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Yang M, Pan L, Tian H, Zhou T, Xin H, Feng Y, Zou X, Lv Z, Xu Y, Jin X, Gui S, Lu X. pH- and Matrix Metalloproteinase-Responsive Multifunctional Bilayer Microneedles Platform for Treatment of Tinea Pedis. ACS Biomater Sci Eng 2024; 10:3108-3119. [PMID: 38659287 DOI: 10.1021/acsbiomaterials.4c00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Persistent foot odor and itchiness are common symptoms of tinea pedis, significantly disrupting the daily life of those affected. The cuticular barrier at the site of the tinea pedis is thickened, which impedes the effective penetration of antifungal agents. Additionally, fungi can migrate from the skin surface to deeper tissues, posing challenges in the current clinical treatment for tinea pedis. To effectively treat tinea pedis, we developed a platform of bilayer gelatin methacrylate (GelMA) microneedles (MNs) loaded with salicylic acid (SA) and FK13-a1 (SA/FK13-a1@GelMA MNs). SA/FK13-a1@GelMA MNs exhibit pH- and matrix metalloproteinase (MMP)-responsive properties for efficient drug delivery. The MNs are designed to deliver salicylic acid (SA) deep into the stratum corneum, softening the cuticle and creating microchannels. This process enables the antibacterial peptide FK13-a1 to penetrate through the stratum corneum barrier, facilitating intradermal diffusion and exerting antifungal and anti-inflammatory effects. In severe cases of tinea pedis, heightened local pH levels and MMP activity further accelerate drug release. Our research demonstrates that SA/FK13-a1@GelMA MNs are highly effective against Trichophyton mentagrophytes, Trichophyton rubrum, and Candida albicans. They also reduced stratum corneum thickness, fungal burden, and inflammation in a guinea pig model of tinea pedis induced by T. mentagrophytes. Furthermore, it was discovered that SA/FK13-a1@GelMA MNs exhibit excellent biocompatibility. These findings suggest that SA/FK13-a1@GelMA MNs have significant potential for the clinical treatment of tinea pedis as well as other fungal skin disorders.
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Affiliation(s)
- Musheng Yang
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Lingling Pan
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Hongmei Tian
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Tao Zhou
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Hui Xin
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yonglin Feng
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Ziquan Lv
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yinghua Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotechnology Products, National Institutes for Food and Drug Control, Beijing 102629, China
| | - Xiaobao Jin
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Shuiqing Gui
- Intensive Care Unit, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518031, China
| | - Xuemei Lu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
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Ogawa T, Matsuda A, Ogawa Y, Tanaka R. Risk factors for the development of tinea pedis and onychomycosis: Real-world evidence from a single-podiatry center, large-scale database in Japan. J Dermatol 2024; 51:30-39. [PMID: 37904622 DOI: 10.1111/1346-8138.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 11/01/2023]
Abstract
Dermatomycosis, including tinea pedis and onychomycosis, is frequently encountered in routine medical care in Japan. Identifying the risk factors for tinea pedis and onychomycosis development is important to encourage hospital visits by patients who may have these diseases but who are not undergoing any treatment. This approach may lead to the prevention of disease progression and the spread of infections to others. Risk factors for onychomycosis development have been reported both in and outside of Japan. However, most of the risk factors were identified based on a multicenter, questionnaire survey study and included evidence obtained from unclear or inconsistent diagnostic criteria for tinea pedis, onychomycosis, and identified risk factors. The current study analyzed the risk factors for developing tinea pedis and onychomycosis in real-world practice in Japan using a single-center, large-scale database that included the data of patients managed with consistent diagnostic criteria at the Podiatry Center of Juntendo University Hospital. A total of 2476 patients (1012 males, 1464 females) with a mean age of 63.4 years were included. Among these patients, 337 (13.6%) had tinea pedis and 346 (14.0%) had onychomycosis. A total of 259 patients (~ 75% of each patient population) had both diseases concomitantly. Multivariate logistic regression analysis adjusted for the possible risk factors of age (per 10 years), sex, diabetes, dialysis, visual impairment, ulcer history, lower-limb ischemia (LLI), and diabetic peripheral neuropathy (DPN) revealed that advanced age, male sex, diabetes, and LLI were independent risk factors for the development of tinea pedis. In addition, DPN was an independent risk factor for developing onychomycosis. We believe that these data are useful for identifying patients who are at high risk of developing tinea pedis and onychomycosis, which may result in disease prevention and suppression in real-world clinical practice in Japan.
