What's New in Onychomycosis?

Molly Henshaw discusses the diagnosis of onychomycosis, emphasizing the importance of ancillary testing to confirm the condition, as many patients with dystrophic nails do not have onychomycosis. She highlights that ancillary testing can save patients time and costs by avoiding unnecessary antifungal treatments. Various conditions can mimic onychomycosis, such as squamous cell carcinoma, lichen planus, and chronic paronychia, making accurate diagnosis essential. Henshaw notes a rise in mixed fungal infections, particularly with non-Dermatophyte molds and yeasts, which may complicate treatment. Current diagnostic methods involve sampling the nail and using techniques like KOH prep and cultures, though emerging technologies such as AI, fluorescence, and confocal imaging show potential for the future, albeit needing further development and resources. Henshaw advises careful interpretation of laboratory results, especially regarding cultures and PCR tests, which are valuable for mixed infections and resistance cases. The presentation reinforces that dermatopathologists should collaborate closely to confirm accurate diagnoses, urging practitioners to be diligent in their approach due to the multiple potential conditions affecting dystrophic nails.