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Nail & Cutaneous Fungal Workup · 9-Target Panel

Confirm the Fungus Before You Treat the Nail.

Before you commit a patient to twelve weeks of systemic antifungal, confirm the organism — dermatophyte, yeast, or mold — in 24–48 hours.

The Onychomycosis Lab
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Fungal Targets
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Aspergillus Species
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Candida Species
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Hour TAT for results
The clinical problem
Half of clinically diagnosed onychomycosis isn't fungal.

Empirical terbinafine and oral itraconazole carry real hepatic risk, real cost, and three-month treatment commitments. Studies consistently show that 30–50% of nails clinically diagnosed as onychomycosis are negative on confirmatory testing — and KOH microscopy misses the rest.

Nine molecular targets covering dermatophytes, Candida, Aspergillus, and clinically relevant molds — confirmed in 24–48 hours from a nail clipping or skin scraping. Treat with confidence.

By the Numbers

The clinical weight behind this panel.

Industry statistics from public-health bodies and peer-reviewed literature — context for why this testing matters.

10%
global prevalence of onychomycosis — up to 50% in adults over 70
Source · JAAD
<60%
sensitivity of traditional KOH + fungal culture

PCR identifies the species — and detects co-infections culture misses.

Source · British J Dermatology
Candida auris
an urgent CDC threat — multidrug-resistant and often misidentified
Source · CDC AR Threats 2019/2022
Species-specific
antifungal choice matters: terbinafine vs. azoles vs. echinocandins

Empiric therapy fails in non-dermatophyte molds.

Figures reflect publicly reported epidemiology and clinical literature for context only. They are not performance claims for the Chaseville Labs assay. See individual citations from the U.S. Centers for Disease Control and Prevention, World Health Organization, National Institutes of Health, and peer-reviewed journals.

What This Panel Diagnoses

Conditions, syndromes & infections covered.

The clinical scenarios where this panel is the right call — built around the differential your providers are actually working through.

Onychomycosis (Nail Fungus)

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Dermatophyte Onychomycosis (Trichophyton, Microsporum, Epidermophyton)

The most common cause of toenail fungus — confirms fungal etiology before committing to 6–12 weeks of systemic antifungal.

Clinical Impact ·30–50% of nails clinically diagnosed as onychomycosis are NOT fungal. Confirmation prevents unnecessary terbinafine exposure and hepatic monitoring.
Candida Onychomycosis

More common in fingernails, paronychia, and immunocompromised hosts.

Clinical Impact ·Species-level ID — Candida onychomycosis typically responds to itraconazole, not terbinafine.
Non-Dermatophyte Mold (NDM) Onychomycosis

Aspergillus species, Fusarium oxysporum — increasingly recognized and frequently terbinafine-resistant.

Clinical Impact ·NDM detection redirects therapy to itraconazole or combination/topical regimens — terbinafine alone will fail.

Cutaneous Fungal Infections

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Tinea Pedis (Athlete's Foot)

Trichophyton rubrum is the most common cause — interdigital, moccasin, and vesicular patterns.

Clinical Impact ·Confirmed dermatophyte ID supports topical terbinafine or oral therapy for refractory cases.
Tinea Corporis, Cruris, Capitis

Ringworm of the body, groin (jock itch), and scalp — common in athletes, children, and household contacts.

Clinical Impact ·Tinea capitis requires oral therapy (griseofulvin or terbinafine); topical alone will fail.
Pityriasis Versicolor (Malassezia furfur / M. sympodialis)

Hypopigmented or hyperpigmented patches on chest, back, and shoulders — often misdiagnosed as vitiligo or eczema.

Clinical Impact ·Antifungal shampoo (ketoconazole, selenium sulfide) is the right answer — steroids make it worse.

Emerging & Resistant Fungi

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Candida auris

Emerging multidrug-resistant yeast — causes invasive infection in healthcare settings, hard to eradicate, and an infection-control nightmare.

Clinical Impact ·Detection mandates contact precautions, environmental cleaning protocols, and public-health notification.
Aspergillus Species (niger, flavus, fumigatus, terreus)

Mold species causing onychomycosis, otomycosis, and (rarely from these sites) invasive disease in immunocompromised hosts.

Clinical Impact ·Species ID matters — A. terreus is intrinsically amphotericin-resistant; voriconazole preferred.
Treatment-Refractory Cutaneous Fungal Disease

Patient who has failed empirical antifungal and is still symptomatic.

Clinical Impact ·Resolves the actual organism so the next prescription is the right one.
Complete Target List

9 targets, resolved from a single specimen.

Each organism below is reported individually as Detected, Not Detected, or Inconclusive — grouped here by pathogen class for clinical scanability.

Dermatophytes

2 targets
Trichophyton sppEpidermophyton floccosum

Candida

4 targets
Candida kruseiCandida albicansCandida glabrataCandida parapsilosis

Aspergillus

2 targets
Aspergillus nigerAspergillus flavus

Other Molds

1 target
Fusarium oxysporum
Why Molecular

Culture was built for a different century.

Multiplex real-time PCR resolves what culture and rapid antigen miss — fastidious organisms, polymicrobial infections, viruses, and resistance markers — from a single specimen.

Conventional
The Old Way

Culture & rapid antigen

  • 3–5 days
    Patient empirically treated before any answer arrives
  • Misses fastidious & viral organisms
    No growth ≠ no infection
  • Single-organism bias
    Polymicrobial infections under-reported
  • No resistance data
    Susceptibilities arrive a day later, if at all
  • Specimen-quality dependent
    Pre-treated patients culture negative
Multiplex PCR
The CRL Way

Nail / Fungal on Bio-Rad CFX384

  • 24–48 hours
    Most reports back the next clinical day
  • 9 targets, one run
    Bacterial, viral, fungal, and parasitic in a single multiplex
  • Detects what culture can't
    Fastidious organisms, viruses, and polymicrobial infections, all reported individually
  • Validated LDT
    CLIA-certified, internally controlled, per-target Detected / Not Detected reporting
Primary Specimen
Nail clipping, skin scraping, or affected tissue
Collection Container
Sterile dry container
Volume
Sufficient for testing
Storage
Room temperature acceptable
Transport
Pre-paid FedEx Priority Overnight
Stability
Validated per storage condition
Chain of Custody
Barcoded, temperature-logged in transit
Result Format

Per-target results, with clinical context.

Every analyte is reported individually as Detected, Not Detected, or Inconclusive. What a Detected result means clinically depends on which category the target falls into:

Dermatophytes
Trichophyton sppEpidermophyton floccosum
If Detected

Dermatophyte detection (Trichophyton, Microsporum, Epidermophyton) confirms tinea unguium and supports oral terbinafine or itraconazole as first-line therapy.

Candida
Candida kruseiCandida albicansCandida glabrataCandida parapsilosis
If Detected

Candida onychomycosis is more common in fingernails and immunocompromised hosts; C. auris detection warrants infection-control follow-up.

Aspergillus
Aspergillus nigerAspergillus flavus
If Detected

Aspergillus species cause non-dermatophyte mold onychomycosis that often resists terbinafine; itraconazole or combination therapy is typically preferred.

Other Molds
Fusarium oxysporum
If Detected

Malassezia, Fusarium, and Trichosporon detections explain treatment-refractory nail disease and direct species-specific antifungal selection.

Qualitative multiplex real-time PCR (Bio-Rad CFX384)
Turnaround: 24–48 hours