Before treating a fungal nail, it’s important to ensure you have the correct diagnosis. As studies have shown, just by looking at a dystrophic nail to diagnose the condition can lead to errors but it is surprising how often a proper diagnosis is not made. This was something a wrote in an earlier paper entitled “Be sure of the cure”. Moving forward, in a paper published recently Gupta and colleagues (1) have highlighted this issue and suggest from earlier work that 36%-47% of clinicians do not use any form of testing prior to treating a potentially fungal nail. This, the authors put down to the fact that clinicians don’t like the waiting for the results (up to 4 weeks) and the cost saving that can be made by not employing any form of diagnostic test. Of course, on the downside, not confirming a diagnosis which is subsequently proven to be incorrect can lead to inappropriate treatment, potential unwanted side effects and costs in terms of time and money for the patient and clinician alike.
In their paper, Gupta and colleagues set about to quantify the benefit of confirmatory testing using traditional laboratory tests. What they find it that confirmatory testing is a cost saving for the clinician when one takes into account the price of the medicines and treatment. Although they only reviewed the cost-effectiveness for medicines, this is important too when one considers other modalities using medical devices such as lasers and nail drilling with Clearanail® for example. The cost of these treatments can run into the £100’s and so it’s important to reassure the clinician and the patient to know it is definitively fungal and therefore that their financial investment in the treatment is likely to have a benefit.
1. Gupta AK, Versteeg SG, Shear NH. Confirmatory Testing Prior to Initiating Onychomycosis Therapy Is Cost-Effective. J Cutan Med Surg. 2017:1203475417733461.