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Affiliation(s)
- Takasuke Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Podiatry Center, Juntendo University Hospital, Tokyo, Japan
| | - Akinori Matsuda
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yumi Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rica Tanaka
- Podiatry Center, Juntendo University Hospital, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Alhammadi N, Al-Jallal M, AlKaabi HA, Malibari WM, Al Jallal RS, Almarshad AS, Binshalhoub FH, Albalawi AN, Adam TA, Al-Khairat AH. Prevalence and Factors Associated With Tinea Pedis Among Diabetic Patients in Saudi Arabia: A Descriptive Cross-Sectional Study. Cureus 2023; 15:e51210. [PMID: 38288233 PMCID: PMC10823190 DOI: 10.7759/cureus.51210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND It has been estimated that 30% of diabetic people experience dermatological problems. Fungal infections are the most frequent cause of these lesions. While tinea infections in non-diabetic individuals rarely cause symptoms, in diabetes patients, they can create fistulas and entry sites that can result in catastrophic bacterial infections. AIM This research paper aims to evaluate the prevalence and factors associated with tinea pedis among diabetic patients in Saudi Arabia. METHODS The research paper incorporated a cross-sectional study approach with the involvement of a questionnaire-based response aimed at all Saudi inhabitants with diabetes mellitus (DM) who conceded to be part of the study. This research was carried out from March 22, 2023, to May 22, 2023, spanning for three months. The participants who satisfied our requirements provided data using computerized Google Forms for data collection; no nominative information disseminated via social media platforms was visible. The three components of the questionnaire address diabetic information, tinea pedis infections, and foot care. RESULTS A total of 295 people with diabetes case were involved in the study. Among them, 149 (50.5%) were males, and their ages stretched from 16 to above 60 years, with a mean age of 49.5 ± 12.9 years old. A total of 194 (65.8%) of the study patients had type II DM. Of 134 (45.4%) were diagnosed with diabetes for more than 10 years. Exact 152 (52%) of the study diabetic patients were diagnosed with tinea pedis. Only patients' BMI showed a significant association with having tinea pedis as 47 of overweight diabetics were diagnosed with tinea pedis versus 47 of obese patients and only five patients of others who were underweight (p=0.049). CONCLUSION This research concluded that almost 50% of patients with diabetes were suffering from obesity and were earlier diagnosed with tinea pedis and poor glycemic control irrespective of reported good diabetic foot care.
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Affiliation(s)
| | | | | | | | - Rahaf S Al Jallal
- Radiology, Applied Medical Sciences, King Khalid University, Abha, SAU
| | | | - Fahad H Binshalhoub
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Tahani A Adam
- Statistics and Operation Research, Qassim University, Buraydah, SAU
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Benedict K, Gold JAW, Jones CT, Tushla LA, Lipner SR, Joseph WS, Tower DE, Elewski B, Pappas PG. Concerning rates of laboratory-confirmed antifungal-resistant onychomycosis and tinea pedis: An online survey of podiatrists, United States. Health Sci Rep 2023; 6:e1694. [PMID: 38028688 PMCID: PMC10667959 DOI: 10.1002/hsr2.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carolynn T. Jones
- Mycoses Study Group Education and Research ConsortiumBirminghamAlabamaUSA
- College of NursingThe Ohio State UniversityColumbusOhioUSA
| | | | - Shari R. Lipner
- Department of DermatologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Warren S. Joseph
- Arizona College of Podiatric MedicineMidwestern UniversityGlendaleArizonaUSA
| | - Dyane E. Tower
- American Podiatric Medical AssociationBethesdaMarylandUSA
| | - Boni Elewski
- Department of DermatologyUniversity of BirminghamBirminghamAlabamaUSA
| | - Peter G. Pappas
- Department of Medicine, Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Leeyaphan C, Chai-Adisaksopha C, Tovanabutra N, Phinyo P, Bunyaratavej S. Developing diagnostic criteria to differentiate fungal foot infections caused by Neoscytalidium dimidiatum and dermatophytes. Heliyon 2023; 9:e18963. [PMID: 37600426 PMCID: PMC10432213 DOI: 10.1016/j.heliyon.2023.e18963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background The predisposing factors and clinical presentations of fungal foot infections caused by non-dermatophytes and dermatophytes are challenging to differentiate. Definite diagnoses of non-dermatophyte infections at first visits facilitate their treatment. Objectives This study aimed to develop diagnostic criteria to differentiate fungal foot infections caused by Neoscytalidium dimidiatum and dermatophytes. Methods Diagnostic prediction research based on a retrospective, observational, cross-sectional study. The reviewed patients were aged ≥18 and underwent a mycological examination for fungal foot infections. A