Value: aids in visualizing hyphae and confirming the diagnosis of dermatophyte infection The diagnosis of onychomycosis should be confirmed by KOH microscopy, culture, or histologic examination before therapy is initiated, because of the expense, duration, and potential adverse effects of treatment. For onychomycosis, “pulse” oral therapy with the newer imidazoles (itraconazole or flucona-zole) or allylamines (terbinafine) is considerably less expensive than continuous treatment but has a somewhat lower mycologic cure rate. Topical treatment of onychomycosis with ciclopirox nail lacquer has a low cure rate. Orally administered griseofulvin remains the standard treatment for tinea capitis. Oral therapy is preferred for tinea capitis, tinea barbae, and onychomycosis. Cure rates are higher and treatment courses are shorter with topical fungicidal allylamines than with fungistatic azoles. Topical therapy is used for most dermatophyte infections. Diagnosis occasionally requires Wood's lamp examination and fungal culture or histologic examination. Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomites. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are fungi that require keratin for growth.
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