An epidemiological and clinical study of untreated patients with tinea pedis within a company in Japan

In this study, we investigated epidemiological and clinical aspects of dermatophyte foot infections among employees of one dairy product company located in Kanagawa prefecture in central Japan. Sixty-nine of 377 subjects were reported having "athlete's foot" in response to a simple questionnaire. A subsequent mycological examination revealed 41 untreated patients with tinea pedis and/or tinea unguium (89% of subjects examined) and the overall prevalence was estimated at 18%. Comparing severity scores of five clinical symptoms (itching, erythema, vesicles/pustules, erosion/maceration, and scales) between those untreated patients within the subjects and another group of patients who spontaneously attended dermatological clinics to treat tinea pedis, itching, erythema, and total score were significantly higher in the latter group.

[Tinea pedis and Onychomycosis in Children of the Mazahua Indian Community in Mexico]

BACKGROUND

Tinea pedis and onychomycosis in childhood are unusual, The previous reported prevalence range from 4.2 to 8.2%. In a mestizo population, in the South of Mexico a 3.4% has been found.

OBJECTIVE

To determine the frequency of dermatophytosis of feet and toenails in scholars in an Indian Mazahua community.

METHODOLOGY

A total of 456 children were studied. The age range from 5 to 15 years of age (average 11.4). Only 71 children with suggestive lesions of dermatophytosis were studied (15.57%). Mycological samples (66/71) and a KOH and Chlorazol black, and cultures on Mycocel agar were performed.

RESULTS

71 children (15.57%) presented suggestive lesions of dermatophytosis of the feet and toenails. A fungal infection was demonstrated in 13 cases (18%), 8 males and 5 females (mean age 12.3 years), but pathogenic fungi were isolated only in 7 (10%). All of them with tinea pedis and three also had toenail involvement (4.2%) and also Trichosporon sp was isolated in two cases and Candida albicans in one.

CONCLUSIONS

We found a low frequency of tinea pedis and onychomycosis in children from this Mazahua community. The environmental factors such as humidity, and the frequently use of rubber and leather shoes instead of the traditional "huarache" (sandals), make them prone to maceration and can be cofactors in the development of mycotic infections and in the high incidence of pitted keratolysis (29.5%).

Clinical and mycological study of occult tinea pedis and tinea unguium in dermatological patients from Tokyo

An epidemiological investigation was conducted to determine the prevalence and circumstances of untreated, unsuspected tinea pedis and tinea unguium, morbid conditions that could be termed occult athlete's foot, in patients visiting a dermatology clinic in Tokyo, Japan, for the first time, for other complaints. All subjects completed a questionnaire covering comprehensive anamnestic details, and were examined for disposition of toes, presence of signs suggestive of tinea pedis, other diseases of the foot, score of clinical signs and symptoms, potassium hydroxide (KOH) test, severity score, and mycological culture. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as age, disposition of toes, and predisposing disease.

[Mycoses frequency in three communities in the North mountain of the State of Puebla]

In order to know mycosis frequency in the North of the State of Puebla, Mexico, in habitants from the communities of Ayotoxco, Mazatepec and Zacatipan were studied. Previous medical study biological samples were submitted to direct examination, smear and culture. Histoplasmin and sporotrichin skin test were applied to 57 individual from Zacatipan. From 110 patients 146 mycological studies were performed. Eighty six cases (59%) of mycosis were detected: 43 finger or toenails onychomycosis, 25 tinea pedis, seven tinea capitis, four cases of tinea manum and, finally, five cases of seborrhoeic dermatitis and two of pitiriasis versicolor. We isolated: 18 streins of dermatophytes, mainly Trichophyton rubrum and T. mentagrophytes (11 and 5 strains respectively); 12 cultures of non-dermatophytes filamentous fungi; six cases of mycelia sterile; six yeast strains, most of them Candida spp but none C. albicans. From 57 patients to whom skin tests were applied, five of them (8.8%) were positive to both antigens; ten positive (17.6%) only to histoplasmin and eight (14%) to sporotrichin. This study showed that rural population from Puebla present a high frequency of superficial mycosis (61% of mycological studies). Considering the percentage of positive skin test we suppose that there are many not diagnosed sporotrichosis and histoplasmosis cases.

Tinea pedis observed in Cagliari, Italy, between 1996 and 2000

The aim of this study was to verify the incidence of tinea pedis in patients observed in the Department of Dermatology of the University of Cagliari, Italy, in the period from 1996 to 2000. We examined 722 patients, 536 with lesions and 186 without lesions of the feet and in 169 of them (23.4%) we diagnosed tinea pedis. All patients suffering from tinea pedis belonged to the group with lesions. In the 536 patients with clinical manifestations which were evident to a certain degree, microscope and cultural examination gave positive results for dermatophytes in 169 cases (31.5%). The most frequently isolated dermatophyte was Trichophyton mentagrophytes (51.5%), followed by Trichophyton rubrum (45.2%) and Epidermophyton floccosum (3.3%). In the 186 patients without lesions, direct microscope examination was consistently negative while cultural examination showed the growth of sparse colonies of Candida albicans in two cases (1.1%) We analysed distribution by sex, age, residence, occupation and clinical manifestations. Stressing the high frequency of tinea pedis in this region, the discovery of a dermatophytic infection of the feet with an absence of signs and symptoms is an exceptional event.

