conservative treatment options for plantar warts, but none have proven to be universally effective. Nitric acid is often used empirically by podiatrists in the treatment of plantar warts. A novel medical device or topical solution of nitric–zinc complex solution (NZCS) could potentially offer an effective and safe alternative for the targeted treatment of plantar warts. Objective: To observe the rate of complete healing of NZCS in a series of plantar wart cases and to establish the minimum number of product applications and time needed for healing. This will help standardize and protocolize its use. Methods: A descriptive study was conducted involving 72 patients who exhibited symptoms of plantar warts. These patients underwent chemical treatment using a nitric–zinc complex. Results: The cure rate with NZCS was 59.2%. The average number of NZCS applications was 5.9 ± 3.0 and the mean duration of treatment was 9.4 ± 7.1 weeks. A recurrence rate of 6.7% was observed. Conclusions: The topical solution of the nitric–zinc complex is an effective treatment for plantar warts, which can be considered a first-line treatment option in the general population.

Background: Plantar warts caused by the human papilloma virus (HPV) are one of the most frequent pathologies in podiatry. Diagnosis is usually limited to the clinical presentation of the lesion. Biopsy and polymerase chain reaction (PCR) are expensive and can be difficult to access. However, the dermatoscope is a noninvasive tool that covers the gap between microscopic and macroscopic diagnosis.Objective: This study compares the effectiveness of diagnosis of plantar warts using a dermatoscope versus visual clinical signs.Methods: The study evaluated 25 patients with suspected HPV plantar warts by visual or dermatoscopic signs. Upon clinical suspicion of HPV, a sample was taken for PCR analysis. A dermatoscopic image of the plantar wart was collected, and the characteristic clinical signs were evaluated, including the discontinuity of dermatoglyphs, hemorrhagic dots, reddish linear vessels, verruciform surface and frog‐spawn appearance.Results: All 25 patients showed positive results in molecular testing. Dermatoscopic findings compatible with HPV were obtained for 100% (25/25) of patients, while clinical signs were observed in 84% (21/25). The most common finding was the alteration of dermatoglyphs, which was present in all patients at the dermoscopic level. The sensitivity of the dermatoscope was 100% and identical to that of PCR.Conclusion: The dermatoscope appears to be a useful, noninvasive and rapid tool for clinical use in the diagnosis of plantar warts.