27% of dermatologists use molecular methods in their daily practice

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

Read the paper: Saunte et al (2019) A survey among dermatologists. JEADV 33:421-7