Diagnostic and Therapeutic Utility of Onychoscopy in Subungual Foreign Body.

Abstract

Dermoscopy is a simple, non-invasive procedure used commonly in the diagnosis of various pigmentary, infectious and papulosquamous disorders. Dermoscopy may also allow identification of indwelling cutaneous foreign bodies with far greater accuracy than with the naked eye and its removal.[1] A 24-year-old female presented with pain over her left index finger for three days. There was a history of trivial trauma with metal pipe brushing the fingertip. There was no discharge or fever. Examination revealed localized brown discoloration of the anterior nail suggestive of subungual hematoma [Figure 1]. She was managed conservatively but reported with persisting pain after two days. An indwelling subungual foreign body was suspected.Figure 1: Brown discoloration of the tip of nail suggestive of subungual hematomaVideo onychoscopy of the nail was performed (Medicam Fotofinder II), which revealed homogenous brown discoloration with some peripheral streaking [Figure 2]. There was also a distinct dark brown discoloration with straight edges and protruding tip suggestive of the presence of a foreign body. Onychoscopy enabled visualization and localization of the foreign body, which was otherwise not seen by the naked eye. The foreign body was gradually removed using a 26-gauge-needle and iris forceps under onychoscopic visualization [Figure 2].Figure 2: Contact Dermoscopy with FotoFinder II Medicam at 70X magnification showing homogenous brown discoloration (black arrow), peripheral streaking (yellow arrow) suggestive of subungual hematoma with distinct dark brown discoloration (green arrow) and protruding tip (blue arrow) suggestive of foreign body. The inset image shows the extracted foreign bodySubungual hematoma may present with various onychoscopic patterns.[2] The foreign body should be distinguished onychoscopically from hematoma by the sharp edges and protruding tip. Performing onychoscopy assisted the diagnosis and smooth extirpation of the foreign body in our case as a safe alternative to surgical intervention. To the best of our knowledge, this is the first case of onychoscopy of a subungual foreign body to be reported. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.