fungal culture at the initial visit was the gold standard for determining causative organisms. Results Analyses were carried out on the data from 371 patients. N. dimidiatum accounted for 184 (49.6%) infections, and dermatophytes caused the remaining 187 (50.4%) cases. Five significant predefined predictors were used to develop the diagnostic criteria and score. They were immunocompetence status, no family history of fungal infections, the absence of pruritus, the absence of other concurrent fungal skin infections, and agricultural work. The lower score cutoff was <8 (sensitivity 97.8% and specificity 25.7%). The higher cutoff was >11 (sensitivity 83.7% and specificity 57.8%). The score showed an area under the receiver operating characteristic curve of 0.755 and was well calibrated. Conclusions The criteria and score show promise for clinical use, with acceptable discriminative performance and good calibration. They will help physicians differentiate the causative organisms in patients with fungal foot infections at the first visit, enabling the determination of appropriate antifungal treatment.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatree Chai-Adisaksopha
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napatra Tovanabutra
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Reynolds FH, Tusa MG, Banks SL. Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review. Adv Skin Wound Care 2023; 36:377-384. [PMID: 37224470 PMCID: PMC10289232 DOI: 10.1097/01.asw.0000933728.56221.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/22/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To present the toe web space as an anatomically, physiologically, and pathologically unique part of the human body; characterize toe web infections and discuss why they occur; and highlight toe web psoriasis as an uncommon condition that providers should consider if toe web intertrigo does not respond to treatment. DATA SOURCE This review encompassed many years of clinical observation and photographs; medical textbooks; and a literature search of MEDLINE, PubMed, and Google Scholar. STUDY SELECTION Primary research keywords included intertrigo, toe web intertrigo, toe web infection, tinea pedis, microbiome, skin microbiome, toe web microbiome, ecology, psoriasis, psoriasis microbiome, intertriginous psoriasis, and Wood's lamp. More than 190 journal articles met the search criteria. DATA EXTRACTION The authors sought data relating to what makes for a healthy toe web space and what makes for disease. They extracted and collated relevant information to compare and contrast among sources. DATA SYNTHESIS After understanding the normal toe web space and the microorganisms that normally reside there, the authors investigated why infections occur, how they should be treated, what complications may result, and what other diseases occur in the toe web area. CONCLUSIONS This review of toe web infection illustrates the effect of the microbiome and reports a rare form of psoriasis that is usually misdiagnosed as athlete's foot. The toe web space is a unique part of the human body that can be affected by a variety of both common and unusual conditions.
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Affiliation(s)
- F Hall Reynolds
- F. Hall Reynolds II, MD, FAASD; Mark G. Tusa, MD, FAAD; and Samuel L. Banks, MD, FAAD, are Staff Dermatologists, Chattanooga Skin & Cancer Clinic, Tennessee, USA
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Khalifa A, Alreshidi IG, Alaradi LA, Alrashidi YM. Tinea Unguium and Tinea Pedis and Their Correlation With Diabetes Mellitus in the General Population in the Hail Region, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e40116. [PMID: 37425521 PMCID: PMC10329282 DOI: 10.7759/cureus.40116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Tinea pedis or foot ringworm is an infection of the feet affecting the soles, interdigital clefts of toes, and nails, with a dermatophyte fungus. It is also called athlete's foot. Onychomycosis of the nail is caused by dermatophytes called Tinea unguium. An abnormal nail not caused by a fungal infection is a type of dystrophic nail. Onychomycosis can infect both fingernails and toenails, but onychomycosis of the toenail is much more prevalent. Aim The study aimed to assess the knowledge, perception, and awareness among a sample from Ha'il City, Saudi Arabia, of the definitions, risk factors, symptoms, diagnosis, complications, and treatment of both Tinea pedis and Tinea unguium, along withtheir correlation with diabetic patients. Material A cross-sectional survey was distributed throughout Ha'il City. An online questionnaire was designed and distributed via various social media apps, which included questions concerning participants' sociodemographic information, alongside questions regarding the risk factors, signs, symptoms, complications, and management of both Tinea pedis and Tinea unguium. Methods SPSS for Windows v22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used for statistical analysis. Results The overall awareness of the study's participants about Tinea Pedis and Tinea unguium infection was low (34.82%).