Prevalence and Patient's Consciousness of Tinea Pedis and Onychomycosis

Epidemiological studies on tinea pedis and onychomycosis have been performed across Europe and East Asia. The prevalence of these conditions was 20%, respectively, and it increased with advancing age, more men than women had fungal infection of the feet. The prevalent predisposing factors were sports participation, average temperature, and family history of tinea pedis. The predisposing diseases were hypercholesterolemia, cardiovascular disease, diabetes mellitus, and osteoarticular disease. We conducted an epidemiological investigation to determine the prevalence and circumstances of untreated and unsuspected tinea pedis and onychomycosis. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as past history of tinea pedis and/or onychomycosis, age, disposition of toes, and predisposing disease, as well as the type of shoes worn daily. We suspected that a patient's local and systemic conditions affected each other, creating good conditions for tinea pedis and onychomycosis so that the prevalence has increased. More understanding of occult athlete's foot will lead to prevention and improvement in treatment and diagnosis.

[Epidemiology of mycoses in submariners based on the Kola Peninsula]

Subject of the study was spreading of mycoses in the troops based on the Kola Peninsula. Examined were the military serving on atomic submarines, maintenance crews of deactivated atomic submarines awaiting disposal, and coastal units. Spreading of skin lesions among the submariners was not same as among the coastal military. Signs of clinical mycoses were observed in 41.2% of submariners of the active unit, in 66.9% of the maintenance crews, and in 38.1% of the coastal military. Infection agents were fungi g. Candida (albicans, guilliermondii, krusei, pseudotropicalis), Epidermophytia plicarum, Ptyriasis versicolor, Trichophyton interdigitale. Among the fighters on active submarines, 53.8% of the clinical observations were accounted for onychomycosis and foot skin lesions and 38.5%--for erythema, maceration and suppuration. Among the maintenance crews 51.8% of the observations were accounted for onychomycosis and foot skin lesions and maceration; hyperkeratosis and fissures prevailed in the coastal military (31.1%). For submariners most common were Candida albicans (80.7%) and guilliermondii (11.6%), and Trichophyton interdigitale (7.7%). In the maintenance crew those were Candida albicans (84.1%) and guilliermondii (11.6%) and in the coastal military, Candida albicans (70.6%), guilliermondii (11.8%) and krusei (14.7%).

Shoe Contact Dermatitis in Israel

BACKGROUND

Patch testing with the shoe series may be useful for the diagnosis of shoe contact dermatitis.

OBJECTIVE

The aim of the study was to verify the usefulness of the shoe series and the association of fungal infection with positive results in the shoe series.

METHODS

A total of 140 patients with suspected shoe contact dermatitis underwent patch testing with the standard series and shoe series; 41 underwent mycologic examination.

RESULTS

Positive results in the shoe series were noted in 58 patients (41.4%). The most common allergens were potassium dichromate (27.2%), nickel sulfate (11.9%), Kathon CG (10.9%), and 4-tert-butylphenol formaldehyde resin (8.7%). Of the 41 patients with suspected tinea pedis, 13 (32%) had positive mycologic findings and 9 (69.2%) also had a positive response to the shoe series. Of the patients with a negative result on mycologic examination, only 10 (35.7%) had a positive result in the shoe series.

CONCLUSION

Our study indicates that all patients with foot dermatitis should undergo patch testing with the shoe series. Positive results in the shoe series seem to be more prevalent in patients with a fungal infection.

Skin disease among staff in a large Korean nursing home

Although previous studies have documented reasonably high rates of skin disease among nursing home staff, the prevalence among Korean workers is not well known. For this investigation we selected a large Korean nursing home and distributed a skin disease questionnaire to all staff. Questions included job title, job description, employment history, working hours, patient contact and the occurrence of skin disease over the past 12 months. Workers who reported a dermatological problem then underwent skin examinations conducted by specialist occupational physicians and a dermatologist. Contact dermatitis was the most common skin disease detected, with 4.8% of staff currently suffering from it and 6.0% reporting it in the previous 12-month period. Tinea pedis was another common condition, affecting 3.6% on our examination day. However, only two-thirds of them (2.4%) recounted a past history of tinea pedis. Scabies was diagnosed among 2.4% of staff and reported as a previous infection by 6.0%. Overall, the prevalence of dermatitis and scabies were quite low when compared to previous studies, while fungal infection rates were similar to other investigations. Further research into this growing occupational demographic is indicated.

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong found foot disease in 64% of patients screened. All of the patients were ethnically Chinese. Of the conditions specified in the questionnaire, fungal foot infection, tinea pedis, and toenail onychomycosis were the most frequently encountered conditions, followed by metatarsal corns, eczema, psoriasis, and pes planus. Vascular disease, osteoarticular pathology, diabetes mellitus, obesity, atopy, and participation in sports were the main factors coexisting with the foot conditions. Of the study population, 17% and 21% reported that their quality of life was affected by pain and discomfort, respectively. These percentages are much lower than those obtained in other studies; it may therefore be inferred that foot complaints are being neglected by the ethnic Chinese population in Hong Kong.

Population-based epidemiologic study of tinea pedis in Israeli children

BACKGROUND

In recent years we have seen an increasing number of children in Israel with tinea pedis.

OBJECTIVE

To determine the prevalence of tinea pedis in 5- to 14-year-old schoolchildren in a comprehensive epidemiologic population-based study.

METHODS

A total of 1148 children, ages 5 to 14 years, from 7 schools with different socioeconomic backgrounds from the Jerusalem area were examined for the presence of tinea pedis. Scrapings from suspected lesions of fungal infection were sent to a mycologic laboratory for KOH microscopy and fungal identification. Information on the children's background and predisposing factors (regarding living conditions, hygiene, etc.) were provided by means of questionnaires filled out by each child.

RESULTS

Of the 1148 children examined, 29.6% exhibited erythema and scaling, but only 6.9% of these were mycologically positive for tinea pedis. was the main causative agent (68%) of tinea pedis. The prevalence of tinea pedis increased with age, hyperhidrosis and particularly repeated foot washing (a 3.2 higher rate in children who washed their feet twice a day those who did not wash daily).

