Dear Mrs. Smith,
It's so nice to hear from you again! We hope you had a wonderful summer vacation in the rainforests of Puerto Rico. El Yunue is truly a magnificent natural wonder and the vistas are incredible. Please send us some pictures for our Facebook Fan Page!
Sorry to hear about your nail problem. Don't be embarrassed Mrs. Smith, abnormalities of the pedal nail unit affect roughly 10-20% of all adults between the ages of 40 and 60. Your nail condition could be a result of a nail fungal infection (onychomysosis), microtrauma (persistent rubbing against your shoes), non-infectious dermatological diseases such as psoriasis or lichen planus, or even a neoplastic process such as melanoma. The thickening and discoloration of the nail can be painful and unsightly. In addition, the malformation of your nail, coupled with your diabetes could cause other problems, such as an ulcer or even amputation. Even your Manolo Blahnik's can't make you feel better about this issue. Scheduling an appointment to see your podiatrist is the first step to resolving your nail problem.
Your podiatrist has seen nail problems such as yours many times. In fact, they are the foremost providers of medical therapy for nail unit abnormalities. We appreciate the fact that you've taken the time to visit our website and research our testing menu and hope this will clear up any questions related to testing methods for nail abnormalities. In order to know EXACTLY what is going on in your nail plate, your podiatrist will perform a nail unit biopsy (histopathologic examination with a period acid-Schiff reaction, or PAS reaction). The nail unit biopsy is much more sensitive than other forms of mycology testing (KOH, culture). A nail unit biopsy will give much more detail, not just whether a fungus is present, but also information regarding the pattern of growth, fungal load, and other pathologic concerns. If the PAS reaction is positive for fungus, the report will tell your podiatrist if the fungal elements are most consistent with dermatophytes, saprophytes or yeast, thereby guiding antifungal therapy. If the PAS reaction is negative, the histopathologic exam will attempt to identify exactly what is causing the abnormal changes within the nail unit. Is there evidence of psoriasis, microtrauma, or something else going on in the nail unit? Histopathology can also identify squamous cell carcinomas and even melanomas that may give the clinical appearance of onychomycosis.
A nail unit biopsy sent to Bako Pathology Services will be reported in a timely manner (24-48 hour turn-around time) with an accurate diagnosis. In contrast to fungal culture which requires a large number of living organisms to yield a positive fungal culture, a PAS reaction will allow for identification of rare fungal elements, even when no longer living. A nail unit biopsy is examined by a dermatopathologist whereas the fungus culture is grown out in the lab (a 4 to 6 week process) and processed by a medical technologist. A fungus culture cannot diagnose psoriasis, microtrauma, or cancer. There may be times, however, when a fungal culture (mycology testing) is warranted, in order to identify specific fungal organisms.
Your podiatrist will submit a generous sample of the nail unit derived tissue. This will be a quick process in which the nail unit sample will be harvested with special forceps. Subungual nailbed-derived keratin will be further sampled using a curette. The nail unit sample will be placed into formalin fixative, allowing for preservation of the tissue, and ultimately, better testing sensitivity. The PAS reaction produces a color change within the carbohydrates of the fungal cell wall. These carbohydrates will turn bright red for a significant amount of time, even if the organisms are dead.
So, Mrs. Smith, don't despair! Once your podiatrist has established the correct diagnosis, and can appropriately treat your nail condition, you'll be back to wearing your favorite havaianas in no time!
Sincerely,
Your friends at Bako Podiatric Pathology Services 877-DPM-PATH
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Bako Pathology Services www.bakopathology.com is a physician-owned provider of a wide array of pathology services ranging from histopathologic examination of bone, soft tissue, and skin/nail unit, to microbiology and epidermal nerve fiber density testing. We pride ourselves on providing the best available customer service, concise reports with therapeutic options, photomicrographic imaging, compliant and patient-friendly billing policies, internet-based report access, and a client/patient comes-first business model.
At Bako Pathology Services, we're not just providing a premium pathology service; we're dedicated to the advancement of this great profession through Education, Research, and Financial Support.
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