MedicalResearch.com Interview with:
Adam Friedman, MD, FAAD
Associate Professor of Dermatology
Residency Program Director
Director of Translational Research
Department of Dermatology
George Washington School of Medicine and Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was developed out of a session I and my colleague, Neal Bhatia, held at the 2016 Orlando Dermatology Aesthetic and Clinical Conference.
As an interactive session which had the audience answer whether they clinically thought an image was representative of a fungal skin infection or not, we collected audience responses and were impressed by how even dermatologists struggle with making this diagnosis clinically. This is not so surprising given the protean nature and diverse presentations of these infections, not to mention the many mimics which are not due to infection. Only one of the thirteen images shown was appropriately diagnosed by 90% of the audience. This highlights that the importance of using bedside diagnostic techniques such as KOH preps and culture to identify underlying cause in order to appropriately use the right therapy for the right condition.
MedicalResearch.com: What should readers take away from your report?
Response: Clinically identifying fungal infections of skin, hair and nails is difficult even for dermatologists. The opposite is also true – many conditions can mimic dermatophyte infections and therefore delays in diagnosis and proper treatment could potentially ensue. It is important that physicians take thorough histories and use all of our tools in order to make the right diagnosis. It is very easy to jump to a doorway diagnosis, which ultimately can be a detriment to patient care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: I think better non-invasive diagnostic tools would be helpful. The utility of slide preps to identify fungal infections is very operator dependent so to speak. Colorimetric assays or even confocal microscopy for example would be helpful for physicians of all specialties, vs visually identifying hyphae using a microscope.
MedicalResearch.com: Is there anything else you would like to add?
Response: Delays in appropriate care due to the misdiagnosis of common yet elusive Dermatologic conditions is an ongoing and documented issue. Keeping an open mind and differential is of the utmost important.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Ramsin Joseph Yadgar, Neal Bhatia, Adam Friedman. Cutaneous fungal infections are commonly misdiagnosed: A survey-based study. Journal of the American Academy of Dermatology, 2016; DOI: 10.1016/j.jaad.2016.09.041
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