CONCLUSION

The prevalence of tinea pedis in children has increased in recent decades in Israel and should be considered in the differential diagnosis of dermatologic diseases affecting the feet. Washing habits have a significant effect on tinea pedis in children.

Case Report. Tinea pedis and onychomycosis in primary school children in Turkey

A cross-sectional study was performed in two primary schools with different socioeconomic status in the suburban and central areas of Manisa, Turkey, in order to determine the prevalence of tinea pedis and onychomycosis. A full dermatological examination and a questionnaire on socioeconomic conditions were performed in a group of 785 randomly selected children aged 6-14. Of 9 clinically suspected tinea pedis and 4 onychomycoses cases, KOH examination (direct microscopy) and/or mycological cultures were positive in six boys, in whom Candida glabrata and C. tropicalis grew. Older age and higher number of siblings were found to be significant factors for fungal infection.

A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong

OBJECTIVE

To study the epidemiology of foot diseases, including tinea pedis and onychomycosis in clinic attendees in Hong Kong.

METHODS

Two groups were included: the institutional group consisted of clinical evaluation and mycological investigations by dermatologists; and the private group consisted of clinical evaluation only by the private physicians. Patients who had a regular visit to the clinics were randomly invited to have a clinical examination of their feet.

RESULTS

A total of 1014 patients were studied. The prevalence rate of foot disease, fungal infections, tinea pedis and toe nail onychomycosis were respectively 50.7%, 26.9%, 20.4% and 16.6%. More male and elderly patients were affected except that the sex prevalence in toe nail onychomycosis was not shown to be significant. Vascular disease, diabetes mellitus and obesity were the three most prevalent predisposing factors in foot disease, fungal disease and fungal nail disease. Dermatophytes, in particular Trichophyton rubrum, were shown to be the most common pathogen in both skin and nail infections.

CONCLUSIONS

Foot diseases, especially tinea pedis and toe nail onychomycosis, are common in patients attending local clinics in Hong Kong. Both physicians and patients should be more aware of foot problems and have more active approaches and management strategies.

Tinea pedis in European marathon runners

BACKGROUND

Epidemiological studies suggest that 15% of the population in industrial countries suffer from tinea pedis (athlete's foot) and that persons who do sports are a high-risk population.

OBJECTIVE

To investigate the responsibility of dermatophytes in interdigital lesions of the feet in European marathon runners and to identify associated risk factors.

SUBJECTS AND METHODS

Runners of the 14th Médoc Marathon (n = 147) were interviewed on risk factors for tinea pedis and underwent physical and mycological examinations.

RESULTS

Interdigital lesions of the feet were found in 66 runners (45%). A dermatophyte was isolated in 45 runners (31%), 12 of whom were asymptomatic. Trichophyton interdigitale and T. rubrum accounted for 49% and 35.5%, respectively, of the cases of tinea pedis. Thirty-three (22%) of the 102 runners free of dermatophyte infection had lesions resembling those of tinea pedis. Increasing age and use of communal bathing facilities were predictive of T. rubrum culture.

CONCLUSIONS

Marathon runners are at high risk for tinea pedis, but dermatophytes are responsible for only half of the foot lesions found in runners. The existence of asymptomatic carriers calls for prophylactic measures.

Epidemiology of dermatophytoses in children living in northeast France: a 5-year study

Dermatologic fungal infections are thought to occur less frequently in children than in adults. This study, performed over a 5-year period, emphasizes the interregional variability of dermatophytes that cause skin and cutaneous apprendageal diseases in children. In northeast France, two-thirds of dermatophytoses are due to zoophilic fungi, while they are most commonly caused by anthropophilic agents in the Paris region and in other countries. The clinical features of pediatric dermatophytoses vary with the age of the child: tinea capitis and tinea corporis are far more frequent before the age of 12 years. After the age of 12, even if these are still quite frequent, tinea pedis and onychomycosis become more common.

[Epidemiological investigation of tinea pedis in groups of healthy students, research workers and females wearing boots]

The infection rate, causative dermatophytes, and dermatophyte dissemination of tinea pedis in young healthy Japanese were studied by direct microscopic examination, slant cultures, and foot-press culture method. Questionnaires on subjective symptoms and treatments were also distributed. Among fifty-eight medical students with a mean age of 23.9 years, thirteen (22.4%) showed positive by direct microscopic examination and T. mentagrophytes was more dominant than T. rubrum by slant cultures. In one hundred and sixteen student feet, twelve were infected and disseminating dermatophytes, four were infected but not disseminating, three were not infected but adhering dermatophytes. The infection rate of tinea pedis was thus 24.1%. Among thirty-seven research workers (mean age: 34.8), twenty-one (56.8%) showed positive by direct microscopic examination. All the dermatophytes isolated by slant cultures were T. mentagrophytes. In seventy-four feet, twenty-nine were infected and disseminating, ten were infected but not disseminating, and three were adhering dermatophytes. The infection rate was 64.9%. Among thirty-one females wearing boots (mean age: 21.0), seven (22.6%) were infected and T. mentagrophytes was more dominant. In sixty-two feet, eight were infected and disseminating, one was infected but not disseminating, and five were adhering dermatophytes. The infection rate of tinea pedis was quite high and T.r/T.m rate was low in the three groups. Most of the patients had had no treatment and were disseminating dermatophytes.

Dermatological manifestations of Down's syndrome

BACKGROUND

Down's syndrome (DS) is an extensively researched congenital condition characterized by mental retardation and distinct physical features. The cutaneous manifestations of DS are numerous, yet they seldom receive appropriate attention.

OBJECTIVE

To review the dermatological conditions associated with DS.

METHODS

A review of the medical literature.

