The performance of the Bruker Biotyper matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometer (MS) for the identification of dermatophytes from clinical cultures was compared to that of dermatophyte identification using 28S rRNA gene sequencing. The MALDI Biotyper library (MBL; version 3.0) was used alone and in combination with a supplemented library containing an additional 20 dermatophyte spectra (S-MBL). Acquired spectra were interpreted using both the manufacturer-recommended scores (genus, >1.7; species, >2.0) and adjusted cutoff values established by this study (genus, >1.5; species, >1.7); identifications required a minimum 10% difference in scores between the top two different organisms to be considered correct. One hundred well-characterized, archived dermatophyte isolates and 71 fresh dermatophyte cultures were evaluated using both libraries and both sets of cutoff criteria. Collectively, the S-MBL significantly outperformed the MBL at both the genus (93% versus 37.4%; P < 0,0001) and species (59.6% versus 20.5%; P < 0.0001) levels when using the adjusted score criteria. Importantly, application of the lowered cutoff values significantly improved genus (P ؍ 0.005)-and species (P < 0.0001)-level identification for the S-MBL, without leading to an increase in misidentifications. MALDI-TOF MS is a cost-effective and rapid alternative to traditional or molecular methods for dermatophyte identification, provided that the reference library is supplemented to sufficiently encompass clinically relevant, intraspecies strain diversity.Dermatophytes, comprising species within the genera Epidermophyton, Microsporum, and Trichophyton, exclusively invade and infect keratinized tissues (i.e., hair, skin, and nails). These organisms are among the most common fungal infections in humans, accounting for over 5 million physician visits annually in the United States (7, 26). Dermatophytes primarily cause superficial dermal mycoses and rarely progress to more invasive disease (8). In the United States, Trichophyton rubrum remains the most common cause of tinea infections and the most frequently isolated dermatophytic pathogen (7,24).Laboratory identification of dermatophytes is typically based on macroscopic observation of colony morphology (i.e., pigmentation, growth rate, texture, etc.) on selective media, followed by microscopic examination of conidia. In addition, specialized Trichophyton agars may be used for differentiation of species within the genera (14). These phenotypic techniques require experienced technologists and are often labor-intensive with a prolonged turnaround time. With the advancement of modern molecular techniques, some laboratories have turned to dermatophyte identification schemes involving sequencing of specific ribosomal DNA regions or real-time PCR amplification of discrete genes (2, 20). While these methods are highly accurate and rapid, they are costly and can be complex to implement.Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) m...