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MUSINGS, OPINIONS, TIPS AND EXPERIENCES
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 131-132  

Transillumination: A simple tool to assess subungual extension in periungual warts


1 Department of Dermatology, Alshifa Hospital, Perinthalmanna, Kerala, India
2 Department of Dermatology and Internal Medicine, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia, and Amrita Institute of Medical Sciences, Kochi, Kerala, India

Date of Web Publication17-Apr-2013

Correspondence Address:
K T Ashique
Karalikkattil House, Karakkaparamba, Vaniyambalam Post, Malappuram Dt., Kerala - 679 339
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.110582

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How to cite this article:
Ashique K T, Kaliyadan F. Transillumination: A simple tool to assess subungual extension in periungual warts. Indian Dermatol Online J 2013;4:131-2

How to cite this URL:
Ashique K T, Kaliyadan F. Transillumination: A simple tool to assess subungual extension in periungual warts. Indian Dermatol Online J [serial online] 2013 [cited 2019 Oct 15];4:131-2. Available from: http://www.idoj.in/text.asp?2013/4/2/131/110582

Transillumination is the technique of sample illumination by transmission of light through the sample. [1] In medicine, it has a variety of applications in fields such as skull base surgeries, dentistry, urology, and ophthalmology. [2],[3],[4],[5] However, in dermatology, the use of transillumination has been limited to early detection of melanoma and on a detailed literature search; to the best of our knowledge, there was only one reference to this technique earlier in dermatology literature. [6],[7],[8]

Transillumination can be used as a simple tool to assess the subungual extent of periungual warts. This is especially useful in patients who have a very thick nail plate making visualization of the deeper extent of the wart difficult under normal light. It is a very simple bedside/office procedure. The lights in the clinic are turned off and the flash light with a small mouth and Light Emitting Diode (LED) operated light source) is lit from the distal part with the mouth facing and in direct contact with the pulp (this would enhance the light penetration and also prevent the light leaking through the sides which may interfere in visualizing the lesion [Figure 1] and [Figure 2].
Figure 1: Placing the light source in approximation to the pulp of the affected finger

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Figure 2: Transillumination showing the subungual extent of the wart on the right index finger

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The main advantage is that it is a simple and cost-effective method as there is no extra investment or expensive apparatus required for it Periungual warts are generally difficult to treat. The dermatologist has to at times resort to invasive procedures like nail avulsion to treat the warts effectively. Transillumination would ensure that nail avulsion surgery, which is an unwelcome and traumatic procedure for most of the patients, is avoided. The technique also helps in winning the confidence of the patients who can visualize the problems themselves and therefore understand the rationale for surgical treatment if necessary.

Transillumination can also serve as an adjuvant diagnostic tool in other conditions affecting the nail like onychomycosis and psoriasis [Figure 3] and [Figure 4], though it has its own limitations.
Figure 3: Transillumination for onychomycosis

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Figure 4: Transillumination for nail psoriasis

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There are various limitations to the said technique including the difference of intensity of the light that is transmitted in each individual due to the keratosis of the palmar or plantar skin and also the constitutional skin color. It may also be not satisfactory when the limb is not properly cleaned prior to the procedure. Further studies are recommended to assess the sensitivity and specificity of the technique which may help in further enhancing the utility in the dermatologist's diagnostic armamentarium.

 
   References Top

1.Transillumination. Available from: http://www.en.wikipedia.org/wiki/Transillumination. [Last accessed 2012 Mar 20].  Back to cited text no. 1
    
2.Sharan R, Thankappan K, Iyer S, Panicker D, Kuriakose MA. Intraoperative transillumination to determine the extent of frontal sinus in subcranial approach to anterior skull base. Skull Base 2011;21:71-4.  Back to cited text no. 2
    
3.Neuhaus KW, Ellwood R, Lussi A, Pitts NB. Traditional lesion detection aids. Monogr Oral Sci 2009;21:42-51.  Back to cited text no. 3
    
4.García-Segui A. Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination. Actas Urol Esp 2012;36:252-8.  Back to cited text no. 4
    
5.Krohn J, Kjersem B. A modified digital slit lamp camera system for transillumination photography of intraocular tumours. Br J Ophthalmol 2012;96:475-7.  Back to cited text no. 5
    
6.D'Alessandro B, Dhawan AP, Mullani N. Computer aided analysis of epi-illumination and transillumination images of skin lesions for diagnosis of skin cancers. Conf Proc IEEE Eng Med Biol Soc 2011;2011:3434-8.  Back to cited text no. 6
    
7.Goldman L. Transillumination of fingertip as aid in examination of nail changes. Arch Dermatol 1962;85:644.  Back to cited text no. 7
    
8.Goldman L. Letter: Transillumination as diagnostic aid. Arch Dermatol 1976;112:262.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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