Reflectance Confocal Microscopy: An Effective Diagnostic Tool for Dermatophytic Infections
Current methods for diagnosing dermatophytic infections have various drawbacks. Analysis via skin scrapings and biopsies can be invasive and/or take too long to yield results. Reflectance confocal microscopy (RCM) is an emerging in vivo imaging technology that can potentially be used to diagnose cutaneous dermatophytic infections. This modality provides high-resolution images of the skin extending to the level of the superficial reticular dermis that could reveal the presence of fungal hyphae. In this retrospective chart review, we investigated the application of RCM as a diagnostic tool in the setting of a private practice. Images were used to diagnose dermatophyte infections and the results were compared to those of other established diagnostic methods. We found RCM to be a potentially effective and highly sensitive tool in the diagnosis of cutaneous dermatophytic infections.
Practice Points
- Current methods for diagnosing dermatophytosis can be invasive, with variable sensitivity and/or slow turnaround time.
- Reflectance confocal microscopy is a promising option for rapid noninvasive diagnosis of dermatophytosis.
Conclusion
Based on our chart review of a small number of cases, we found that RCM can be a useful tool in diagnosing dermatophytic infections of the skin. With adequate training, dermatologists may be able to use RCM as an in-office tool to capture and evaluate images and subsequently diagnose or exclude dermatophytosis in a quick and noninvasive manner. However, further research and controlled studies of more cases will be required to develop accurate criteria for diagnosing fungal structures by RCM as well as to help determine the role of RCM in our diagnostic armamentarium.
