The gold standard for identifying superficial fungal infections has traditionally been direct microscopy performed by the clinician, in conjunction with fungal culture (and sometimes histopathology) performed by a laboratory. Molecular techniques including PCR and MALDI-ToF are available for these infections but often have drawbacks such as lack of standardisation between laboratories, expensive equipment and suboptimal species libraries. Clinically-relevant non-dermatophyte species (e.g. Candida, Malassezia, Neoscytalidium) are omitted from some libraries, and others include clinically-irrelevant species that represent contamination.
Dr Saunte and colleagues distributed an online questionnaire to members of the EADV mycology Task Force and other relevant dermatologists, with 45 respondents (primarily European)
- Only 27% used molecular methods in their daily practice
- Many wished that in vitro susceptibility testing was more widely available, as various species of Trichophyton have acquired resistance to terbinafine
- Mycological investigation is particularly important before starting systemic treatments
- Molecular methods are useful in establishing a diagnosis, but are of less value in assessing whether treatment was been successful because they detect both viable and non-viable fungal elements