Best method for nail fungus diagnosis must be done because clearly nail fungus is not the only cause of nail disease, although it is the most common cause. Psoriasis, eczema and nail trauma may also mimic the symptoms of nail fungus. Cancer, although uncommon, may be difficult to differentiate from onychomycosis, especially when only a single nail is affected.
Onychomycosis is common, affecting 2% to 18% of the general population. Increasing public awareness and the number of new treatments available make an efficient diagnostic strategy with good sensitivity even more needed. At present, clinicians rely on clinical examination and a combination of direct microscopy and fungal culture (KONCPA method) to achieve a diagnosis for toenail fungus. These diagnostic methods are not only need more time but they may be technically difficult even when performed by experienced hands. High-quality data on sensitivity of direct microscopy performed by experienced operators are lacking. Fungal cultures are not highly sensitive or specific. For these reasons, many clinicians are not confirming the diagnosis of onychomycosis before treatment. New antifungal drugs are more effective and safer than previous nail fungus treatments, but are relatively expensive and have recognized risks. An accurate diagnostic strategy is needed to confirm the diagnosis of toenail fungus infections.
Above problem is making some researchers think about the diagnostic method which is more accurate than the KONCPA method. Finally, the researchers conducted a study to compare two methods for the diagnosis of nail fungus, KONCPA methods and PATHPAS methods. 63 patients consisted of 34 male patients and 29 women were included in this study. From 63 patients, 54 of whom suffer from toenail fungus and the rest suffered from fungal infections on fingernails. From the results of these studies we found that a single method using PATHPAS have a higher sensitivity than the other single method. PATHPAS combining with the culture technique can indeed be more sensitive in diagnosing nail fungus, but the increase was not statistically significant. However, PATHPAS method also has weaknesses. The PATHPAS test fails to identify the species of the fungal Organism. This is probably not clinically significant unless the Organism is a nondermatophyte agent that may be resistant to certain drugs.
So what can we conclude from these results?
The PATHPAS method appears to be the single most sensitive method for diagnosing nail fungus. It is easily performed and not cause trauma. We also can see the results of this PATHPAS method quickly. Although PATHPAS appears to be the best single method for diagnosing onychomycosis, it is clearly not acceptable as a gold standard. Further study is needed to determine the sensitivity of PATHPAS plus fungal cultures obtained by combined sampling methods (clipping, subungual curettage, and nail plate shaving). This may allow for the development of a highly sensitive and efficient method for diagnosing onychomycosis.