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Echuri H, Sivesind TE, Dellavalle RP. From the Cochrane library: Oral treatments for fungal infections of the skin of the foot. J Am Acad Dermatol 2022; 87:e183-e184. [PMID: 35810839 DOI: 10.1016/j.jaad.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Harika Echuri
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Ward H, Parkes N, Smith C, Kluzek S, Pearson R. Consensus for the Treatment of Tinea Pedis: A Systematic Review of Randomised Controlled Trials. J Fungi (Basel) 2022; 8:jof8040351. [PMID: 35448582 PMCID: PMC9027577 DOI: 10.3390/jof8040351] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: To systematically review literature enabling the comparison of the efficacy of pharmaceutical treatments for tinea pedis in adults. Design: Systematic review of randomised controlled trials (RCTs) with mycological cure as the primary outcome. Secondary outcomes did include the clinical assessment of resolving infection or symptoms, duration of treatment, adverse events, adherence, and recurrence. Eligibility Criteria: Study participants suffering from only tinea pedis that were treated with a pharmaceutical treatment. The study must have been conducted using an RCT study design and recording age of the participant > 16 years of age. Results: A total of seven studies met the inclusion criteria, involving 1042 participants. The likelihood of resolution in study participants treated with terbinafine was RR 3.9 (95% CI: 2.0−7.8) times those with a placebo. Similarly, the allylamine butenafine was effective by RR 5.3 (95% CI: 1.4−19.6) compared to a placebo. Butenafine was similarly efficacious to terbinafine RR 1.3 (95% CI: 0.4−4.4). Terbinafine was marginally more efficacious than itraconazole, RR 1.3 (95% CI: 1.1−1.5). Summary/Conclusion: Topical terbinafine and butenafine treatments of tinea pedis were more efficacious than placebo. Tableted terbinafine and itraconazole administered orally were efficacious in the drug treatment of tinea pedis fungal infection. We are concerned about how few studies were available that reported the baseline characteristics for each treatment arm and that did not suffer greater than 20% loss to follow-up. We would like to see improved reporting of clinical trials in academic literature. Registration name: Treatment’s for athlete’s foot—systematic review with meta-analysis [CRD42020162078].
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Affiliation(s)
- Harry Ward
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham NG7 2UH, UK;
- Bodleian Health Care Libraries, Oxford University, Oxford OX3 9DU, UK;
- Correspondence:
| | - Nicholas Parkes
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham NG7 2UH, UK;
- Bodleian Health Care Libraries, Oxford University, Oxford OX3 9DU, UK;
| | - Carolyn Smith
- Bodleian Health Care Libraries, Oxford University, Oxford OX3 9DU, UK;
| | - Stefan Kluzek
- Orthopaedics, Trauma and Sports Medicine, School of Medicine, Queen’s Medical, Centre University of Nottingham, Nottingham NG7 2UH, UK; (S.K.); (R.P.)
| | - Richard Pearson
- Orthopaedics, Trauma and Sports Medicine, School of Medicine, Queen’s Medical, Centre University of Nottingham, Nottingham NG7 2UH, UK; (S.K.); (R.P.)
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Ishijima SA, Ezawa K, Abe S. Lemongrass and Perilla Essential Oils Synergistically Increased Antimicrobial Activity. Med Mycol J 2021; 62:79-87. [PMID: 34853254 DOI: 10.3314/mmj.21-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We postulated that disinfection of viable Trichophyton species in shoes would help reduce the number of patients with tinea pedis in Japan and that this might be accomplished safely using volatile components of essential oils. As vapor of lemongrass (Cymbopogon citratus) oil and citral have strong antimicrobial activities against Trichophyton, we examined the conditions under which lemongrass oil or citral show optimal antimicrobial activity in shoes. First, we investigated whether or not a strong antimicrobial effect could be obtained by combining with terpene aldehydes or aromatic aldehydes. When combined with citral, perillaldehyde showed superior antimicrobial activity to citronellal, cinnamaldehyde, cuminaldehyde, hydroxycitronellal, and vanillin. The combined effects of citral and perillaldehyde against Trichophyton mentagrophytes, Bacillus subtilis, and Candida albicans as volatile components dotted on filter paper placed away from the petri dish inoculated with fungi or bacteria were examined. Citral (2.5 mg/mL) and perillaldehyde (2.5 mg/mL) showed a greater inhibitory effect on growth of C. albicans than either solution alone in the aromatogram (disc diffusion) descent method (fractional inhibitory concentration [FIC] index of 0.58). Citral (2.5 mg/mL) and perillaldehyde (1.25 mg/mL) vapors in a closed box synergistically inhibited growth of B. subtilis and T. mentagrophytes (FIC indexes of 0.5 and 0.38, respectively). These results suggested that this combination would be safe and useful for disinfection of shoes.
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Affiliation(s)
| | - Kunio Ezawa
- Teikyo University Institute of Medical Mycology
| | - Shigeru Abe
- Teikyo University Institute of Medical Mycology
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Mizumoto J. Two Feet-One Hand Syndrome. Cureus 2021; 13:e20758. [PMID: 35111444 PMCID: PMC8791668 DOI: 10.7759/cureus.20758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
Ringworm infection is a common but frequently misdiagnosed skin disease. An 81-year-old woman presented with a complaint of mild itch of the third and fourth fingers of her right hand and the toes of both feet. A crusted rash was seen on the right hand and both feet. The results of potassium hydroxide testing were positive for filamentous fungi. The diagnosis of two feet-one hand syndrome was made. The rash was treated successfully by topical ketoconazole. Recognition of this typical distribution of the rash may help make a prompt diagnosis of ringworm infection.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
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Kabtani J, Diongue K, Dione JN, Delmas A, L'Ollivier C, Amoureux MC, Ndiaye D, Ranque S. Real-Time PCR Assay for the Detection of Dermatophytes: Comparison between an In-House Method and a Commercial Kit for the Diagnosis of Dermatophytoses in Patients from Dakar, Senegal. J Fungi (Basel) 2021; 7:949. [PMID: 34829236 DOI: 10.3390/jof7110949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background. PCR assays have been developed for the diagnosis of dermatophytes, yet data in African populations are scarce. Objective. This study aimed to compare two PCR assays for the diagnosis of dermatophytosis in outpatients at the Aristide Le Dantec University Hospital in Dakar, Senegal. Patients and methods. A total of 105 samples, including 24 skin, 19 nail and 62 hair samples collected from 99 patients were included in this study. Each sample was subjected to conventional diagnosis (CD), including direct microscopy and culture, and two real-time PCR assays: one in-house (IH)-PCR, used at the University Hospital of Marseille and the Eurobio Scientific commercial kit (CK): designed for the specific detection of six dermatophytes not including Microsporum audouinii. Results. Of the 105 specimens, 24.8%, 36.2% and 20% were positive by CD, IH-PCR and CK-PCR, respectively. The IH-PCR and CK-PCR exhibited 88.9% and 65.4% sensitivity, respectively. With a 36.6 diagnostic odd ratio and 1.41 needed to diagnose, the IH-PCR displayed better diagnostic indices than the CK-PCR. It is notable that, when considering the species that it claims to detect, when it came to skin and nail samples, CK-PCR sensitivity increased to 77%. Conclusions. The pan-dermatophyte IH-PCR performed better in the diagnosis of dermatophytosis in this African population than the CK-PCR, which is not designed to detect M. audouinii. Nevertheless, both assays exhibited similarly good diagnostic indices for tinea corporis and tinea unguium, both of which are localisations where M. audouinii is more rarely involved than in tinea capitis.
