title: Screening for tinea unguium by thermography in older adults with subungual hyperkeratosis.
abstract: OBJECTIVE
  The purpose of the present study was to assess the difference in foot temperature between tinea unguium-positive older adults with subungual hyperkeratosis and tinea unguium-negative older adults with subungual hyperkeratosis to develop a temperature-based screening method for tinea unguium.
  
  
  METHODS
  The present cross-sectional, observational study investigated 51 residents with subungual hyperkeratosis in two facilities covered by long-term care insurance between October 2011 and December 2011. One dermatologist recorded the clinical signs of abnormal toenails. Nail specimens were collected from all abnormal nails, and the presence of tinea unguium was confirmed when fungus was detected by direct microscopy. Foot temperature was measured by infrared thermography. A receiver operating characteristic curve was used to assess the ability to determine whether residents with subungual hyperkeratosis have tinea unguium and to determine the cut-off point.
  
  
  RESULTS
  Among the people with subungual hyperkeratosis, the mean toe temperature in the tinea unguium-positive group (30.2 ± 2.6°C) was significantly lower than that in the tinea unguium-negative group (32.8 ± 3.2°C, P = 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval 0.621-0.876), and the threshold temperature was set at 33.0°C, resulting in a sensitivity of 81.8% and specificity of 65.7%.
  
  
  CONCLUSIONS
  Our study suggests that foot temperature can be used to screen for tinea unguium in people with subungual hyperkeratosis. This non-invasive and simple screening method would help clinicians to set priorities in terms of carrying out direct microscopy to diagnose tinea unguium in elderly residents in care facilities.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Japan Society for the Promotion of Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Department of Nursing Administration, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kimie
authors.initials: K
authors.lastname: Takehara
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Japan Society for the Promotion of Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Amemiya
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Kimura
authors.affiliation: St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kishi
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yuiko
authors.initials: Y
authors.lastname: Koyano
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Tamai
authors.affiliation: Shukokai Medical Corporation, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawashima
authors.affiliation: Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Tsunemi
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D005260:Female; D005533:Foot Dermatoses / Q000175:diagnosis* / Q000453:epidemiology; D006707:Homes for the Aged; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000379:methods; D014009:Onychomycosis / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013817:Thermography / Q000379:methods*
keywords: aged; nail diseases; onychomycosis; sensitivity and specificity; thermography