PCR-technique in the diagnosis of nail fungus

Onychomycosis, known as nail fungus, is an infection that usually affects the toenails and can make them discoloured, elevated and porous. Onychomycosis can be caused by dermatophytes, yeast and mould. Diagnosis of onychomycosis is usually done by culture or direct microscopy but can also be done through DNA-diagnosis through polymerase chain reaction (PCR) of DNA extracted from nail clippings or nail scrapings.


What scientific studies are there on the diagnostic accuracy of PCR-technique in onychomycosis?

Identified literature

No relevant systematic review was identified but 19 primary studies were identified [1–19]. The primary studies were not assessed for risk of bias.


  1. Lubis NZ, Muis K, Nasution LH. Polymerase Chain Reaction-Restriction Fragment Length Polymorphism as a Confirmatory Test for Onychomycosis. Open Access Maced J Med Sci 2018;6:280-283.
  2. Vrioni G, Kazani MV, Tsiamis C, Tsiamis H, Tsakris A. Evaluation of a multiplex-PCR-based method for the rapid identification of dermatophytes in nail specimens from patients with suspected onychomycosis. Acta Microbiologica Hellenica 2017;62:25-33.
  3. Bao F, Fan Y, Sun L, Yu Y, Wang Z, Pan Q, et al. Comparison of fungal fluorescent staining and ITS rDNA PCR-based sequencing with conventional methods for the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol 2018;32:1017-1021.
  4. Emam SM, Abd El-salam OH. Real-time PCR: A rapid and sensitive method for diagnosis of dermatophyte induced onychomycosis, a comparative study. Alexandria Journal of Medicine 2016;52:83-90.
  5. Gong J, Ran M, Wang X, Wan Z, Li R. Development and Evaluation of a Novel Real-Time PCR for Pan-Dermatophyte Detection in Nail Specimens. Mycopathologia 2016;181:51-7.
  6. Gustafson E, Bakotic W, Bennett L, Page L, McCarthy L. DNA-based detection for onychomycosis correlates better to histopathology than does fungal culture. Dermatol Online J 2019;25.
  7. Han HW, Hsu MM, Choi JS, Hsu CK, Hsieh HY, Li HC, et al. Rapid detection of dermatophytes and Candida albicans in onychomycosis specimens by an oligonucleotide array. BMC Infect Dis 2014;14:581.
  8. Hayette MP, Seidel L, Adjetey C, Darfouf R, Wery M, Boreux R, et al. Clinical evaluation of the DermaGenius(R) Nail real-time PCR assay for the detection of dermatophytes and Candida albicans in nails. Med Mycol 2019;57:277-283.
  9. Kondori N, Abrahamsson AL, Ataollahy N, Wenneras C. Comparison of a new commercial test, Dermatophyte-PCR kit, with conventional methods for rapid detection and identification of Trichophyton rubrum in nail specimens. Med Mycol 2010;48:1005-8.
  10. Koo SH, Teoh YL, Koh WL, Ochi H, Tan SK, Sim DMF, et al. Development and validation of a real-time multiplex PCR assay for the detection of dermatophytes and Fusarium spp. J Med Microbiol 2019;68:1641-1648.
  11. Li XF, Tian W, Wang H, Chen H, Shen YN, Lv GX, et al. Direct detection and differentiation of causative fungi of onychomycosis by multiplex polymerase chain reaction-based assay. Eur J Dermatol 2011;21:37-42.
  12. Menotti J, Machouart M, Benderdouche M, Cetre-Sossah C, Morel P, Dubertret L, et al. Polymerase chain reaction for diagnosis of dermatophyte and Scytalidium spp. onychomycosis. Br J Dermatol 2004;151:518-9.
  13. Ohst T, Kupsch C, Gräser Y. Detection of common dermatophytes in clinical specimens using a simple quantitative real-time TaqMan polymerase chain reaction assay. British Journal of Dermatology 2016;174:602-609.
  14. Paugam A, L'Ollivier C, Viguie C, Anaya L, Mary C, de Ponfilly G, et al. Comparison of real-time PCR with conventional methods to detect dermatophytes in samples from patients with suspected dermatophytosis. J Microbiol Methods 2013;95:218-22.
  15. Petinataud D, Berger S, Ferdynus C, Debourgogne A, Contet-Audonneau N, Machouart M. Optimising the diagnostic strategy for onychomycosis from sample collection to FUNGAL identification evaluation of a diagnostic kit for real-time PCR. Mycoses 2016;59:304-11.
  16. Rothmund G, Sattler EC, Kaestle R, Fischer C, Haas CJ, Starz H, et al. Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods. Mycoses 2013;56:47-55.
  17. Savin C, Huck S, Rolland C, Benderdouche M, Faure O, Noacco G, et al. Multicenter evaluation of a commercial PCR-enzyme-linked immunosorbent assay diagnostic kit (Onychodiag) for diagnosis of dermatophytic onychomycosis. J Clin Microbiol 2007;45:1205-10.
  18. Spiliopoulou A, Bartzavali C, Jelastopulu E, Anastassiou ED, Christofidou M. Evaluation of a commercial PCR test for the diagnosis of dermatophyte nail infections. J Med Microbiol 2015;64:25-31.
  19. Vahidnia A, Bekers W, Bliekendaal H, Spaargaren J. High throughput multiplex-PCR for direct detection and diagnosis of dermatophyte species, Candida albicans and Candida parapsilosis in clinical specimen. Journal of Microbiological Methods 2015;113:38-40.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 2/14/2020
Contact SBU: registrator@sbu.se
Report no: ut202007
Registration no: SBU 2019/765