July 12, 2023, Wednesday — A study letter in the July issue of the Journal of the American Academy of Dermatology says that confirmatory lab tests are only used in one out of every five cases of tinea capitis (TC).
Jeremy A.W. Gold, M.D., from the U.S. Centres for Disease Control and Prevention in Atlanta, and his colleagues looked at the Merative MarketScan Commercial Database to find 3.9 million commercially insured U.S. children from July 1, 2016, to December 31, 2020. They found out how often TC happened and what testing and treatment methods were used.
The researchers found that the TC rate over one year was 16.3 per 10,000 person-years. The rates were highest among 5-year-olds (31.6 per 10,000 person-years), boys (20.9), and people from the South (22.5). The doctors who made the most findings were paediatricians (54.6%), then dermatologists (11.7%), and finally family practitioners (10.4%). Only 21.9% of the time did clinicians use confirmatory tests. Most of the time, direct microscopy (9.7 percent) and fungal culture (17.8 percent) were used as studies. When dermatologists (51.0%) made a diagnosis, testing was much more common than when paediatricians (16.4%) or family practitioners (11.0%) did the same. Three quarters of the patients were given an antifungal (61.2 percent were given an oral antifungal and 14.7 percent were given a topical antifungal treatment).
“Most of the patients who were diagnosed with TC did not receive any confirmatory laboratory tests. This is concerning because visual inspection alone of suspected cutaneous fungal infections can lead to diagnostic errors and the use of antifungals that are not needed,” the authors write.
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