While fungal cultures are slow, expensive, and rarely available in the very regions where disease burden is highest, a simple and inexpensive test—10% KOH microscopy of skin scrapings—can detect fungal elements in nearly 80% of cases when done well.

Yet this basic outpatient diagnostic skill is disappearing. The erosion of clinical acumen, combined with the neglect of simple microscopy, has normalised blind treatment, delayed correct diagnoses, and prolonged avoidable suffering.