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Nenoff P, Klonowski E, Uhrlaß S, Schaller M, Paasch U, Mayser P. [Dermatomycoses: topical and systemic antifungal treatment]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:655-673. [PMID: 38874607 DOI: 10.1007/s00105-024-05359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/15/2024]
Abstract
Topical antifungals with activity against dermatophytes include amorolfine, allylamines, azoles, ciclopiroxolamine, and tolnaftate. Polyene antimycotics, such as amphotericin B and nystatin, alternatively, miconazole are suitable for yeast infections of the skin and mucous membranes. For severe yeast infections of the skin and mucous membranes, oral triazole antimycotics, such as fluconazole and itraconazole, are used. Pityriasis versicolor is treated topically with antimycotics, and in severe forms also orally with itraconazole, alternatively fluconazole. Terbinafine, itraconazole and fluconazole are currently available for the systemic treatment of severe dermatophytoses, tinea capitis and onychomycosis. In addition to proven therapeutic regimens, unapproved (off-label use) intermittent low-dose therapies are increasingly being used, particularly in onychomycosis. Oral antimycotics for the treatment of tinea capitis and onychomycosis in children and adolescents can only be used off-label in Germany. In general, any oral antifungal treatment should always be combined with topical antifungal therapy. In tinea corporis and tinea cruris caused by Trichophyton (T.) mentagrophytes ITS (internal transcribed spacer) genotype VIII (T. indotineae), there is usually terbinafine resistance. Identification of the species and genotype of the dermatophyte and resistance testing are required. The drug of choice for T. mentagrophytes ITS genotype VIII dermatophytoses is itraconazole. In individual cases, treatment-refractory onychomycosis may be due to terbinafine resistance of T. rubrum. Here too, resistance testing and alternative treatment with itraconazole should be considered. Therapy monitoring should be carried out culturally and, if possible, using molecular methods (polymerase chain reaction). Alternative treatment options include laser application, and photodynamic therapy (PDT).
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Affiliation(s)
- Pietro Nenoff
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
| | - Esther Klonowski
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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2
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Nenoff P, Klonowski E, Uhrlaß S, Verma SB, Mayser P. [Clinical picture, causative agents and diagnostics of dermatomycoses]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 74:974-993. [PMID: 37889305 DOI: 10.1007/s00105-023-05245-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
Dermatomycoses affect free skin, hairy scalp, fingernails and toenails. In addition, oral mucosa and genital mucosa can also be affected by fungal infections. The most common pathogens causing skin fungal infections are dermatophytes. They are responsible for, among others, tinea corporis, tinea capitis and onychomycosis (tinea unguium). Mainly anthropophilic dermatophytes are found as pathogens. In the case of tinea capitis-at least in Europe and in German-speaking countries-zoophilic skin fungi must also be considered. Rarely, geophilic dermatophytes can also be isolated. Yeast infections of the skin, mostly caused by Candida albicans, primarily affect the intertriginous skin areas, for example, the groin region, but also the submammary area and the spaces between the fingers and toes. Elderly patients are often affected, but also infants and, in particular, immunocompromised patients. These patient groups are also more frequently affected by oral mucosal infections caused by Candida albicans and other Candida species. Pseudomembranous candidiasis of the oral mucosa and tongue typically affects patients with HIV/AIDS. Mold infections in dermatology are relevant in onychomycosis of the big toenail. The causative agent is usually Scopulariopsis brevicaulis. Cutaneous mold infections are rare and only occur in immunocompromised patients. The mycological diagnosis of dermatomycoses is based on the microscopic, if possible fluorescence-optical detection of fungal hyphae and spores from skin scales, nail shavings and hair roots. The culture detection of dermatophytes, yeasts and molds allows the identification of the causative fungal species, but often fails, especially in patients who have already been treated with antifungal agents. In view of the high sensitivity and specificity of the molecular methods for fungal detection compared to culture, polymerase chain reaction (PCR) must realistically be regarded as the gold standard for dermatophytosis diagnostics. However, it should not be neglected that the three pillars of diagnostics-preparation, culture, PCR-currently deliver the best results.
