The main challenges confronting us in the tropical mycoses are 1) rapid and accurate diagnosis 2) the availability of appropriate therapy and 3) a rising incidence of certain infections. Diagnosis is dependent on the logical association between the clinical appearances and appropriate laboratory steps. However key features of fungi that aid their recognition are their size and the simple cultural and histological techniques used to detect them. Use of conventional histopathology or immunopathological techniques is highly effective in many cases but molecular tools are now used for some conditions including dermatophytosis and sporotrichosis. With some mycoses the process is simpler. In mycetomas, for instance, histological or cultural evidence can be obtained directly from sinuses or by biopsy. Most new antifungals have not been profiled with tropical mycoses in mind and there are few evidence-based clinical trials to establish usage or duration of therapy. The commonest of these infections that present major therapeutic problems are the mycetomas and chromoblastomycosis. Fungal mycetomas seldom respond to normal doses of antifungals; whereas those caused by bacteria, actinomycetomas, respond to a range of antibacterials such as dapsone, amikacin, fusidic acid, imipenem etc unless they are very extensive. There is only limited reporting of the use of newer azoles, posaconazole and voriconazole in these mycoses. Mycoses where there have been changes in epidemiology, suggesting, spread include tinea capitis. Spread of Trichophyton tonsurans infections to South America and West Africa are examples. Whereas HIV in many countries is controlled through the use of antiretrovirals in infected individuals late recognition is a feature in many areas of the tropics and therefore there is a continuing risk of systemic fungal infections presenting with skin lesions as their first and most obvious clinical manifestation. Being alert to these changes provides a rapid means of dealing with these infections. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive