{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:18:01Z","timestamp":1787840281931,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Superficial cutaneous fungal infections are common dermatologic conditions. A significant proportion do not present with typical clinical findings. However, the 10% potassium hydroxide (KOH) smear, a simple bedside test, is often underused when diagnosing cutaneous fungal infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>We aimed to evaluate whether KOH smear results altered dermatologists\u2019 diagnosis and management, and the factors that influenced its ability to detect cutaneous fungal infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 373 patients with suspected cutaneous fungal infection were identified retrospectively from the dermatology database of inpatient referrals in a Singapore tertiary hospital between 1 January 2017 and 30 June 2020. The dermatologists\u2019 eventual diagnoses, based on their assessment until 2 months post-discharge to allow consideration of KOH smear results and response to treatment, were taken as a gold standard. Statistical analyses evaluated for changes between initial and eventual diagnoses and management relative to the KOH smear. Use of topical steroids, topical and\/or systemic antifungals before skin sampling, and whether sampling was done by dermatologically-trained personnel, were assessed for association with KOH smear positivity in eventually diagnosed cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The percentage of uncertain diagnoses was reduced, and the use of topical antifungal as the sole treatment significantly changed after the KOH smear result was available. The adjusted odds ratio of a positive KOH smear in eventually diagnosed cases was 0.19 when systemic antifungals were used before skin sampling, and 3.03 if sampling was performed by a dermatologically-trained person.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Limitations of our study include dependence on retrospective medical records which may result in misclassification bias and the limited generalisability of our results to patients managed by non-dermatologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>KOH smear is a useful adjunct in diagnosing and managing cutaneous fungal infections. Clinicians should consider the presence of confounders affecting KOH smears when making an overall clinical diagnosis. Focused training of personnel on skin sample collection may improve the detection rate of KOH smear.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijd.ijd_859_23","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T04:00:07Z","timestamp":1728878407000},"page":"453-460","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective Investigation of the Utility of Potassium Hydroxide Smear in the Diagnosis and Management of Cutaneous Fungal Infections by Dermatologists"],"prefix":"10.4103","volume":"69","author":[{"given":"Xuan Qi","family":"Koh","sequence":"first","affiliation":[{"name":"From the Department of Medicine, Division of Dermatology, National University Hospital Singapore, Singapore, 5 Lower Kent Ridge Rd, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huirong","family":"Han","sequence":"additional","affiliation":[{"name":"From the Department of Medicine, Division of Dermatology, National University Hospital Singapore, Singapore, 5 Lower Kent Ridge Rd, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha S.","family":"Chandran","sequence":"additional","affiliation":[{"name":"From the Department of Medicine, Division of Dermatology, National University Hospital Singapore, Singapore, 5 Lower Kent Ridge Rd, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"key":"R1-20241101","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3314\/jjmm.46.77","article-title":"Superficial fungal infections seen at the National Skin Centre, Singapore","volume":"46","author":"Tan","year":"2005","journal-title":"Nihon Ishinkin Gakkai Zasshi"},{"key":"R2-20241101","first-page":"921","article-title":"[Examenul micologic direct in micozele cutanate superficiale. Direct mycologic examination in superficial cutaneous mycoses","volume":"107","author":"Solovastru","year":"2003","journal-title":"Rev Med Chir Soc Med Nat Iasi"},{"key":"R3-20241101","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/jdv.15361","article-title":"A survey among dermatologists:Diagnostics of superficial fungal infections-What is used and what is needed to initiate therapy and assess efficacy?","volume":"33","author":"Saunte","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R4-20241101","first-page":"25","article-title":"Diagnosis directs treatment in fungal infections of the skin","volume":"259","author":"Panthagani","year":"2015","journal-title":"Practitioner"},{"key":"R5-20241101","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1111\/ijd.14448","article-title":"Office-based dermatologic diagnostic procedure utilization in the United States Medicare population from 2000-2016","volume":"58","author":"Guzman","year":"2019","journal-title":"Int J Dermatol"},{"key":"R6-20241101","first-page":"798","article-title":"Use of in-office preparations by dermatologists for the diagnosis of cutaneous fungal infections","volume":"18","author":"Murphy","year":"2019","journal-title":"J Drugs Dermatol"},{"key":"R7-20241101","doi-asserted-by":"crossref","first-page":"764843","DOI":"10.1155\/2010\/764843","article-title":"The sensitivity and specificity of potassium hydroxide smear and fungal culture relative to clinical assessment in the evaluation of tinea pedis:A pooled analysis","volume":"2010","author":"Levitt","year":"2010","journal-title":"Dermatol Res Pract"},{"key":"R8-20241101","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1440-0960.2007.00320.x","article-title":"Comparison of direct smear, culture and histology for the diagnosis of onychomycosis","volume":"48","author":"Karimzadegan-Nia","year":"2007","journal-title":"Australas J Dermatol"},{"key":"R9-20241101","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/odi.13293","article-title":"Fluorescence staining vs. routine KOH smear for rapid diagnosis of oral candidiasis-A diagnostic test","volume":"26","author":"Hu","year":"2020","journal-title":"Oral Dis"},{"key":"R10-20241101","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.jaad.2016.09.041","article-title":"Cutaneous fungal infections are commonly misdiagnosed:A survey-based study","volume":"76","author":"Yadgar","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"R11-20241101","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0190-9622(87)70198-4","article-title":"Primary care physicians'errors in handling cutaneous disorders. A prospective survey","volume":"17","author":"Pariser","year":"1987","journal-title":"J Am Acad Dermatol"},{"key":"R12-20241101","first-page":"110","article-title":"Successive potassium hydroxide testing for improved diagnosis of tinea pedis","volume":"100","author":"Karaman","year":"2017","journal-title":"Cutis"},{"key":"R13-20241101","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00000441-200602000-00015","article-title":"The necessity of culture for the diagnosis of tinea pedis","volume":"331","author":"Ecemis","year":"2006","journal-title":"Am J Med Sci"}],"container-title":["Indian Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_859_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:19:14Z","timestamp":1787836754000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_859_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,29]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijd.ijd_859_23","relation":{},"ISSN":["0019-5154","1998-3611"],"issn-type":[{"value":"0019-5154","type":"print"},{"value":"1998-3611","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,29]]},"assertion":[{"value":"2023-09-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}