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.

Tinea pedis in children presenting as unilateral inflammatory lesions of the sole

Tinea pedis is uncommon in prepubescent children and therefore the diagnosis may be difficult to make. We report tinea pedis in five children presenting as unilateral inflammatory lesions of the sole which was not readily diagnosed. The pathogen in all of our cases was Trichophyton rubrum.

Common pediatric foot dermatoses

The pediatric foot dermatoses known as tinea pedis, shoe dermatitis, and juvenile plantar dermatosis are seen commonly in clinical practice. A knowledge of the clinical presentations and causes of these disorders can help pediatric and family nurse practitioners identify, diagnose, and treat childhood rashes of the feet. The conventional view in pediatrics is that small children rarely have tinea pedis. However, a 1992 study disputes this claim. Any child who has an atypical or persistent foot rash will need a referral or consultation.

Advances in the treatment of superficial fungal infections: focus on onychomycosis and dry tinea pedis

Onychomycosis is one of the most stubborn superficial mycoses. With few exceptions, oral antifungal therapy is needed to achieve resolution. Before oral itraconazole, fluconazole, and terbinafine hydrochloride became available, physicians had to rely on prolonged therapy with griseofulvin or oral ketoconazole. Of the newer oral agents, itraconazole appears to have the broadest spectrum of action, with therapeutic activity against dermatophytes, yeasts, and some nondermatophyte molds. Tissue pharmacokinetics accounts for significantly greater efficacy and much shorter treatment courses for fungal infections of the skin and nails. In general, oral itraconazole, fluconazole, and terbinafine are very well tolerated. The newer oral agents offer improved efficacy over griseofulvin and ketoconazole for onychomycosis and dry tinea pedis.

Allergic contact dermatitis from pyoctanin

Although pyoctanin is widely used in medicine, there are hardly any reports of contact allergy to it. Most reports of side-effects refer to irritant reactions after topical application. We describe 2 patients who developed pyoctanin contact dermatitis after long-term application on damaged skin. Positive patch test results down to concentrations of 0.0025% and 0.05% aqueous pyoctanin solution, respectively, were found.

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.

Diagnosing and treating onychomycosis

Onychomycosis is a persistent fungal infection of the toenails or fingernails that is usually not painful but is unsightly and can affect a patient's quality of life by interfering with footwear. It may affect up to 30% of the population by age 60. In more that 99% of cases, it is caused by dermatophytes, the most common of which are Trichophyton rubrum and Trichophyton mentagrophytes. Each of the four clinical types of onychomycosis, as defined by the route of fungal invasion, has a characteristic appearance, but other diseases, particularly psoriasis, may have a similar appearance. Proper management, therefore, includes confirmation of fungal infection by potassium hydroxide slide preparation and culture. Traditionally, pharmacologic treatment has been less than optimal. In many cases, griseofulvin, the first oral agent approved for onychomycosis in the United States, must be given for 1 year or more to be effective. Low cure rates are related to poor bioavailability and the fungistatic rather than fungicidal effect of the drug. Newer agents, such as oral itraconazole and oral terbinafine, promise to substantially increase cure rates while shortening treatment duration. Oral terbinafine is potently fungicidal against dermatophytes and has proven efficacious with regimens as brief as 12 weeks when the nail is not 100% involved.

Dermatophytosis of the feet

Tinea pedis is the most common fungal infection worldwide. There are three well-accepted clinical presentations based on the offending organism. Predisposing factors include heat, humidity, and occlusion. Mild disease can evolve to "dermatophytosis complex" through bacterial superinfection. Potassium hydroxide preparation and culture are important diagnostic tests in each case.

Tinea pedis: diagnosis and treatment

The authors review the common dermatophyte genera and the forms of tinea pedia they cause. They also provide a differential diagnosis, review diagnostic procedures, and outline the pathophysiology of this complex condition. A classification and treatment plan is provided, with an extensive review of recent clinical trials. The aim of the article is to expand practitioners' treatment options for individualizing treatment plans.

Minipreparation of total cellular DNA is useful as an alternative molecular marker of mitochondrial DNA for the identification of Trichophyton mentagrophytes and T. rubrum

Total cellular DNA was extracted from 18 isolates of Trichophyton mentagrophytes and six isolates of unidentified Trichophyton species taken from tinea corporis, tinea cruris and tinea pedis patients by a minipreparation method. The DNA was digested with the restriction enzymes HaeIII and MspI, followed by electrophoresis on agarose gels. The restriction enzyme profiles of the DNAs were compared with those of mitochondrial (mt) DNA extracted from reference strains of T. mentagrophytes (Arthroderma simii, A. benhamiae and A. vanbreuseghemii) and T. rubrum. All 18 T. mentagrophytes isolates showed the same DNA profiles as mtDNA from A. vanbreuseghemii. The six unidentified Trichophyton isolates exhibited DNA profiles the same as that of mtDNA from T. rubrum. Consequently, these isolates were identified as T. rubrum. In conclusion, restriction enzyme analysis of total cellular DNA prepared by the minipreparation method is considered to be useful as an alternative method of mtDNA analysis and is helpful for the identification of these dermatophyte species.

Tinea pedis survey in members of the Japanese Self-Defense Forces undergoing ranger training

The conditions surrounding tinea pedis infection were surveyed--the degrees of infection and of aggravation attendant upon training, and the skin temperature within the leather boots of members of the Japanese Self-Defense Forces undergoing winter and summer ranger training. Before winter training, tinea pedis was diagnosed in 8 of the 15 subjects. The mean atmospheric temperature was 7.1 degrees C, the total precipitation, 23 mm, and the mean skin temperature of the feet during training, 33.7 degrees C. After training, 1 further subject had contracted tinea pedis, 5 of the 8 showed slight aggravation, and 3 showed no change. Before summer training, tinea pedis was found in 9 of another 15 subjects. The mean atmospheric temperature was 20.0 degrees C, total rainfall, 353 mm, and the mean skin temperature of the feet during training, 36.6 degrees C. After the training, aggravation had occurred in 3 of the 9, and slight aggravation in the other 6. In these 9, vesiculation, pustules and erosion were seen, so that summer training had a more severe effect than winter training. Investigation of the predisposing factors for tinea pedis due to the wearing of boots and shoes is considered extremely important for the prevention and treatment of this disease.

Dermatologic disorders of the foot

This article includes a description of common problems of greatest interest to nondermatologist physicians who treat the foot. These include plantar warts, corns and callouses, toenail problems, and some common skin disorders, such as tinea pedis, pitted keratolysis, hyperkeratosis and fissures, and contact dermatitis. Certain neoplasms, including squamous cell carcinoma, verrucous carcinoma, and melanoma also are discussed.