What's New in Diagnosis of Onychomycosis

The presentation focuses on the diagnosis of onychomycosis, emphasizing its nature as a clinical pathologic diagnosis. It discusses the importance of pretest probability and quality of nail clippings in establishing an accurate diagnosis. Various conventional testing methods such as Koh culture, histopathology, and the newer polymerase chain reaction (PCR) testing are evaluated, highlighting their respective pros and cons. Clinical cases are presented to illustrate common mimickers of onychomycosis, reinforcing the need for proper assessment before administering antifungals. Dermoscopy is suggested as a useful tool to guide nail clipping, and the significance of comprehensive epidemiological risk factors is reiterated. The presentation points out the necessity of collecting adequate nail samples and advises against the assumption that a single negative test is definitive. A recent study comparing histopathology and PCR underscores the potential for PCR to enhance species identification in fungal diagnoses. The conclusion calls for a multifaceted approach to testing while recognizing that clinical diagnosis alone is inadequate.