{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:32:03Z","timestamp":1762079523410,"version":"build-2065373602"},"reference-count":15,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in contrast to traditional mycological testing, is a noninvasive, point-of-care tool that can rapidly identify fungal lesions. This systematic review aims to understand the utility of RCM in evaluating onychomycosis and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of four databases was conducted. A total of five articles\u2014three prospective cohort studies and two case reports\u2014which reported RCM findings in nails clinically suspicious for onychomycosis were analyzed. Fungal hyphae or spores were visualized on RCM in 67 (81.7%) of the 82 mycologically confirmed cases of onychomycosis. Terms used to describe hyphae included bright, linear, lengthy, thready-like, branching and filamentous. Spores were described as bright, roundish structures with high reflection. The three cohort studies demonstrated RCM had a sensitivity of 52.9\u201391.7, a specificity of 57.58\u201390.2%, a positive predictive value of 61.1\u201388.6% and a negative predictive value of 68.0\u201390.5%. In conclusion, existing studies demonstrate how RCM can assist the diagnosis of onychomycosis at the bedside. Larger studies incorporating multiple testing modalities to confirm the diagnosis of onychomycosis are warranted to further explore the diagnostic utility of RCM.<\/jats:p>","DOI":"10.3390\/jof8121272","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T01:44:46Z","timestamp":1669945486000},"page":"1272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review"],"prefix":"10.3390","volume":"8","author":[{"given":"Sophie Soyeon","family":"Lim","sequence":"first","affiliation":[{"name":"Alfred Health, Melbourne 3004, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2223-1606","authenticated-orcid":false,"given":"Bo Ri","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"},{"name":"Department of Dermatology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0734-2850","authenticated-orcid":false,"given":"Je-Ho","family":"Mun","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"},{"name":"Department of Dermatology, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jaad.2018.03.062","article-title":"Onychomycosis: Clinical overview and diagnosis","volume":"80","author":"Lipner","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Guida, S., Alma, A., Shaniko, K., Chester, J., Ciardo, S., Proietti, I., Giuffrida, R., Zalaudek, I., Manfredini, M., and Longo, C. (2022). Non-Melanoma Skin Cancer Clearance after Medical Treatment Detected with Noninvasive Skin Imaging: A Systematic Review and Meta-Analysis. Cancers, 14.","DOI":"10.3390\/cancers14122836"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1001\/jamadermatol.2022.1570","article-title":"Effect of Reflectance Confocal Microscopy for Suspect Lesions on Diagnostic Accuracy in Melanoma: A Randomized Clinical Trial","volume":"158","author":"Pellacani","year":"2022","journal-title":"JAMA Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2020.05.153","article-title":"Reflectance confocal microscopy: Principles, basic terminology, clinical indications, limitations, and practical considerations","volume":"84","author":"Shahriari","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jconrel.2017.10.014","article-title":"Precise laser poration to control drug delivery into and through human nail","volume":"268","author":"Vanstone","year":"2017","journal-title":"J. Control. Release"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S0190-9622(00)90128-2","article-title":"Confirmation of onychomycosis by in vivo confocal microscopy","volume":"42","author":"Hongcharu","year":"2000","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1439-0507.2012.02198.x","article-title":"Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis\u2014Comparison of six diagnostic methods","volume":"56","author":"Rothmund","year":"2013","journal-title":"Mycoses"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jaad.2014.02.020","article-title":"Diagnosis and treatment monitoring of toenail onychomycosis by reflectance confocal microscopy: Prospective cohort study in 58 patients","volume":"71","author":"Pharaon","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_10","first-page":"E9","article-title":"In vivo confocal microscopy in the diagnosis of onychomycosis","volume":"95","author":"Turan","year":"2015","journal-title":"Cutis"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"586648","DOI":"10.3389\/fmed.2020.586648","article-title":"Ex vivo Confocal Laser Scanning Microscopy: A Potential New Diagnostic Imaging Tool in Onychomycosis Comparable with Gold Standard Techniques","volume":"7","author":"Krammer","year":"2020","journal-title":"Front. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"637216","DOI":"10.3389\/fmed.2021.637216","article-title":"Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence","volume":"8","author":"Lim","year":"2021","journal-title":"Front. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/j.1365-2710.2009.01107.x","article-title":"Toenail onychomycosis: An important global disease burden","volume":"35","author":"Thomas","year":"2010","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1007\/s10103-022-03561-9","article-title":"Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: A systematic review and meta-analysis of randomised controlled trials","volume":"37","author":"Zhang","year":"2022","journal-title":"Lasers Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Falotico, J.M., Lapides, R., and Lipner, S.R. (2022). Combination Therapy Should Be Reserved as Second-Line Treatment of Onychomycosis: A Systematic Review of Onychomycosis Clinical Trials. J. Fungi, 8.","DOI":"10.3390\/jof8030279"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/12\/1272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:32:32Z","timestamp":1760146352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/12\/1272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":15,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jof8121272"],"URL":"https:\/\/doi.org\/10.3390\/jof8121272","relation":{},"ISSN":["2309-608X"],"issn-type":[{"type":"electronic","value":"2309-608X"}],"subject":[],"published":{"date-parts":[[2022,12,2]]}}}