Why Don't More Derms Use Lab-based Tools to ID Fungal Infections?

Fungal diagnostic preparations can assist the accurate diagnosis of cutaneous fungal infections. A survey from a team at the George Washington University (GW) identifies barriers that prevent their consistent use. The study is published in the Journal of Drugs in Dermatology.

With cutaneous fungal infections accounting for up to 6.5 million dermatologist office visits per year, dermatologists know the diverse presentations of fungal infections can lead to misdiagnosis. “Because of the extraordinary ability for these fungal infections to mimic other skin diseases, identification based on clinical inspection alone can often lead to misdiagnosis and mismanagement,” says Adam Friedman, MD, professor and interim chair of the Department of Dermatology at the GW School of Medicine and Health Sciences and senior author on the study.

Direct microscopy using potassium hydroxide (KOH) or other stains provide an inexpensive method to diagnose fungal infections. However, this requires clinics to have the Clinical Laboratory Improvement Amendment (CLIA) certification. Dr. Friedman’s previously published research highlighting the difficulty of distinguishing between skin fungal infections and other inflammatory skin diseases highlights the importance of using laboratory-based tools to aid in patient care.

The new survey was distributed via email to participants of the Orlando Dermatology Aesthetic and Clinical Conference, and the data was compiled in a web-based platform. Of the respondents, around 21 percent indicated they rarely/never perform fungal preparations and about 20 percent reported they sometimes do, often because they think clinical diagnosis is adequate or because fungal preparations take too long. Additionally, about 21 percent of respondents reported not having CLIA certifications, mostly because the process requires too much work or because they do not know how to apply. Of the providers who have CLIA certification, more than 25 percent reported that it was difficult to obtain.

“Our results indicate the need for increased education about the many clinical faces of cutaneous fungal infections and proper use of bedside diagnostics,” Dr. Friedman says. “It also highlights the need for policy-based interventions in order to ease the process of CLIA certification, to ensure that dermatology clinics are equipped to accurately diagnose infections.”