RESULTS

DS is associated with an increased incidence of numerous dermatological conditions, some of which may be related to an immunological deficiency.

CONCLUSION

Along with the importance of understanding the physical and psychosocial aspects of DS, an appreciation of the dermatological manifestations of this condition is integral to comprehensive medical care.

Prevalence of superficial fungal infections among sports-active individuals: results from the Achilles survey, a review of the literature

OBJECTIVE

To examine the effect of sport activities on the prevalence of foot disease in the Achilles survey, conducted during the spring of 1997 and 1998 in several European countries.

SUBJECT

Foot diseases, especially fungal infections (tinea pedis and onychomycosis).

METHODS

A questionnaire and a clinical examination regarding individuals presenting to a general practitioner for disorders irrespective of possible foot problems.

RESULTS

More than 50% of subjects visiting a general practitioner had clinical evidence of foot disease, and approximately two-thirds of these had clinical evidence of a superficial fungal infection. The survey evidenced a significant age-dependent association between sporting activities and the prevalence of foot diseases and superficial fungal infection, especially in children.

CONCLUSIONS

The results of this pan-European survey indicate that sporting activities can have an unfavourable effect on the individual regarding the occurrence of foot disease and superficial fungal infection. The results indicate a need to pay more attention to foot disease, to predict and prevent future diseases and further complications.

Prevalence of dermatophytic skin and nail infections in diabetic patients

To determine whether there is a higher frequency of mycotic infections due to dermatophytes in diabetics, 171 diabetic outpatients and 276 controls were recruited in the period 1997-98. Patients with suspicious lesions underwent mycological examination which was positive in seven diabetics and 17 controls. In diabetics the most frequent infection was tinea pedis, followed by distal subungual onychomycosis; the most frequently isolated fungus was Trichophyton mentagrophytes. The results of the study did not show a prevalence of dermatophyte infections in diabetics. No correlation was found between dermatophytosis and duration or type of diabetes and its complications, blood sugar levels or levels of glycosylated haemoglobin. None of the diabetic patients with dermatophytosis had complications related to diabetes and basal blood sugar and glycosylated haemoglobin levels indicated good metabolic control.

Prevalence and awareness of tinea pedis in Italian sailors

BACKGROUND

It is difficult to carry out studies on the prevalence of tinea pedis in the community. Some studies are performed on selected groups of subjects, exposed to the same risk factors, i.e. schoolchildren, public bathers, athletes and military men.

OBJECTIVE

The aim of this work was to detect in a sample of military men the prevalence of tinea pedis and the awareness of their condition, and to relate the infection to risk factors of the group as well.

METHODS

410 male Italian navy cadets in an Italian navy petty officers school were clinically examined and mycological cultures were performed, employing the skin scrapings obtained from suspected lesions.

RESULTS

Dermatophytes were isolated from toe clefts in 10 subjects, giving a point prevalence of 2.4% (95% confidence interval 1.3-4.4%). The isolated dermatophytes were Trichophyton mentagrophytes (70%), Trichophyton rubrum (20%) and Epidermophyton floccosum (10%). None of the subjects was aware of his disease. No significant association was observed between tinea pedis and risk factors (i.e. hyperhidrosis and habits).

CONCLUSION

The prevalence in our sample was lower than that observed in previous studies on military men. That can be attributed to the general amelioration of hygienic conditions and strengthening of preventive habits. Therefore the prevalence of tinea pedis in Italian sailors seems to be reduced but still rather relevant. That is important because these subjects are a reservoir of ringworm infection.

Etiology of toe-web disease in Al-Ain, United Arab Emirates: bacteriological and mycological studies

We examined and sampled 45 patients with toe-web intertrigo for bacteriological and mycological studies. Prominent isolated pathogens were the genus Candida (57.7%), genus Aspergillus (28.8%), Pseudomonas aeruginosa (26.7%) and coliforms (24.4%). Dermatophytes scored 4.4% (Trichophyton rubrum). There were 43 patents (95.5%) who presented with marked hyperkeratosis and maceration of the toe-webs involved. The tradition of the Emirati population of sitting cross-legged may, over time, induce in the toe-webs of overweight individuals a macerated pressure-reaction hyperkeratosis that is colonized by environmental germs. T. rubrum and T. mentagrophytes are uncommon in the Al-Ain environment and this may explain the rarity of dermatophytes in toe-web intertrigo in our study.

Erysipelas and tinea pedis

During a 2-year period 30 adults were selected out of a group of patients diagnosed with erysipelas, who, except for tinea pedis, were apparently otherwise healthy patients. Clinical and epidemiological studies were performed to establish how tinea pedis and erysipelas are related. Thirteen of 30 patients with a diagnosis of erysipelas were found to have tinea pedis due to Trichophyton mentagrophytes and Trichophyton rubrum. In seven of the patients (23%) tinea pedis was found to be the unique predisposing factor for erysipelas. Tinea pedis may be a risk factor for streptococcal infections such as erysipelas, mainly in tropical countries, where tinea pedis is a frequent disease.

Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain

This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified as Trichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) and Trichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes (44.8%), followed by Epidermophyton floccosum (7%) and T. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).

The frequency of tinea pedis in patients with tinea cruris in Tehran, Iran

The objective of this study is to define the frequency of tinea pedis in patients with tinea cruris. Sixty patients (46 males and 14 females) entered our study. Epidermophyton floccosum was the most frequently isolated fungus in tinea cruris. Four patients (6.4%) had concurrent tinea pedis and the only isolate from the foot was Trichophyton mentagrophytes. In three of them, the corresponding dermatophyte in the groin was E. floccosum.

