Mycological visits requested in a tertiary referral center: What can be hiding behind a suspected skin mycosis?

BACKGROUND: Few studies have so far specifically addressed referrals for mycological visits to analyze the requests for mycological visits in a tertiary referral centre, with particular regard to the rate of true mycoses, the correlation between correct diagnostic hypothesis and specialization of the referring physicians, and the most frequently misdiagnosed dermatological disorders. METHODS: A number of 415 consecutive patients attending our Mycology Unit for suspected superficial fungal infections were enrolled. Final diagnosis was made on clinical features, history, microscopic and cultural analyses and, when necessary, histology. RESULTS: The results show that 118 patients (28.43%) were diagnosed to be affected with fungi, mainly dermatophytes (57%) and Candida (29%). Among nail referrals, onychoystrophies due to mechanical injuries and psoriasis were the most frequently misdiagnosed disorders. Eczema accounted for the main part of the suspected mycoses of glabrous skin, while tinea capitis was the most common referral for hair diseases. The rate of confirmed dermatomychosis was higher among patients referred by dermatologists than by other physicians. The majority of the study patients had undergone previous therapies, mainly antimycotics. CONCLUSIONS: Clinical assessment is often insufficient for diagnosing cutaneous mycoses. Mycological examination is advisable not only for a conclusive diagnosis but also to avoid unnecessary treatments. Nevertheless, clinical competence is relevant for correct suspicion of dermatomycosis.