Ringworm in the South-West of England, 1960-1970, with special reference to onychomycosis

The numbers of dermatophytes isolated from specimens sent to a mycological diagnostic service in the West of England from i960 to 1970 are reported. An increasing rate of failure to culture from microscopically positive specimens is noted. One reason for this was the large number of nail clippings sent in unaccompanied by scrapings from skin lesions. The cultural failure rate from nail clippings makes the diagnosis of the causal fungi in onychomycosis very unsatisfactory. For treatment purposes, means of deducing the nature of these uncultured fungi by combining clinical and laboratory observations are proposed. It is suggested that two features of mycological diagnostic services—(a) failure to culture from a proportion of microscopically positive specimens, and (b) the fact that only the more severe, widespread and recalcitrant lesions are usually seen by dermatologists—result in a very misleading picture if these figures are used to assess the incidence of the various dermatophyte species in the general population.