[Epidemiology, physiopathology and treatment of a frequent ailment: tinea pedis]

Tinea pedis is an infection of the stratum corneum caused by dermatophytes. Nowadays, fitness centers, saunas, subtropical swimming pools and sport-shoes are more and more fashionable and are certainly responsible for the increase of cases of tinea pedis as dermatophytes grow preferentially in warm and humid environments. The clinical aspect is affected by several factors such as the host reaction to the infection, the virulence of the infective strain, species, and some local and environmental factors. If a dermatophytosis is suspected, it is mandatory to validate the provisional diagnosis by demonstration of the fungus (by culture or/and microscopic examination) to avoid useless and expensive treatments. The new antifungal molecules are very effective, well tolerated and allow short course of therapy improving the compliance of the patient in clinical practice. Relapse of tinea pedis is very common but could be avoided by several simple preventive measures of hygiene.

Tinea pedis in Korean children

BACKGROUND

Tinea pedis is an infrequent disease in children before the age of puberty. There are few epidemiologic and clinical data regarding cases of tinea pedis observed in children. Materials and methods We prospectively collected all cases of tinea pedis in children diagnosed during the years 1995-1997. Only those showing a positive result with potassium hydroxide preparation were included in the study. We performed fungal cultures in Sabouraud's agar in all cases to document the etiologic fungi. The clinical characteristics were investigated.

RESULTS

A total of 21 children, aged 3 months to 14 years, were included. Fifteen patients were boys and six were girls. The mean age was 7.1 years. All the children were otherwise healthy. Prior to the establishment of the diagnosis of tinea pedis, 17 patients (80.9%) were treated for eczema without improvement. The intertriginous type was most common (53.3%). The first or second toe-webs were the sites of predilection (32.3%). Eighteen children (86%) had a family history of tinea pedis and more than half of cases (52.4%) showed occurrence in the summer. The results of fungal cultures were positive in 13 patients (57%). Trichophyton rubrum was the most commonly isolated pathogen (69.2%). The other associated dermatoses were onychomycosis (33.3%), atopic dermatitis (14%), plantar warts (10%), and chronic urticaria (5%). Tinea pedis and onychomycosis cleared after treatment with topical antifungals with or without systemic antifungals in all cases.

CONCLUSIONS

Tinea pedis in children can occur more frequently than suspected. Our study shows the strong association with a family history and the seasonal relationship with occurrence in summer in more than half of cases. We suggest that tinea pedis should be considered in the differential diagnosis of foot dermatitis in children.

Epidemiology of dermatomycoses of humans in central Poland. Part III. Tinea pedis

The total number of dermatophytoses (7393) included 2025 (27.4%) tinea pedis cases. Etiological factors in descending order by contribution were: Trichophyton rubrum (41.7%), Trichophyton mentagrophytes var. granulosum (30.9%), T. mentagrophytes var. interdigitale (10.0%), Epidermophyton floccosum (7.4%), T. mentagrophytes var. quinckeanum (6.9%), Trichophyton tonsurans (2.3%), Trichophyton spec. (0.4%), Trichophyton terrestre (0.2%), Trichophyton violaceum (0.1%). In the years 1987-93 the incidence of tinea pedis substantially increased over 1994-96. Today tinea pedis is second by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lódź region.

Tinea pedis and onychomycosis in Danish soldiers before and after service in ex-Yugoslavia

Seventy-three 1-year-experienced Danish soldiers were examined for tinea pedis as well as onychomycoses before and after a duty period of 6 months in ex-Yugoslavia. The incidence of fungal infections was 16.4% before and 32.3% after their duty period abroad. At first investigation Trichophyton rubrum and T. mentagrophytes were dominant but onychomycosis and tinea pedis were found as well. In contrast, Candida albicans was the predominant pathogen in the second investigation. We explain this by means of the more aggressive nature that yeasts can show when host-parasite relations are disturbed or compromised. Twelve soldiers with positive mycology were offered treatment and the final investigation showed a cure rate of 50%. This result is satisfactory in view of the difficult sanitary conditions.

Achilles foot screening project: preliminary results of patients screened by dermatologists

OBJECTIVE

Presentation of the preliminary results from the foot screening project, 'Achilles', conducted in spring of 1997 and 1998 in several European countries. At the EADV congress, only the preliminary results of the study, i.e. patients screened by dermatologists, were presented.

SUBJECT

Foot diseases, especially fungal infections (tinea pedis and onychomycosis).

METHODS

A questionnaire and a mycological examination in patients visiting a dermatologist for disorders irrespective of their foot problems.

RESULTS

The proportion of patients with foot diseases visiting a dermatologist was high (58%). In the total population, fungal infections were the most prevalent clinically diagnosed foot diseases (35%), especially onychomycosis (23%) and tinea pedis (22%). The prevalence of foot diseases increased with advancing age and more men as compared with women had fungal infections of the feet. The most prevalent predisposing factors were vascular disease and sports participation. In subjects with onychomycosis, the big toenail was affected most often. Twenty-three percent of the participants with clinically diagnosed tinea pedis and/or onychomycosis had infection of both the skin and the nail. The most frequently isolated pathogen was Trichophyton rubrum. Patients with onychomycosis often reported quality of life problems, especially pain and discomfort in walking.

CONCLUSION

The preliminary results of this pan-European study show that epidemiological studies can give a better idea of foot diseases in dermatological patients. The results indicate a need to pay more attention to foot disease, to predict and prevent future diseases and complications. The most frequent foot diseases were fungal infections, especially onychomycosis, which affects the quality of life of the patients. More results will be available in 1999.

Achilles foot-screening project: background, objectives and design

OBJECTIVE

A description of the background, objectives and design of the Achilles foot screening project.

SUBJECT

Foot diseases, especially tinea pedis and onychomycosis.

METHODS

Literature review and description of the Achilles set-up.

RESULTS

The prevalence of tinea pedis and onychomycosis has sharply increased since 1950. Tinea pedis is one of the most common mycological diseases and onychomycosis is the most frequent nail disorder. They occur mainly in adults with an estimated overall prevalence of 10-20%, although epidemiological data are limited. The pan-European Achilles foot-screening project was undertaken to gather basic information on foot diseases, using a survey by questionnaire and a mycological assessment study.

CONCLUSION

The prevalence of foot mycoses, particularly onychomycoses, is much higher than anticipated.

The prevalence of common skin conditions in Australian school students: 4 Tinea pedis

Tinea pedis is a condition that is common, often undiagnosed and frequently inadequately treated. It is reported as being rare in young children, but there are relatively few population-based reports of prevalence. A randomized sample of 2491 students from schools throughout the State of Victoria, Australia, were examined by dermatologists and dermatology registrars, who recorded clinical signs suggestive of tinea pedis, which were then confirmed by fungal culture. The age- and sex-adjusted prevalence of culture-proven tinea pedis was 5.2% [95% confidence interval (CI) 3.58-6.82] increasing with age from 2.1% (95% CI 0.95-3.28) in 4-6 year olds to 9.7% (95% CI 5.21-14.26) in 16-18 year olds. A higher proportion of males (6.0%) had tinea pedis than females (4.3%). Trichophyton mentagrophytes and T. rubrum were the most common dermatophytes isolated on culture. Less than 40% of those with a positive diagnosis had reported on the questionnaire that they had tinea. Of those who reported correctly that they had tinea, 75% had used one or more products to treat their condition, of which more than 40% were classified as unlikely to have any therapeutic effect on tinea pedis. These data confirm that tinea pedis, a potentially transmissible disease, is common in Australian schoolchildren, including those in primary school. There is a need for education programmes in schools on the nature of tinea pedis, the treatment available, and the public health approach to infection control within the school and home environment.

A ten-year survey of Tinea pedis in the central region of the Rio Grande do Sul, Brazil

Tinea pedis in the most common type of dermatophytosis, but can mimic many cutaneous diseases and tend to be chronic. We present a study of the frequency, epidemiology and clinical aspects of tinea pedis in the central region of Rio Grande do Sul during the period 1988-1997.

Tinea pedis et unguium in the Muslim community of Durban, South Africa

BACKGROUND

In a pilot study performed in eight mosques in the Durban area, it was found that the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques was higher than in the nonMuslim male population. The aims of the present study were: (i) to determine the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques; (ii) to investigate the role of mosque carpets and ablution areas in the spread of infection; and (iii) to develop strategies to combat the infection.

METHOD

Seventy-eight regular worshippers comprising adult Muslim males, chosen at random from five mosques in the Durban area, were examined for clinical evidence of tinea pedis et unguium. Skin scrapings and nail clippings were taken from clinically infected individuals and submitted for microscopy and culture for fungal organisms. A control group, comprising 72 nonMuslim adult male office workers from the administration departments of King Edward VIII Hospital, was similarly examined. In addition, scrapings from high traffic areas of the mosque carpets and swabs from the ablution areas were cultured for fungi.

RESULTS

In the mosque group, it was found that the prevalence of tinea pedis et unguium was 85%, taking either microscopy or culture positivity as indicative of infection. In the control group, the prevalence was 41%. Thus a statistical difference of 44% (P < 0.0001) between the two groups was demonstrated. Dermatophytes and yeasts were isolated from the carpets and/or floors of the ablution areas in all the mosques under investigation.

CONCLUSIONS

The high prevalence of tinea pedis et unguium among regular male worshippers in the Muslim community can be attributed to the spread of fungal organisms in the communal ablution areas and prayer carpets of the mosques. Strategies to combat this spread of infection are being developed. These strategies are expected to find important practical applications in other communal environments, such as gymnasia, health spas, swimming pools, changing rooms of sports clubs, public showers, and even hotels.

Two feet-one hand syndrome: a retrospective multicenter survey

BACKGROUND

The two feet-one hand syndrome is not uncommon; however, there have only been a few reports on this condition. This study was undertaken to obtain a better understanding of the epidemiology of the two feet-one hand syndrome.

METHODS

A retrospective chart review was conducted of all the patients seen in our practices over the past 15 years with the diagnosis of two feet-one hand syndrome.

RESULTS

A total of 80 patients with mycologically confirmed disease were identified (men, 72 (90%); women, 8 (10%); 77 (96%) Caucasian; 3 (4%) African-American; age (mean +/- standard error (SE)), 55.9 +/- 2.1 years). The mean age of the patients when the physician was first seen for the condition was 51.3 +/- 2.0 years. The mean ages when the symptoms first developed on the feet and hand were 37.1 +/- 2.4 years and 45.7 +/- 2.2 years, respectively. Tinea pedis was found to occur at an earlier age than tinea manuum (t(65) = 6.92, P < 0.01). There was a significant relationship between the hand in which tinea manuum developed, the hand used to excoriate the soles of feet (chi 2(4) = 14.82, P < 0.01), and the hand used to pick toenails (chi 2(4) = 14.82, P < 0.01); however, there was no significant relationship between handedness and the development of tinea manuum in the dominant hand. The occupation of the patient at the time of development of the two feet-one hand syndrome was categorized according to whether the intensity of hand use was high, moderate, or low. Patients with a high intensity of hand use in their jobs were significantly more likely to develop tinea pedis/onychomycosis (r = -0.27, F(1,61) = 4.77, P < 0.05) and tinea manuum (r = -0.30, F(1,62) = 6.31, P < 0.05) at an earlier age. The best multiple predictors of the age at which medical attention was sought were the age of onset of tinea manuum and a family history of tinea infection (r = 0.86, F(2,59) = 86.9, P < 0.01). The age of onset of tinea manuum was the best single predictor, with a correlation of 0.85.

CONCLUSIONS

In the two feet-one hand syndrome, the development of tinea pedis/onychomycosis generally preceded the development of tinea manuum. Tinea manuum usually developed in the hand used to excoriate the feet or pick toenails. Patients whose occupation involved a high intensity of use of the hands were more likely to develop the disease at an earlier age. Patients were more likely to seek attention once tinea manuum had developed, particularly if there was a family history of tinea infection.

[Study of dermatomycosis and survey of pathogens in troops of Hainan area]

Subtropical area is the prevalent area of dermatomycosis with natural conditions suptable for the growth and proliferation of fungi causing suterficial dermatomycosis. Dermatomycosis not only brings about certain sufferings to the military personnel in peacetime, but also causes nonbattle loss in manpower in war time. In the present work, a survey of dermatomycosis in Hainan subtropical area of China and isolation of the pathogens were carried out. The results were as follows: The morbidity of superficial dermatomycosis was 34.1% and it was manifested clinically as tinea pedis, tinea versicolor, tinea corporis, tinea axillaris, tinea cruris, etc.; The main pathogen causing dermatomycosis in this area was Trichophyton rubrum which accounted for 50.4% of the pathogens isolated and the next was Trichophyton gypseum which accounted for 20.3%; Trichophyton rubrum could cause dermatomycosis of many sites of the body in this area, but the main lesious were tinea corporis and tinea cruris.

Tinea pedis outbreak in swimming pools in Japan

This study was conducted to show a higher prevalence of interdigital tinea pedis in athletes by comparing athletes and non-athletes, and to examine swimming pools as a route of infection. The subjects were 282 athletes, 137 non-athletes, and 140 students enrolled in a swimming class at the University of Tsukuba. This study included the taking of cotton-swab samples from the interdigital skin surfaces of both feet and cultures, microscopical examinations of scales collected from subjects with lesions, and questionnaires. There was a significant difference between athletes and non-athletes in the prevalence of the relevant pathogens, and a higher risk of infection was shown in athletes. The study also found that 63.6% of the swimming class students were carriers, and that 85.0% of their dermatophytes were Trichophyton mentagrophytes. In addition, dermatophytes were also isolated from the floors of the swimming pool and the public baths. The results of these controlled studies suggested that there was a significant risk of dermatophytosis in both athletes and non-athletes using the swimming pool.

Tinea pedis: clinical experience and efficacy of short treatment

Tinea pedis is the commonest fungal infection in developed countries. Topical therapy is an accepted and successful method for the management of this condition. This has usually involved the application of an antifungal twice or 3 times a day for 3-4 weeks to achieve a cure rate of > or = 80%. Terbinafine, a new antifungal, has been shown in a number of studies to give equally good results when applied once or twice daily for 1-2 weeks. In one study, a cure rate of 78% was achieved in patients with tinea pedis after a single application of 1% terbinafine cream, demonstrating the high potency of this antifungal. Topical terbinafine has also been compared to clotrimazole for the treatment of tinea pedis. Terbinafine 1% cream applied twice daily for 1 week was significantly superior to a 4-week course of clotrimazole 1% cream for treating this common mycosis. Overall, the high efficacy of topical terbinafine in treating tinea pedis following such-short-duration therapy is undoubtedly due to its fungicidal mode of action.

The descriptive epidemiology of tinea pedis in the community

Tinea pedis is a common inflammatory skin condition due to infection by dermatophyte fungi. A number of epidemiological studies have been completed on the frequency of tinea pedis in the community, particularly sporting and occupational groups and schools. Most studies have focused on small, high-risk populations. These include occupational groups involving manual labour, sporting groups such as swimmers, and those working or living in confined conditions with shared washing facilities, which favour the opportunity for cross-infection. Most studies show that the frequency of tinea pedis is higher in males than females. Tinea pedis infections appear to be least common among children, but do occur, and are commonly misdiagnosed. The difference between clinical disease and confirmed diagnosis by culture is not always clear when statistics of disease frequency have been presented. Clear diagnosis criteria indicating the level of mycologically confirmed diagnosis should be reported in future studies that include statistics on disease frequency. Future epidemiological studies should also aim to be population-based in order to obtain a more complete picture of disease frequency.

A U.S. epidemiologic survey of superficial fungal diseases

BACKGROUND

Large-scale studies performed outside the United States have demonstrated that most cases of onychomycosis and tinea pedis are caused by dermatophytes, primarily Trichophyton rubrum. However, other studies have suggested that yeasts and nondermatophytic molds may play a role, particularly in onychomycosis.

OBJECTIVE

This study was undertaken to determine the epidemiology of superficial fungal infections in a U.S. population.

METHODS

Fungal cultures were performed on patients with clinically suspected tinea cruris, tinea corporis, tinea capitis, tinea pedis, and onychomycosis.

RESULTS

Dermatophytes were the most commonly isolated fungi in each type of superficial fungal disease studied. T. rubrum was the most commonly isolated dermatophyte species, although Trichophyton tonsurans was more common in tinea capitis and equally common in tinea corporis/tinea cruris. In tinea pedis and onychomycosis, dermatophytes appeared in approximately 95% and 82% of isolates, respectively. Candida albicans and nondermatophyte molds played only a minor role in onychomycosis; C. albicans was isolated in 7% of nail cultures and nondermatophytic molds were isolated in 11%.

CONCLUSION

These results are in general agreement with other major epidemiologic studies performed outside the United States. Dermatophyte fungi cause most superficial fungal infections.

Dermatophytosis in schoolchildren in Ekpoma, Nigeria

Of 1400 pupils from two public primary schools in Ekpoma, Edo State, Nigeria, who were screened for dermatophyte infection, 188 (13.4%) were infected. The causative agents isolated included Microsporum audouinii in 88 (46.8%), Trichophyton mentagrophytes in 48 (25.5%), T. rubrum in 40 (21.3%), T. tonsurans in four (2.1%) and Epidermophyton floccosum in eight (4.3%). There were significant differences in the rate of infection between male and female schoolchildren as well as between children from different socioeconomic backgrounds.

Tinea pedis in members of the Japanese Self-defence Forces: relationships of its prevalence and its severity with length of military service and width of interdigital spaces

We examined the relationship between prevalence and severity of tinea pedis and the length of service and the width of the spaces between the toes in 74 members of the Japanese Self-Defence Forces (SDF) undergoing special training. The subjects were divided according to the width of these spaces into: group I, wide; group II, fairly wide; and group III, closed. The severity of tinea pedis was determined by its duration and the extent of the lesions in the 49 subjects who had tinea pedis. The combined prevalence of tinea pedis and tinea unguium was 66%. There was a tendency for the prevalence to be higher in subjects who had served for 10 years or more in the SDF than in those with fewer than 10 years of service. Classified by the disposition of their toes, 10 subjects fell into group I, 34 into group II, and 30 into group III. The prevalence of 90% (27/30) in group III was significantly higher than in the other groups. A significant positive correlation was seen between length of SDF service and severity. Subjects with both a long service record and closed interdigital spaces showed both a high prevalence and marked severity.

Dermatophytes in northern Finland in 1982-90

The epidemiology of human dermatophytes was studied in northern Finland in 1982-90. The samples were analysed at the Department of Medical Microbiology, University of Oulu. The total number of samples was 17,822, of which 3185 (18%) were positive. The annual number of samples and positive cultures remained relatively constant. Trichophyton rubrum was the most common species being isolated from 2101 samples (66% of all positive cultures), while Trichophyton mentagrophytes was isolated from 815 samples (26%) and Epidermophyton floccosum from 193 samples (6%). T. verrucosum caused an epidemic among cattle keepers in 1987-90, causing 47 infections. Microsporum canis, T. terrestre and T. violaceum were rare. The same species affected both children and adults. There was a tendency towards a decrease in tinea in the groin and a slight increase in tinea pedis. T. rubrum and T. mentagrophytes occurred most frequently in patients aged 41-45 years and as foot infections. E. floccosum usually affected the toe web and the groin in patients aged 21-25 years, more often infecting men. Fifty-four per cent of all positive samples came from men and 46% from women.

Epidemiology of dermatophytoses observed in Rome, Italy, between 1985 and 1993

Between 1985 and 1993, 13,880 patients were studied for possible forms of dermatophytoses. The most frequently isolated dermatophyte was in 2821 positive cases Microsporum canis (50%), followed by Trichophyton rubrum (27%), Trichophyton mentagrophytes (10.6%), Epidermophyton floccosum (9.3%), Microsporum gypseum (2.3%), Trichophyton violaceum (0.6%), Trichophyton tonsurans (0.2%) and Trichophyton verrucosum (< 0.1%). The genera and species isolated were also considered in relation to the site of the lesion. Our epidemiological data were compared with those obtained by other authors in other cities and with those obtained in Rome in previous studies conducted between 1972-77 and 1978-83. Results obtained by various investigators in Europe are also discussed.

Fungal skin infections in a paediatric dermatology clinic

A diagnosis of fungal infection was established in 8.6% of patients who attended the dermatology clinic at the Lady Ridgeway Hospital, Colombo over a one year period. Only 4.3% were confirmed in the laboratory. The agreement between clinical and laboratory diagnosis was 96.6% for patients with typical clinical features, but only 26.4% for patients who did not have the classical appearance. Both direct microscopy and culture are required to determine the causative agent, although the majority (92%) of patients could be diagnosed on microscopy alone. Microsporum gypseum was the commonest fungus isolated from children.

Epidemiology of tinea pedis in marathon runners: prevalence of occult athlete's foot

Studies on the prevalence of tinea pedis, a frequently encountered dermatophytic infection, have been conducted mostly in swimmers although people who regularly practise other types of physical activities may also have a high rate of clinical or subclinical infection. This investigation was undertaken to establish the rate of infection in marathon runners, and to determine the incidence of occult athlete's foot disease in this population. Among samples obtained from 405 individuals, 22% were positive. The rate of infection was highest in the older age groups. The prevalence of infection was 24.2% in men and 6.1% in women. Trichophyton rubrum and Trichophyton mentagrophytes were the two species of dermatophytes most commonly isolated on culture. Occult athlete's foot disease represented 48% of cases with a positive culture. Finally, routine sampling of both feet was confirmed necessary to adequately establish the rate of infection: 26.9% of cases with a positive culture would have been missed by unilateral sampling. Other epidemiological factors were not clearly linked to the prevalence of disease in marathon runners: weight; presence of pet animals; practice of other sports; race and country of origin. In conclusion, we establish that marathon runners represent a population at risk for the occurrence of both clinical and subclinical tinea pedis infection.

Cutaneous alterations in patients with chronic renal failure

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Candida albicans--saprophyte or pathogen?

Skin scrapings taken from toe spaces of 200 healthy volunteers and from toe webs and groins of 150 pediatric patients were cultured for Candida albicans using the serum germ-tube test. The results showed that Candida albicans can be isolated in about 15% of normal toe spaces and 14% of children with normal groins. Although Candida albicans can be found in various grades of athlete's foot and also in some abnormal groins, we believe that it is not necessarily responsible for these conditions and is often present at these sites only as a saprophyte.