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Affiliation(s)
- Pietro Nenoff
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
| | - Esther Klonowski
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Shyam B Verma
- Nirvan & 'In Skin Clinic', Vadodara, Indien
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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3
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Wendrock-Shiga G, Mechtel D, Uhrlaß S, Koch D, Krüger C, Nenoff P. [Tinea barbae profunda due to Trichophyton mentagrophytes after journey to Thailand : Case report and review]. Hautarzt 2019; 68:639-648. [PMID: 28616693 DOI: 10.1007/s00105-017-4008-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tinea barbae represents a very rare dermatophytosis. We report on a tinea barbae profunda following a journey to Southeast Asia. After travel to Thailand, a businessman was affected by a foudroyant proceeding abscessing infection of the upper lip and beard area. The initial therapy with oral acyclovir and oral ciprofloxacin, which later was changed to ampicillin plus sulbactam, intravenously, was unsuccessful. In a biopsy sample, histologically, with Grocott-Gomori's methenamine silver stain, fungal mycelium was apparent in the tissue. Thereupon, terbinafine 250 mg was given for 4 weeks, topically, a 1% ciclopiroxolamine-containing cream. In fungal culture, T. mentagrophytes were found to grow. Meanwhile, the patient's German wife suffered from a tinea faciei. From skin scrapings from the cheek, T. mentagrophytes was also cultivated. This zoophilic dermatophyte was identical with other zoophilic strains of T. mentagrophytes currently found in Germany, which were also acquired in Thailand. The patient had contact with Thai female sex workers who must be considered as a source of infection of the dermatophytosis. There was no animal contact, neither in Thailand, nor in Germany. The infection chain of the dermatophytosis from Thailand probably reached from a female sex worker via the here described patient to his wife in Germany. This pathway of infection has been known for 1 or 2 years, but until now, in Germany, Switzerland, and Austria exclusively via pubogenital infections (tinea genitalis profunda) due to T. mentagrophytes after journeys to Southeast Asia. For treatment, oral antifungal agents should be used, first of all terbinafine, alternatively fluconazole or itraconazole.
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Affiliation(s)
- G Wendrock-Shiga
- Hautarztpraxis, Untere Hauptstr. 4a, 09376, Oelsnitz, Deutschland
| | - D Mechtel
- Klinik für Hautkrankheiten und Allergologie, Heinrich-Braun-Klinikum gGmbH, Karl-Keil-Str. 35, 08060, Zwickau, Deutschland
| | - S Uhrlaß
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - D Koch
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - C Krüger
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - P Nenoff
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
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4
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Kirsten H, Haiduk J, Nenoff P, Uhrlaß S, Ziemer M, Simon JC. [Tinea barbae profunda due to Trichophyton mentagrophytes : Case report and review]. Hautarzt 2019; 70:601-611. [PMID: 31001659 DOI: 10.1007/s00105-019-4407-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tinea barbae is a rare dermatomycocis, by definition follicular bound in the beard area of adult men. Manifestation usually starts with erythema accompanied by desquamation. Deeper distribution along terminal hairs leads to folliculitis with formation of pustules and nodes as well as abscesses; fixed adherent yellowish crusts may appear. Frequently there is locoregional swelling of the lymph nodes and occasionally a deterioration of general condition with (sub)febrile temperatures. Often this leads to the initial suspected diagnosis of a bacterial folliculitis barbae or impetigo contagiosa. Tinea barbae is mostly induced by species of the genus Trichophyton (T.). The pathogens are diverse and are mostly zoophilic, sometimes anthropophilic and rarely geophilic dermatophytes. With the help of a specific anamnesis and diagnostic procedure, including mycological examinations, histology and molecular detection of dermatophytes via polymerase chain reaction (PCR), tinea barbae-in our patient induced by T. mentagrophytes-can be rapidly diagnosed. Early initiation and adequate treatment duration lead to restitutio ad integrum.
