Conventional and molecular techniques can aid podiatric physicians in accurately diagnosing nail dystrophy.
Fungal nail polymerase chain reaction (PCR) technology is a real time molecular DNA test that has analyzed more than 1.6 million cases of nail dystrophy. The laboratory, Bako Diagnostics, says the technology produces results within 24 to 48 hours, in comparison with other tests for fungal nail culture, which can take several weeks for results.
Physicians can use the DNA test to detect 15 different genera or species of fungal pathogens that cause onychomycosis, including dermatophytes, saprophytes and/or yeast, notes Bako Dx. The company adds that the system can also diagnose pathologies that may mimic dermatophyte nail infection, including psoriasis, lichen planus or trauma.
The company says its DNA assay allows physicians to deliver to patients a comprehensive evaluation of nail unit dystrophy and then determine the proper therapy for the underlying etiology.
Justin Lewis, DPM, acknowledges the challenges of diagnosing dystrophic nail disorders, as there can be multiple pathogens, fungal and bacterial, that can damage a nail.
Dr. Lewis adds that research is ongoing with pharmaceutical companies to address nail disorders. By having DNA testing with defined results, physicians can use this data for future research to develop more effective antifungals, notes Dr. Lewis, who is in private practice in Eldersburg, Md.
BakoDx notes most national health insurance payers require physicians to identify genus and species for preauthorization of newer antifungal prescriptions. It emphasizes precise diagnosis of pathogens, saying most national payers require the correct identification of T. rubrum and T. mentagrophytes when prescribing antifungal therapies. BakoDx emphasizes that its proprietary DNA assay recently had enhancement to detect Pseudomonas aeruginosa, the most common bacterial cause of nail infection.
“Just as wound culture and sensitivities are vital to address and treat bacterial infections, I feel the same should be said for nail infections,” says Dr. Lewis. “Having that definitive result from DNA testing gives the clinician confidence on how to address and treat the condition.”
In addition, BakoDx provides a Monthly Malignancy Report to the podiatric community about the diagnosis of malignancies from specimens submitted to the company’s laboratory. Through the use of a simple biopsy technique and specialized dermatologic exams, the company notes patients can benefit from the best outcome prognosis with the least morbidity.