Mycological examination

Mycological examination is the diagnostic procedure necessary to confirm a fungal disease, from the Greek word “mykes” meaning mushroom. The mycological test is also necessary to document the complete cure response to treatment, as clinical recovery is often followed by a relapse if the fungus has not been completely eliminated from the skin (mycological cure). The diagnosis of a fungal infection is considered simple from a clinical point of view, but the report of unusual presentations, misdiagnosed or sometimes neglected, has increased worldwide causing extensive and long-standing disease. General immunosuppressive treatment for inflammatory chronic diseases and acquired immune depression syndrome are frequently complicated with fungal superinfections, both from common strain and rare or opportunistic fungal species, such as cryptococcosis, histoplasmosis, sporotrichosis, blastomycosis, and aspergillosis. In the immunocompetent patient, dermatophytes are the main fungal infection, being the primary pathogen. Clinical presentation has also changed with time, from the classic ringworm appearance (tinea) to more veiled eczematous undefined patches, simulating more frequent diseases, such as atopic or contact eczema, seborrheic dermatitis, impetigo, rosacea, and lupus erythematosus. A general common attitude to prescribe combination treatments and/or corticosteroid topics before confirming the diagnosis (“ex adjuvantibus”) is one of the possible causes of further dermatophyte pathomorphosis and misdiagnosis, named tinea incognita or tinea atypica.