Dermatophytosis other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Most of the time, ringworm can be diagnosed by looking at the skin. The fungus may glow when skin is examined with a blue light (called a Wood's lamp) in a dark room.
Other Diagnostic Studies
Other diagnostic studies to confirm the diagnosis may include:
Matrix-assisted laser desorption ionization-time of flight mass spectrometry
It is based on the detection of biochemical characteristics, proteolytic degradation product which is a result of the activity of mycological infections or noninfectious diseases. These are represented by proteolytic degradation products of native proteins. The peptide patterns of affected samples are identified by comparison with known peptide spectra from skin disorders stored in an already existing database. This procedure is immensely time saving, as it enables simultaneous identification of up to 64 dermatophyte strains, with results coming back within 24 h.
Reflectance confocal microscopy
It provides in vivo imaging of the epidermis and superficial dermis at cellular level resolution and can be used to detect cutaneous fungi and parasitic infestations. Branching fungal hyphae can be detected over an erythematous annular scaly patch. Advantage of the test being noninvasive and in a retrospective analysis of the test by Friedman et al. sensitivity was found to be 100%.
Summarizing it can be safely recommended that a clinical diagnosis of cutaneous dermatophytic infection should always be supplemented by a mycologic confirmation. While traditional methods like direct demonstration of fungus by KOH offer a reasonably sensitive and inexpensive option, newer noninvasive methods such as dermoscopy have additional advantage of ease of use, ability to detect involvement of vellus hair and thus, influence the choice of treatment (topical versus systemic). Fungal culture and antifungal testing are costlier and more specialized investigations, but such infrastructure needs to build up at most centers, especially in the present scenario of rising prevalence of nonresponsive dermatophytosis. Other methods such as PCR and reflectance confocal microscopy are still used primarily for research purposes.