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Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 1, January-February, 2009, pp. 73-74 Letter to the Editor Authors' reply Shenoy ManjunathM, Teerthanath S, Karnaker VimalK, Girisha BS, Prasad Krishna, Pinto Jerome Department of Dermatology, K.S. Hegde Medical Academy, Mangalore, Karnataka Code Number: dv09019 Sir, We thank Singh and Lavanya for showing interest and responding to our article "Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis". [1] We agree with some of the views expressed, however others may need reconsideration. It is true that mycological culture has a higher specificity, but it has lower sensitivity as compared to histopathology with periodic acid-Schiff staining (HP/PAS). [1],[2] HP/PAS is relatively quick, and a specificity of 72% cannot be overlooked. [3] In most cases, morphological aspect of the hyphae and/or spores can suggest the group to which pathogens belong. [3] In personal view of the authors, cost of HP/PAS is not so high considering all these informations obtained after doing this test, and when compared to the cost of onychomycosis therapy. HP/PAS is not an alternate test to mycologic culture. It a simple and highly sensitive screening test and can be performed as a complementary to mycological culture and potassium hydroxide (KOH) mount to close the diagnostic gap. [1] PAS staining can be performed routinely as a standard of practice in the lab diagnosis of onychomycosis, however, histochemical staining using Gomori methenamine silver may have higher sensitivity. [4] All these factors suggest that HP/PAS staining of nail clips should be considered as a valuable test in the diagnosis of onychomycosis. References
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