Tinea pedis in prepubertal children: does it occur?

Epidemiologic Analysis of Onychomycosis in the San Diego Pediatric Population

BACKGROUND

Onychomycosis (OM) is thought to be a rare disease in children, although there are few epidemiologic studies.

METHODS

This 3-year retrospective case series of nearly 400 children seen at Rady Children's Hospital-San Diego (RCHSD) describes the characteristics of OM found in this pediatric population.

RESULTS

From 2011 to 2013, the Pediatric and Adolescent Dermatology Clinic at RCHSD saw a total of 36,634 unique patients, of whom 433 were unique patients with OM. Thirty-four patients met exclusion criteria, leaving 399 (1.1%) with a diagnosis of OM by a pediatric dermatologist. Nail cultures were obtained in 242 cases (60.7%), 116 (48.0%) of which were positive. Trichophyton rubrum was the most commonly isolated pathogen, responsible for 106 cases (91.3%) of positive cultures in the cohort.

CONCLUSIONS

Our study provides important regional information regarding epidemiologic data in pediatric onychomycosis, highlighting the diagnostic methods most commonly used and the pathogens most frequently encountered in our practice.

Prevalence of dermatophytosis in junior secondary schoolchildren in Ogun State, Nigeria

A total of 2772 randomly selected junior secondary school pupils (aged 8-14) from 60 schools were examined for dermatophytic infections by direct microscopy and culture-based laboratory diagnostic methods. Of these, 641 (23.21%) had dermatophytosis. Out of these, 376 (13.56%) were male while 265 (9.56%) were female. Aetiological agents identified with infection were Microsporum canis (30.19%), Microsporum audouinii (32.92%), Trichophyton interdigitale (14.37%), Trichophyton soudanense (9.73%) and Trichophyton tonsurans (12.05%). Most of the dermatophytes encountered were anthropophilic species. Microsporum canis was the only zoophilic dermatophyte. Differences were not observed in infection pattern for all the different geo-political zones that make up the state. The head and the skin of the students were more frequently infected than the nails and toes. Infection frequency increased steadily up to age 11 after which it drastically decreased.

Onychomycosis is no longer a rare finding in children

Onychomycosis was considered uncommon in children. This survey was carried out to estimate the frequency of fungal nail infections in children and adolescents (0-18 years of age) attending our clinic in the last decade and gain more insight into the aetiology and clinics of this entity in the paediatric age group. This study is based on data obtained from 2320 children and adolescents suspected of superficial fungal infection. Onychomycosis was diagnosed in 99 cases, representing 19.8% of all mycologically confirmed superficial mycoses (500 cases) in our material. Fingernail onychomycosis was recognized in 52 (10.4%) cases; children under 3 years of age were predominantly involved. Candida albicans was the most common isolated pathogen. Toenail onychomycosis concerned 47 (9,4%) patients; the incidence increased steadily with increasing age. Trichophyton rubrum was the most common aetiological agent with respect to toenail infection followed by T. mentagrophytesvar. interdigitale and T. mentagrophytes var. granulosum. The majority of fungal nail infections were characterized clinically by distal and lateral subungual onychomycosis. The growing trend towards the frequency of toenail and fingernail onychomycosis in children and adolescents was found in the last decade in north Poland. The results of our study show that onychomycosis in prepubertal children is not exceptional and should be considered in differential diagnosis of nail plate disorders.

Onychomycosis in children: a survey of 46 cases

This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989-2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection.

Bullous tinea pedis in two children. Bullose Tinea pedis bei zwei Kindern

Tinea pedis is a dermatophytic infection with a high prevalence in adults and also occasionally observed in children. We report here two cases of bullous tinea pedis, one due to Trichophyton rubrum in a 6-year-old child and the second due to T. interdigitale in a 10-year-old child. We suggest that, despite the low prevalence of this infection in childhood, a potassium hydroxide test and a culture for fungi should always be performed when a child is examined for an inflammatory eruption of the feet.

