Derm Topics

What Dermatopathologists Wish Every Derm Knew About Nail Biopsies

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic & Surgical Conference, interviewed to Dr. Molly Hinshaw, professor of dermatology, section chief of dermatopathology and director of the nail clinic at the University of Wisconsin School of Medicine and Public Health. Watch as Dr. Hinshaw shares her tips for performing nail biopsies. Find out what’s the safest and most useful biopsy approach for the nail unit. Hear her approach for procuring tissue when you suspect onychomycosis. Plus find out why it’s important to use the clinical pathological correlation when addressing nail disorders.

Further Reading

If you want to read more about nail disorders, check out the following articles published in the Journal of Drugs in Dermatology:

Nail Psoriasis Improvement During Tildrakizumab Therapy: A Real-Life Experience


The aim of this retrospective study of patients affected by plaque psoriasis who underwent tildrakizumab therapy was to describe and compare the response of the nail psoriasis and the plaque psoriasis elsewhere in the body. Eight patients treated with tildrakizumab, 4 males and 4 females with a mean age of 61 years affected by psoriasis (mean baseline-PASI:13) with nail involvement (mean baseline mNAPSI: 51.9), were followed for at least 20 weeks. At week 4, the mean PASI was 6.6 (49% improvement), and the mean mNAPSI was 30.8 (40.6% improvement). At week 20, the mean PASI was 2.1 (84% improvement), and the mean mNAPSI was 5.1 (90% improvement).

The fast improvement of the nail psoriasis in the 8 patients was unexpected, considering the fact that Tildrakizumab is a molecule that in RCTs (reSURFACE-1 and 2) studies has proved to be efficacious against plaque psoriasis but not strikingly fast, requiring at least 20 weeks to achieve the best PASI-improvements in most patients. Evidence regarding nail improvement during tildrakizumab are scarce. Studies including a higher number of patients are required in order to confirm our observation of the fast improvement of nail psoriasis during Tildrakizumab.

Current Issues in Global Onychomycosis Management


Introduction: Onychomycoses occur worldwide and are complex infections to treat. Diagnosis with standard culture methods has been problematic. Treatment historically used oral monotherapies. A selection of topical agents is now available and can be used in topical/oral combination therapies. Both pharmaceutical and non-pharmaceutical strategies are needed to provide the best efficacy in onychomycosis therapy.
Methods: A 35-question web-based survey of current onychomycosis practice was designed to investigate how onychomycosis diagnosis and treatment is being pursued by physicians from many countries, and what strategies are most frequently implemented to improve onychomycosis outcomes.
Results: Dermatologists (n = 144) indicated that diagnosis is an important factor in treatment success, with most using standard potassium hydroxide (KOH)/culture methods. There appears to be a need to augment diagnosis with newer visualization methods or molecular identification methods such as polymerase chain reaction (PCR). For treatment resistance/failure, dermatologists generally switch antifungals, to either new monotherapy or oral/topical combination therapy. A majority of responders agreed that more effective topical and oral products are needed to improve onychomycosis therapy, and there is a need for more combination therapy data. Patient education and other non-pharmaceutical options are also widely recognized as important factors in improving the results of onychomycosis therapy.

Conclusion: Dermatologists worldwide generally share common concerns about onychomycosis, and particularly about difficulties with obtaining complete disease clearance. This survey confirms that similar pharmaceutical and non-pharmaceutical strategies for success are used across surveyed regions and that more diagnostic and pharmaceutical options are needed to improve onychomycosis outcomes.

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