In this innovative presentation, Dr. Dockery provides a series of cases that are commonly misdiagnosed as fungal infections of the skin. He explains the individual cases and then points out the clinical findings and correct diagnoses. Each category is then reviewed and the most up to date treatment options are covered.

It has been estimated that sixty six percent of these lower extremity conditions that are initially perceived as tinea pedis are actually eczematous in nature. Dr. Dockery recommends that if you have to guess, rather than guessing tinea pedis for everything that develops on the lower extremities, guess eczema. Start patients on 0.5% or 1.0% hydrocortisone and other treatment regimens discussed in the lecture. Then, if it does not respond in a reasonable period of time (1-3 weeks), switch and go to the antifungals. Of course, actual tinea infections are extremely common in the foot. As Dr. Dockery points out, most will respond to topical or oral antifungals.

When we talk about dermatological conditions, the signs may be very subtle. Dr. Dockery urges the viewer to think in a broad manner and not allow narrowly structured thinking to constrict the diagnostic process. If the solution to the diagnostic dilemma is not readily apparent, consider performing a biopsy. Utilizing this mind-set will quickly enable you to become an expert diagnostician.

There are many tests available to use if the condition is infectious, rather than eczematous. Aside from the standard cultures (bacterial or fungal), KOH, DTM and PAS stains are available as well. You might even want to dust off that old Woods light you haven't used in a few years.

Dr. Dockery brings to light the significant value of PAS staining. This particular technique is increasing in popularity because of its lower rate of false negatives compared with KOH and cultures. Accuracy rates are as high as 92%. In PAS staining, the specimen is placed in 10% formalin. The polysacharides in the fungal cell walls stain a bright red or fuchsia color. (See the micrograph on Slide 49) This technique is quite valuable when testing nail specimens for onychomycosis, and is gradually becoming the standard test result to get prior to initiating treatment.  Contact your laboratory and find out if they have this particular service.

Before taking your prescription pad out, take a few seconds to ponder like

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