Dermatophytosis in children and adolescents in Gdansk, Poland. Dermatophytosen bei Kindern und Jugendlichen in Gdansk, Polen

During a 3-year period (1999-2001) a total of 94 cases of dermatophytosis were seen in patients from 0 to 18 years of age attending the Department of Dermatology, Venerology and Allergology of Gdańsk Medical University. Mycoses were diagnosed on the basis of clinical picture and direct microscopy and were confirmed by positive cultures. The most frequent pathogens were Microsporum canis (62%) and Trichophyton rubrum (12%). The most often forms of dermatophytosis in children were tinea cutis glabrae (42%) and tinea capitis (30%). Microsporum canis predominated in both locations. Glabrous skin lesions were the most frequent in children aged 8-15 years; the peak of scalp lesions was observed mainly in children aged 4-7 years. Tinea pedis occurred more frequently than suspected. Tinea pedis was observed mainly in adolescents (above the age of 12 years)--the majority of cases were caused by T. rubrum and T. mentagrophytes var. granulosum. Onychomycosis was highly uncommon, caused mainly by T. rubrum. Dermatomycoses in general were most frequent in October and November.

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.

How often are dermatophytes present in apparently normal versus scaly feet of children?

The purpose of this investigation was to find out how often pathogenic dermatophytes are found in apparently normal versus scaly feet of children. In this prospective protocol, we studied 100 patients, 2 to 12 years of age, consulting for plantar and/or interdigital scaling with or without erythema, maceration, and pruritus, and 100 controls with apparently healthy feet. Direct microscopic examination (KOH) and mycologic culture (Mycosel) of skin scrapings were performed from the lesions of patients and from the soles and interdigital folds of controls. Mean age of patients and controls was 7 years 7 months (SD = 3 years 2 months). Scaling was present in 100% of patients with a mean time of evolution of 8.9 months (SD = 16.3 months). Shoes fashioned from man-made material were significantly more frequently used by patients than by controls (chi 2(df = 1) = 9.4; p = 0.002). Pathogenic dermatophytes were present in the soles and/or interdigital webs of 21 patients and 7 controls. Not all foot scaling in children, pruritic or not, is associated with dermatophytes. Dermatophytes may be present on the apparently healthy feet of children.

Onychomycosis in children: prevalence and treatment strategies

BACKGROUND

Onychomycosis is observed less frequently in children than adults. Until recently management of onychomycosis in children included topical formulations, oral griseofulvin, and in some cases deferral of treatment.

OBJECTIVE

We attempted to determine the prevalence of onychomycosis in North American children 18 years old or younger attending our dermatology offices (three Canadian, two U.S.) and to report the group's experience using fluconazole, itraconazole, and terbinafine for onychomycosis.

METHODS

We undertook a prospective, multicenter survey in which all children, regardless of presenting complaint, were examined for onychomycosis by a dermatologist. In instances of clinical suspicion appropriate nail samples were obtained for light microscopy and culture.

RESULTS

A total of 2500 children under age 18 were examined in the five-center survey (1117 males and 1383 females, mean +/- S.E. age: 11.2 +/- 0.1 years). There was one child with fingernail and ten with mycologically confirmed toenail dermatophyte onychomycosis. The overall prevalence of onychomycosis was 0.44%. Considering those children whose primary or referring diagnosis was not onychomycosis or tinea pedis, the prevalence of onychomycosis was 0.16%. Outside the survey we have seen six other children with dermatophyte onychomycosis; these 17 cases form the basis for the remainder of the report. Of the 17 children, eight (47%) had concomitant tinea pedis infection, and in 11 (65%) a sibling, parent, or grandparent had onychomycosis or tinea pedis. Management included topical terbinafine (two patients: one cured, one failed therapy), topical ketoconazole (one patient: clinical improvement), oral fluconazole (two patients: one cured, one had Down's syndrome and was noncompliant), oral itraconazole (four patients: three cured with subsequent recurrence at follow-up in one patient, one lost to follow-up), oral terbinafine (five patients: four cured with subsequent recurrence at follow-up in one patient, one failed therapy). One child received no therapy following discussion with the parents, one was lost to follow-up and one was found to have asymptomatic hepatic dysfunction with hepatitis C at pretherapy bloodwork.

CONCLUSION

The prevalence of onychomycosis in our sample of North American children 18 years old or younger was 0.44% (n = 2500). In the subset of children whose primary or referring diagnosis was not onychomycosis, the prevalence of onychomycosis was 0.16%. Children with onychomycosis should be carefully examined for concomitant tinea pedis, and their parents and siblings checked for onychomycosis and tinea pedis. The newer oral antifungal agents fluconazole, itraconazole, and terbinafine may be effective and well-tolerated in the treatment of onychomycosis in this age group. These drugs should be carefully evaluated in a larger cohort of children with onychomycosis.

