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Diagnosing dermatomycosis in general practice
D Lousbergh1, F Buntinx, G Piérard
1Department of General Practice, University of Leuven, Belgium.
Family Practice
|January 7, 2000
Summary
Diagnosing fungal skin infections (dermatomycosis) is challenging. Combining clinical judgment with cyanoacrylate surface skin scraping (CSSS) offers the best accuracy and cost-effectiveness for diagnosis.
Area of Science:
- Dermatology
- Mycology
- Diagnostic Medicine
Background:
- Clinical diagnosis of dermatomycosis is often unreliable.
- Traditional methods like KOH microscopy and fungal cultures are underutilized in general practice.
- Cyanoacrylate surface skin scraping (CSSS) presents a novel, potentially simpler diagnostic tool.
Purpose of the Study:
- To evaluate the diagnostic value of clinical signs, KOH-test, and CSSS for erythematosquamous skin lesions.
- To establish an optimal diagnostic algorithm for mycosis, balancing accuracy and cost.
- To use fungal culture as the gold standard for comparison.
Main Methods:
- 148 general practice patients with suspected dermatomycosis were enrolled.
- Skin scales were analyzed using KOH-test, CSSS, and fungal culture.
- Clinical data were gathered via questionnaire.
Main Results:
- Fungal elements were confirmed in 18% of cultures.
- CSSS demonstrated higher sensitivity (62%) and specificity (88%) compared to clinical diagnosis (81% sensitivity, 45% specificity).
- A strategy combining clinical judgment with CSSS in positive cases yielded the best cost-benefit ratio.
Conclusions:
- Clinical assessment alone is insufficient for reliable dermatomycosis diagnosis.
- The combination of clinical judgment and CSSS offers superior diagnostic accuracy and cost-effectiveness.
- This integrated approach optimizes the diagnosis of fungal skin infections in primary care settings.