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Year : 2018  |  Volume : 9  |  Issue : 5  |  Page : 322-323  

Innovative use of felt-tip pen applicator for uniform spread of linkage fluid during dermatoscopy

Department of Dermatology, University College of Medical Sciences, New Delhi, India

Date of Web Publication4-Sep-2018

Correspondence Address:
Chander Grover
Department of Dermatology, University College of Medical Sciences, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_58_18

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How to cite this article:
Jakhar D, Grover C. Innovative use of felt-tip pen applicator for uniform spread of linkage fluid during dermatoscopy. Indian Dermatol Online J 2018;9:322-3

How to cite this URL:
Jakhar D, Grover C. Innovative use of felt-tip pen applicator for uniform spread of linkage fluid during dermatoscopy. Indian Dermatol Online J [serial online] 2018 [cited 2021 Apr 19];9:322-3. Available from: https://www.idoj.in/text.asp?2018/9/5/322/240536

Onychoscopy (nail unit dermatoscopy) and nail-fold capillaroscopy (NFC) are techniques increasingly being used to enable visualization of nail features and vascular components in proximal nail-fold (PNF), respectively. These require examination under polarized light to best discern the details. For this, a uniform application of a thin film of immersion fluid (oil or alcohol) is imperative; especially so for visualizing capillary architecture at higher magnifications.[1] Yet there are no standardized application techniques available. An earlier study had comparatively evaluated the use of an eye dropper, rolling with the lens of the dermatoscope, or the use of plastic misting bottle for spraying the fluid over the area to be examined.[2] The problems however are, that the application can be very messy (especially with oil); may produce an irregular fluid film (oil can be difficult to spread uniformly); or may carry particles or air bubbles, obscuring the field of examination and introducing artefacts.

As we tried one method after the other, we faced the inherent drawbacks of these techniques. With the use of a dropper or glass-tipped or rubber-tipped applicator, there was a problem with the stickiness and messy spread of oil onto the work station. Misting bottles work best for aqueous solutions or alcohol, which tend to be suboptimal linkage fluids as a faster evaporation leaves behind an irregular film, demanding repeated applications, thus making the process of dermatoscopic examination even more tedious.

Subsequently, we devised the use of commonly available felt-tip pen to ensure uniform and non-messy application of linkage fluid on the nail or PNF. The felt-tip pen, as we all know, has a tip made up of porous compressed fiber; as well as a central core of sponge for storing ink [Figure 1]. We took a used pen, from which the ink remnants were removed by soaking overnight in water. Thereafter, the dried sponge removed from the body of the pen was used to absorb the linkage fluid of choice. In our case, it was oil; but it can absorb alcohol as well. The unit was then re-assembled to form an oil-loaded pen. Its tip enabled uniform spread of oil (or alcohol) over the PNF or nail-plate [Figure 2]. We found that this system also took care of various impurities or bubbles in the linkage fluid or on the visualized surface, thus preventing irregular refraction of light, and ensuring that there were no floating particles in the view being examined [Figure 3]a and [Figure 3]b.
Figure 1: Felt-tip pen showing its various parts. The sponge is used to soak the immersion fluid that can then be spread uniformly with the felt-tip

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Figure 2: Immersion fluid (oil) being spread uniformly on the proximal nail-fold for conducting nail-fold capillaroscopy

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Figure 3: Visualized image without (a) and with the interface medium (b). The second image shows better clarity of capillary architecture. Note the absence of dust particles or air bubbles. A uniform, thin film ensures absence of light refraction or diffraction [Dinolite AM413ZT; ×150]

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We have been regularly using the felt-tip pen applicator for NFC, and onychoscopy and find it to be an organized and tidy technique. Though we initially started using it for NFC, we have found it to be equally useful in onychoscopy or dermatoscopy at select sites. It cannot, however, be used on potentially infected surfaces or on/near mucosae due to potential of spread of infection. The fiber tip cannot be sterilized by commonly used means and it is best to dispose it after few uses. The assembly is spill-proof as the linkage fluid has been absorbed into the sponge; thus, preventing accidental leakage into the working kit. It can be easily carried in a pocket, stored with dermoscopy equipment and reduces the mess associated with other spreading methods. We have found it to be equally acceptable by patients as well as examiners.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Lencastre A, Lamas A, Sá D, Tosti A. Onychoscopy. Clin Dermatol 2013;31:587-93.  Back to cited text no. 1
Gewirtzman AJ, Saurat JH, Braun RP. An evaluation of dermoscopy fluids and application techniques. Br J Dermatol 2003;149:59-63.  Back to cited text no. 2


  [Figure 1], [Figure 2], [Figure 3]


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