title: Methods for diagnosing onychomycosis: a comparative study and review of the literature.
abstract: OBJECTIVE
  To identify the sensitivity of several readily available diagnostic tests for onychomycosis.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Dermatology and podiatry departments at a teaching hospital.
  
  
  METHODS
  Sixty-three adult men and women with a clinical examination highly suggestive of onychomycosis.
  
  
  METHODS
  Sensitivity of each test and of several test combinations.
  
  
  RESULTS
  Nail samples underwent 6 diagnostic tests. Routine histopathologic examination with periodic acid-Schiff stain (PAS) (PATHPAS) was 85% sensitive. Sensitivities for potassium hydroxide dissolution and centrifugation combined with PAS, fluorescent brightener, or chlorazol black E were 57%, 53%, and 53%, respectively. Culture on Sabouraud agar withchloramphenicol and cycloheximide (Mycosel agar) was 32% sensitive; on Littman-oxgall agar, 23% sensitive. The most sensitive combination of tests, both culture methods plus PATHPAS, was 94% sensitive (not statistically different from the sensitivity of PATHPAS alone [P = .26]).
  
  
  CONCLUSIONS
  When onychomycosis is suspected clinically, PATHPAS of the nail is the single most sensitive of the diagnostic tests we evaluated. Because it is quickly performed and relatively operator independent, PATHPAS is practical for clinical and research purposes. Further study is needed to determine if sensitivity may be enhanced by combining PATHPAS with cultures obtained by several collection methods (clipping, curettage, and shaving). Such combinations may serve as sensitive and efficient strategies for diagnosing onychomycosis.
authors.affiliation: Department of Dermatology, Kaiser Permanente Medical Group-South Sacramento, 6600 Bruceville Rd, Sacramento, CA 95823, USA. Monica.A.Lawry@kp.org
authors.forename: M A
authors.initials: MA
authors.lastname: Lawry
authors.forename: E
authors.initials: E
authors.lastname: Haneke
authors.forename: K
authors.initials: K
authors.lastname: Strobeck
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.forename: B
authors.initials: B
authors.lastname: Zimmer
authors.forename: P S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D014009:Onychomycosis / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests