Histopathological investigation of onychomycosis frequency in psoriatic nails using periodic acid-Schiff staining

Background and Design: Psoriasis nail involvement is clinically similar to onychomycosis. Especially subungual hyperkeratosis and onycholysis are also common in both nail diseases. These two diseases may be seen separetely or together. The aim of this study was to compare the frequency of onychomycosis with control group in patients with psoriasis and to determine the factors predisposing to onychomycosis in patients with psoriasis.
Materials and Methods: The study included 43 patients with psoriasis who were admitted to Ýstanbul Medipol Mega University, Clinic of Dermatology between 2017 and 2018 and 43 control patients who did not have psoriasis and had nail dystrophy. Participants who received systemic corticosteroid, methotrexate, cyclosporine, and systemic antifungal treatment 4 months ago and who received topical antifungal treatment 4 weeks ago were excluded from the study. The nail samples were examined histochemically with periodic acid-Schiff (PAS) stain.
Results: Onychomycosis was detected in 11 patients with psoriasis (25.6%) (hand and/or foot), while in 17 patients (39.5%) in control group. There was no statistically significant difference between two groups (p=0.170). In control group, toe nail onychomycosis was significantly higher than in the psoriatic group (p=0.024). It was noteworthy that onychomycosis was statistically significant in the group with high educational level and low Psoriasis Area Severity Index (p<0.05 and p=0.021, respectively).
Conclusion: In this study, we determined that nail psoriasis is not a risk factor for onychomycosis by histopathological examination of fungal samples with PAS staining.

Psoriasisli týrnakta onikomikoz sýklýðýnýn periodik asit-Schiff boyama ile histopatolojik olarak araþtýrýlmasý

Amaç: Psoriazis týrnak tutulumu klinik olarak onikomikoza benzer. Özellikle; subungual hiperkeratoz ve onikoliz iki týrnak hastalýðýnda da yaygýn olarak görülür. Bu iki hastalýk ayrý ayrý olabileceði gibi birlikte de olabilir. Bu çalýþmanýn amacý, psoriazisli hastalarda onikomikoz sýklýðýnýn kontrol grubuyla karþýlaþtýrýlmasý ve psoriazisli hastalarda onikomikoza predispozan faktörlerin tespitinin saðlanmasýdýr. Gereç ve Yöntem: Çalýþmaya 2017-2018 yýllarý arasýnda Ýstanbul Medipol Mega Üniversitesi, Dermatoloji Kliniði’ne baþvuran 43 psoriazisli hasta ve 43 psoriazisi olmayan ve týrnak distrofisi olan kontrol grubu alýndý. Dört ay önce sistemik kortikostreoid, metotreksat, siklosporin ve sistemik antifungal tedavi almýþ, 4 hafta önce topikal antifungal tedavi almýþ katýlýmcýlar çalýþmadan çýkartýldý. Alýnan týrnak örnekleri periyodik asit-Schiff (PAS) boyasý ile histokimyasal olarak incelendi.
Bulgular: Psoriazisi olan 11 hastada (25,6) (el ve/veya ayak) onikomikoz tespit edildirken, kontrol grubunda 17 hastada (%39,5) onikomikoz tespit edildi. Her iki grup arasýnda istatistiksel anlamlý fark yoktu (p=0,170). Kontrol grubunda ayak týrnak onikomikozu psoriatic gruba göre chianlamlý dercede yüksekti (p=0,024). Psoriazis hasta grunda eðitim düzeyi yüksek olan ve Psoriazis Alan Þiddet indeksi deðeri düþük olanlarda onikomikozun istatistiksel olarak anlamlý derecede fazla olmasý dikkat çekiciydi (sýrasýyla; p<0,05; p=0,021).
Sonuç: Biz bu çalýþmada, týrnak psoriazisinin onikomikoz için bir risk faktörü olmadýðýný, mantar örneklerinin PAS boyama ile histopatolojik olarak incelenmesi ile tespit ettik.