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Affiliation(s)
- H Kirsten
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
| | - J Haiduk
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
| | - P Nenoff
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Rötha OT Mölbis, Deutschland
| | - S Uhrlaß
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Rötha OT Mölbis, Deutschland
| | - M Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
| | - J C Simon
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
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5
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Furlan KC, Kakizaki P, Chartuni JCN, Valente NYS. Sycosiform tinea barbae caused by trichophyton rubrum and its association with autoinoculation. An Bras Dermatol 2017; 92:160-161. [PMID: 28225985 PMCID: PMC5312207 DOI: 10.1590/abd1806-4841.20174802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/08/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Priscila Kakizaki
- Hospital do Servidor Público Estadual de São Paulo - São Paulo (SP), Brazil
| | | | - Neusa Yuriko Sakai Valente
- Hospital do Servidor Público Estadual de São Paulo - São Paulo (SP), Brazil.,Faculdade de Medicina da Universidade de São Paulo (USP) - São Paulo (SP), Brazil
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6
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Lee WJ, Kim SL, Jang YH, Lee SJ, Kim DW, Bang YJ, Jun JB. Increasing Prevalence of Trichophyton rubrum Identified through an Analysis of 115,846 Cases over the Last 37 Years. J Korean Med Sci 2015; 30:639-43. [PMID: 25931797 PMCID: PMC4414650 DOI: 10.3346/jkms.2015.30.5.639] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/29/2014] [Indexed: 11/23/2022] Open
Abstract
Trichophyton rubrum is the most common dermatophyte in the world with the highest prevalence in Korea. There are few reports about epidemiological and mycological characteristics of T. rubrum based on long-term, large-scale studies. The purpose of this study was to investigate the clinical and epidemiological characteristics of T. rubrum infections in Korea. We retrospectively investigated with patients' records about the epidemiological and mycological status of 115,846 cases with T. rubrum infection that was mycologically diagnosed at Catholic Skin Disease Clinic from 1979 to 2013. Direct microscopy in 15% KOH solution and culture was done in each case. The annual incidence of patients with T. rubrum infection had been increasing during the period; and of 131,122 patients with dermatophytosis, 115,846 patients (88.35%) had T. rubrum infection. Disease was most prevalent among patients in their twenties in the 1970s and 1980s; in their thirties in the 1990s; in their forties in the 2000s; and in their fifties in the 2010s. The sex ratio was 1.5:1. T. rubrum infection was most commonly seen in summer and was found predominantly in patients living in urban areas. Toe webs were most frequently involved, followed by toenails and groin. This epidemiologic findings provide useful information for prevention of T. rubrum infection and future dermatophytosis prospects.
