INTRODUCTION
Cutaneous fungal infections account for 3.5 to 6.5 million office visits per year1 – despite being common, their diverse presentations frequently lead to misdiagnosis.2,3 In one study, only 4 out of 13 dermatophytosis cases presented were accurately identified by more than 75% of board-certified dermatologists.4 In addition, other conditions can mimic fungal infections, such as mycosis fungoides5 or inflammatory diseases including annular psoriasis, secondary syphilis, and pityriasis rosea.4
Given the many presentations of fungal infections and mimicking diseases, in-office tests are useful to facilitate the diagnosis of cutaneous fungal infections. Direct microscopy using potassium hydroxide (KOH) or other stains is a rapid, inexpensive method to diagnose fungal infections,3 however, it requires clinics to have Clinical Laboratory Improvement Amendment (CLIA) certification.6 Specifically, dermatology clinics must apply for a certificate of Provider-Performed Microscopy Procedures to perform KOH preparations and other waived tests, such as urine pregnancy tests.6 Other confirmatory tests for fungal infections are more expensive and require send out cultures that can take days to weeks, and still may not provide a diagnosis.7,8 Despite the importance of bedside fungal preparations, dermatologists’ attitudes towards and utilization of these tests are unknown. This survey study examined dermatologists’ perceptions of fungal preparations and identified barriers preventing their use.
Given the many presentations of fungal infections and mimicking diseases, in-office tests are useful to facilitate the diagnosis of cutaneous fungal infections. Direct microscopy using potassium hydroxide (KOH) or other stains is a rapid, inexpensive method to diagnose fungal infections,3 however, it requires clinics to have Clinical Laboratory Improvement Amendment (CLIA) certification.6 Specifically, dermatology clinics must apply for a certificate of Provider-Performed Microscopy Procedures to perform KOH preparations and other waived tests, such as urine pregnancy tests.6 Other confirmatory tests for fungal infections are more expensive and require send out cultures that can take days to weeks, and still may not provide a diagnosis.7,8 Despite the importance of bedside fungal preparations, dermatologists’ attitudes towards and utilization of these tests are unknown. This survey study examined dermatologists’ perceptions of fungal preparations and identified barriers preventing their use.
METHODS
An IRB-approved survey was disseminated to the Orlando Dermatology Aesthetic and Clinical Conference email list and the data was collected via an internet-based platform. The survey was composed of 18 multiple choice questions and 1 free response question on demographics (Table 1) as well as fungal preparation practices and CLIA certification (Table 2). Before data collection, the survey was reviewed by 10 dermatologists and design suggestions were incorporated into the final survey. Statistical analysis was done using GraphPad Prism, version 7.0 (GraphPad Software Inc.). Survey answers were compared by frequency of fungal preparation performance, practice type (academic versus non-academic practices), and experience level (in residency versus out of residency) using chi-square tests. A P-value less than or equal to 0.05 was considered statistically significant.