Fungal disorders are some of the most common cutaneous infections of childhood and adolescence. Despite their frequency and the ease with which an infectious agent can be correctly identified, fungal lesions are readily mistaken for other diseases or misdiagnosed in patients with entirely different skin conditions. One of the chief reasons for inaccurate diagnosis is a preconceived notion on the part of the physician as to how the lesions should look clinically. In fact, cutaneous fungal infections are extremely pleomorphic in appearance and can be macular and scaly, papular, pustular, vesiculobullous, or nodular. Their morphology may also be altered by self-medication, by treatment prescribed by another physician, or by an immunologic deficit in the host.
Even the most experienced physician will be baffled by these lesions some of the time. Studies assessing clinical acumen by verification with culture data demonstrate a significant degree of error in diagnosis, particularly in nondermatologic settings. Fortunately, most of these mistakes are preventable if three simple procedures are carried out. A Wood's lamp examination and a KOH preparation can be performed rapidly in the office and may provide all of the confirmatory evidence necessary for certain diagnosis. A positive culture of a properly obtained specimen is additional unqualified evidence of a fungous infection.
Immunization Against Superficial Fungous Infection