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Affiliation(s)
- Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Lim Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Jun Bang
- Institute of Medical Mycology, Catholic Skin Clinic, Daegu, Korea
| | - Jae Bok Jun
- Institute of Medical Mycology, Catholic Skin Clinic, Daegu, Korea
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7
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Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014; 12:188-209; quiz 210, 188-211; quiz 212. [PMID: 24533779 DOI: 10.1111/ddg.12245] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/19/2013] [Indexed: 02/05/2023]
Abstract
Dermatomycoses are caused most commonly by dermatophytes. The anthropophilic dermatophyte Trichophyton rubrum is still the most frequent causative agent worldwide. Keratinolytic enzymes, e.g. hydrolases and keratinases, are important virulence factors of T. rubrum. Recently, the cysteine dioxygenase was found as new virulence factor. Predisposing host factors play a similarly important role for the development of dermatophytosis of the skin and nails. Chronic venous insufficiency, diabetes mellitus, disorders of cellular immunity, and genetic predisposition should be considered as risk factors for onychomycosis. A new alarming trend is the increasing number of cases of onychomycosis - mostly due to T. rubrum - in infancy. In Germany, tinea capitis is mostly caused by zoophilic dermatophytes, in particular Microsporum canis. New zoophilic fungi, primarily Trichophyton species of Arthroderma benhamiae, should be taken into differential diagnostic considerations of tinea capitis, tinea faciei, and tinea corporis. Source of infection are small household pets, particularly rodents, like guinea pigs. Anthropophilic dermatophytes may be introduced by families which immigrate from Africa or Asia to Europe. The anthropophilic dermatophytes T. violaceum, T. tonsurans (infections occurring in fighting sports clubs as "tinea gladiatorum capitis et corporis") and M. audouinii are causing outbreaks of small epidemics of tinea corporis and tinea capitis in kindergartens and schools. Superficial infections of the skin and mucous membranes due to yeasts are caused by Candida species. Also common are infections due to the lipophilic yeast fungus Malassezia. Today, within the genus Malassezia more than 10 different species are known. Malassezia globosa seems to play the crucial role in pityriasis versicolor. Molds (also designated non-dermatophyte molds, NDM) are increasingly found as causative agents in onychomycosis. Besides Scopulariopsis brevicaulis, several species of Fusarium and Aspergillus are found.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
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Tinea atypica: report of nine cases. Wien Med Wochenschr 2013; 163:549-55. [DOI: 10.1007/s10354-013-0230-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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9
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Kim WJ, Kim TW, Mun JH, Song M, Kim HS, Ko HC, Kim BS, Park CW, Lee SJ, Lee MH, Lee KS, Kye YC, Suh KS, Chung H, Lee AY, Kim KH, Lee SK, Park KC, Lee JY, Choi JH, Lee ES, Lee KH, Choi EH, Seo JK, Choi GS, Park HJ, Yun SK, Seo SJ, Yoon TY, Kim KH, Yu HJ, Ro YS, Kim MB. Tinea incognito in Korea and its risk factors: nine-year multicenter survey. J Korean Med Sci 2013; 28:145-51. [PMID: 23341725 PMCID: PMC3546093 DOI: 10.3346/jkms.2013.28.1.145] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/31/2012] [Indexed: 11/20/2022] Open
Abstract
Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 ± 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
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Affiliation(s)
- Won-Jeong Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae-Wook Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Je-Ho Mun
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Margaret Song
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Mu Hyoung Lee
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyu Suk Lee
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Young Chul Kye
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Hyun Chung
- Department of Dermatology, The Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Ai Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ki Ho Kim
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
| | - Sook Kyung Lee
- Department of Dermatology, Maryknoll Medical Center, Busan, Korea
| | - Kyoung Chan Park
- Department of Dermatology, Seoul National University Bundang Hostpital, Seongnam, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Keun Seo
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University College of Medicine, Incheon, Korea
| | - Hai Jin Park
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seok Kweon Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Young Yoon
- Department of Dermatology, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University College of Medicine, Anyang, Korea
| | - Hee Joon Yu
- Department of Dermatology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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10
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Onychomycosis: modern diagnostic and treatment approaches. Wien Med Wochenschr 2012; 163:1-12. [PMID: 23053563 DOI: 10.1007/s10354-012-0139-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
The medical term onychomycosis should be understood as chronic infection of the nails caused by a fungus. The most common causative agents are the dermatophytes and Candida species. The less common are certain types of moulds (nondermatophyte moulds or NDMs). In approximately 60-80 % of the cases, onychomycosis is due to dermatophytes. Among dermatophytes, the most often isolated causative pathogen is Trichophyton (T.) rubrum. Other common species are T. interdigitale (formerly T. mentagrophytes), Epidermophyton floccosum, and T. tonsurans. The most significant yeasts causing onychomycosis are Candida albicans and Candida parapsilosis. Predisposing factors for onychomycosis include mainly diseases such as diabetes mellitus, peripheral vascular arterial disease, chronic venous insufficiency, polyneuropathies of diverse etiologies, and immunosuppression, e.g., myeloproliferative diseases (such as lymphoma and paraproteinemia), HIV/AIDS, etc. Other factors facilitating the fungal infection are frequent trauma in professional sportsmen, often accompanied by excessive perspiration. The diagnostic methods that are often applied in different dermatologic departments and ambulatory units are also different. This precludes the creation of a unified diagnostic algorithm that could be used everywhere as a possible standard. In most of the cases, the method of choice depends on the specialist's individual experience. The therapeutic approach depends mostly on the fungal organism identified by the dermatologist or mycologist. This review hereby includes the conventional as well as the newest and most reliable and modern methods used for the identification of the pathogens causing onychomycosis. Moreover, detailed information is suggested, about the choice of therapeutic scheme in case whether dermatophytes, moulds, or yeasts have been identified as causative agents. A thorough discussion of the schemes and duration of the antifungal therapy in certain groups of patients have been included.