Childhood white superficial onychomycosis caused by Trichophyton rubrum: report of seven cases and review of the literature

BACKGROUND

Although white superficial onychomycosis (WSO) is well recognized in adults and considered to be mainly caused by Trichophyton mentagrophytes, childhood WSO is rare. WSO caused by Trichophyton rubrum in prepubertal children has never been reported.

OBJECTIVE

Our purpose was to describe the existence of WSO in children and to emphasize that T. rubrum may be its main cause.

METHODS

Seven children with WSO seen between 1988 and 1993 were examined. Only patients who had a positive potassium hydroxide preparation and a positive fungal culture were included.

RESULTS

Seven healthy prepubertal children, 2 to 9 years of age, were identified with WSO. All cases were proved to be caused by T. rubrum. Six patients had associated tinea pedis, and five had a family history of tinea pedis. Topical antifungal therapy was partially effective in some cases.

CONCLUSION

This report documents the existence of WSO in prepubertal children. All cultures grew T. rubrum. Although onychomycosis is not as common in prepubertal children as in adults, it may be underrecognized.

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.

Dermatophytosis of children in Kuwait: a prospective survey

BACKGROUND

Tinea capitis in children is widely reported, whereas there have been only isolated reports on involvement of sites other than the scalp. The purpose of this study was to examine the epidemiological features and treatment responses of dermatophytosis of children in Kuwait.

METHODS

Epidemiological features and the treatment responses of 202 consecutive children with dermatophytosis were studied.

RESULTS

The 202 children constituted 44% of the total dermatophytic infections seen during a period of 1 year. Tinea capitis was the most commonly encountered infection (78%), followed by tinea corporis, tinea faciei, tinea cruris and manus, respectively. Microsporum canis was the most prevalent species (96%) in this region. A history of pets at home could be elicited in 52% of the cases. A familial occurrence of similar infections was seen in 56% of the patients. In patients with tinea capitis, addition of topical clotrimazole or ketoconazole to oral griseofulvin produced better therapeutic results compared to griseofulvin alone or in combination with selenium sulfide shampoo.

CONCLUSIONS

Tinea capitis is the most common dermatophytic infection in children. Thirty percent of the children may have dermatophytosis at sites other than the scalp. A combination of topical clotrimazole or ketoconazole with oral griseofulvin is superior to griseofulvin alone or in combination with selenium sulfide shampoo in the treatment of tinea capitis.

Dermatophytosis of children in Kuwait

Five hundred fifty-six children constituted 39.5% of total smear- and culture-positive cases of dermatophytosis and 0.6% of the total new dermatology outpatients seen over a period of five years. Males outnumbered females. The youngest child was a 20-day-old neonate (age range 20 days-12 yrs) with a peak of fungal infections seen in patients between 4 and 6 years of age. Microsporum canis was the most prevalent (70.5%) species, followed by Trichophyton violaceum, Microsporum audouinii, Trichophyton rubrum, and Epidermophyton floccosum. Rarely, other species were also isolated. Tinea capitis was the most common (73.7%) clinical type, followed by tinea corporis (19.1%), tinea faciei (3.4%), tinea cruris (3.4%), tinea pedis (0.9%), tinea unguium (0.9%), and tinea manus (0.2%). No racial variations were observed; however, the predominant species differed with the clinical types.

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p less than 0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p less than 0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea pedis and tinea manuum

In the period between April 1984 and April 1988 a total of 4294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 680 were suspected as tinea pedis and tinea manuum. These cases belonged to 21 different nationalities. Both sexes were represented and 649 cases (95.4%) were adults while 31 (4.6%) were prepubertals. Clinical diagnosis was confirmed by direct microscopy in 505 cases or 74.4% (485 adults and 20 prepubertal children). Out of these, 504 cases were positive on culture and yielded 516 isolates. Candida species and other yeasts were responsible for 88.9% and dermatophytes for 11.1% of these infections. The interdigital type of lesions was the most common type (91.9% of all infections) followed by the hyperkeratotic scaling type (6.9%) while the acute inflammatory type was only 1.2% of infections. Treatment showed satisfactory results in most of the cases.

Tinea pedis in children

Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent.

Scaly lesions on the feet in children--tinea or eczema?

Fungal cultures were negative in 20 children aged 1 to 14 years with a clinical picture consistent with juvenile plantar dermatosis. During the same period (April 1987 to August 1988) 4 cases of tinea pedis were seen in the same age group. The important difference between juvenile plantar dermatosis (with or without associated atopic disease) and the clinical picture seen in dermatophytic infection is described.