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British Journal of General Practice
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Research Article

Diagnosis and management of cases of suspected dermatomycosis in The Netherlands: influence of general practice based potassium hydroxide testing.

C A De Kock, G H Sampers and J A Knottnerus
British Journal of General Practice 1995; 45 (396): 349-351.
C A De Kock
University of Limburg, Maastricht, Netherlands.
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G H Sampers
University of Limburg, Maastricht, Netherlands.
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J A Knottnerus
University of Limburg, Maastricht, Netherlands.
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Abstract

BACKGROUND. Microscopy of a potassium hydroxide preparation of skin scrapings or nail clippings, although widely advocated as a test for dermatomycosis, is used in only a small proportion of cases. AIM. This study set out to investigate the effect of potassium hydroxide testing on the subjectively assessed probability that a dermatomycosis was present. METHOD. The study was undertaken in 1992 in Limburg, a province in the south of the Netherlands. Ten general practitioners and eight trainees completed a questionnaire and performed a potassium hydroxide preparation for each patient presenting with a skin condition that they thought might be caused by dermatomycosis. Skin or nail material was also sent to a microbiology laboratory where another potassium hydroxide preparation as well as a culture were performed, these two tests serving as a gold standard against which to judge the potassium hydroxide preparation by the general practitioners. Data from a total of 164 cases were analysed. RESULTS. The results of the potassium hydroxide test carried out in the practice had a considerable influence on the subjectively assessed probability that a dermatomycosis was present, especially if the outcome was positive. The indication for antifungal treatment was altered as a result of the test in a quarter of all cases, mostly from negative to positive. Use of the practice potassium hydroxide test could increase the proportion of correct therapeutic decisions from 54% to 69%, with 20% of cases being undertreated. Of cases that gave a positive test result in the practice 83% also had a positive laboratory test result, while of cases that gave a negative practice result 43% were positive in the laboratory. CONCLUSION. The potassium hydroxide test improves the diagnostic process in cases of possible dermatomycosis and may result in a change in management. The test can provide a confirmation of the diagnosis of dermatomycosis but is not useful in the exclusion of this diagnosis.

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British Journal of General Practice: 45 (396)
British Journal of General Practice
Vol. 45, Issue 396
July 1995
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Diagnosis and management of cases of suspected dermatomycosis in The Netherlands: influence of general practice based potassium hydroxide testing.
C A De Kock, G H Sampers, J A Knottnerus
British Journal of General Practice 1995; 45 (396): 349-351.

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Diagnosis and management of cases of suspected dermatomycosis in The Netherlands: influence of general practice based potassium hydroxide testing.
C A De Kock, G H Sampers, J A Knottnerus
British Journal of General Practice 1995; 45 (396): 349-351.
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Print ISSN: 0960-1643
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