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11
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Nenoff P, Ginter-Hanselmayer G, Tietz HJ. [Fungal nail infections--an update: Part 1--Prevalence, epidemiology, predisposing conditions, and differential diagnosis]. Hautarzt 2012; 63:30-8. [PMID: 22037817 DOI: 10.1007/s00105-011-2251-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Onychomycosis describes a chronic fungal infection of the nails most frequently caused by dermatophytes, primarily Trichophyton rubrum. In addition, yeasts (e. g. Candida parapsilosis), more rarely molds (Scopulariopsis brevicaulis), play a role as causative agents of onychomycosis. However, in every case it has to be decided if these yeasts and molds are contaminants, or if they are growing secondarily on pathological altered nails. The point prevalence of onychomycosis in Germany is 12.4%, as demonstrated within the "Foot-Check-Study", which was a part of the European Achilles project. Although, onychomycosis is rarely diagnosed in children and teens, now an increase of fungal nail infections has been observed in childhood. More and more, diabetes mellitus becomes important as significant disposing factor both for tinea pedis and onychomycosis. By implication, the onychomycosis represents an independent and important predictor for development of diabetic foot syndrome and foot ulcer. When considering onychomycosis, a number of infectious and non-infectious nail changes must be excluded. While psoriasis of the nails does not represent a specific risk factor for onychomycosis, yeasts and molds are increasing isolated from patients with psoriatic nail involvement. In most cases this represents secondary growth of fungi on psoriatic nails. Recently, stigmatization and impairment of quality of life due to the onychomycosis has been proven.
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Affiliation(s)
- P Nenoff
- Haut- und Laborarzt/Allergologie, Andrologie, Labor für medizinische Mikrobiologie, Strasse des Friedens 8, 04579, Mölbis, Deutschland.
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Atzori L, Pau M, Aste N, Aste N. Dermatophyte infections mimicking other skin diseases: a 154-person case survey of tinea atypica in the district of Cagliari (Italy). Int J Dermatol 2012; 51:410-5. [DOI: 10.1111/j.1365-4632.2011.05049.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Tinea incognito was first described 50 years ago. It is a dermatophytic infection with a clinical presentation modified by previous treatment with topical or systemic corticosteroids, as well as by the topical application of immunomodulators such as pimecrolimus and tacrolimus. Tinea incognito usually resembles neurodermatitis, atopic dermatitis, rosacea, seborrheic dermatitis, lupus erythematosus, or contact dermatitis, and the diagnosis is frequently missed or delayed.
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Affiliation(s)
- Roberto Arenas
- Mycology Section, Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Calzada de Tlalpan 4800, 14080 México, DF, México.
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Tchernev G, Patterson JW, Nenoff P, Horn LC. Sarcoidosis of the skin â A dermatological puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition. J Eur Acad Dermatol Venereol 2010; 24:125-37. [DOI: 10.1111/j.1468-3083.2009.03396.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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