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Nowicka D, Nawrot U. Tinea pedis-An embarrassing problem for health and beauty-A narrative review. Mycoses 2021; 64:1140-1150. [PMID: 34145648 DOI: 10.1111/myc.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Fungal infections present with a broad spectrum of diseases in humans (from relatively mild superficial infections of the skin and mucous membranes to the invasive or chronic infections of internal organs, which have a high mortality rate). Globally, up to 1.6 million people die each year as a result of various types of mycoses. Currently, many scientific studies focus on the best possible understanding of the aspects of the epidemiology and pathogenesis of invasive mycoses and effective methods to combat them. However, mycoses of the skin and its appendages remain a relatively less explored area. In some communities, superficial mycoses are a frequent problem as they affect nearly 70% of the population, an example of which is the athlete's foot. It involves the nails (onychomycosis) and skin (tinea pedis). It is mainly caused by keratin-decomposing dermatophyte fungi. Less often, infections are caused by non-dermatophyte moulds (Fusarium, Aspergillus, Scopulariopsis) or yeasts. Several factors have been listed as having substantial influence on the development of dermatophytosis, including those related to climate, season, geographical region, as well as to demography, socioeconomic and cultural customs, professions or contact with animals. In this review, we summarise the current knowledge about aetiology, epidemiology, diagnostics and therapy of tinea pedis with a special focus to the role of podologic management in spreading, prevention and therapy of mycoses. The article presents up-to-date knowledge on the management of the patient from the diagnosis, treatment and skincare, to counselling on how to prevent fungal skin infections in the long term.
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Affiliation(s)
- Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, Wrocław, Poland
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14
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Pham CVA, Rademacher F, Hinrichs H, Beck-Jendroschek V, Harder M, Brasch J, Gläser R, Harder J. Expression of epidermal antimicrobial peptides is increased in tinea pedis. Mycoses 2021; 64:763-770. [PMID: 33797129 DOI: 10.1111/myc.13279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tinea pedis is often chronic or recurrent, but not all individuals are equally susceptible to this infection. Dermatophytes are able to induce the expression of antimicrobial peptides and proteins (AMPs) in human keratinocytes and certain AMPs can inhibit the growth of dermatophytes. OBJECTIVE The focus of this study was to analyse the secretion of relevant AMPs, especially RNase 7, human beta-defensin-2 (hBD-2) and the S-100 protein psoriasin (S100A7), in patients with confirmed tinea pedis. METHODS To verify the diagnosis, skin scales were obtained from all patients (n = 13) and the dermatophytes were identified by potassium hydroxide mount, culture and molecular analysis. To determine the AMP concentrations, the lesional skin area of the foot was rinsed with a buffer that was subsequently analysed by ELISA. The corresponding area of the other unaffected foot as well as defined healthy skin areas of the forearm and forehead and samples from age and gender-matched healthy volunteers served as controls. RESULTS In tinea pedis patients the AMP concentrations were higher in lesional skin than in non-lesional skin and in healthy skin of controls. In particular, concentrations of hBD-2 and psoriasin were significantly elevated. CONCLUSIONS The induction of AMPs in tinea pedis might be triggered directly by the dermatophytes; furthermore, attendant inflammation and/or differentiation processes may play a role. Our results indicate that there is no defect in the constitutive expression and induction of the analysed AMPs by dermatophytes in the epidermis of affected patients. However, it is not known why the elevated AMP concentrations fail to efficiently combat dermatophyte growth.
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Affiliation(s)
- Christina Van Anh Pham
- Department of Dermatology, Venerology and Allergology, Quincke Research Center, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Franziska Rademacher
- Department of Dermatology, Venerology and Allergology, Quincke Research Center, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Heilwig Hinrichs
- Department of Dermatology, Venerology and Allergology, Quincke Research Center, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Vera Beck-Jendroschek
- Department of Dermatology, Venerology and Allergology, Mycological Laboratory, University Hospitals of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Melanie Harder
- EUROIMMUN Medical Laboratory Diagnostic AG, Lübeck, Germany
| | - Jochen Brasch
- Department of Dermatology, Venerology and Allergology, Mycological Laboratory, University Hospitals of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Regine Gläser
- Department of Dermatology, Venerology and Allergology, Quincke Research Center, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jürgen Harder
- Department of Dermatology, Venerology and Allergology, Quincke Research Center, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Aragón-Sánchez J, López-Valverde ME, Víquez-Molina G, Milagro-Beamonte A, Torres-Sopena L. Onychomycosis and Tinea Pedis in the Feet of Patients With Diabetes. INT J LOW EXTR WOUND 2021; 22:321-327. [PMID: 33891512 DOI: 10.1177/15347346211009409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to determine the prevalence of onychomycosis and interdigital tinea pedis in a cohort of Spanish patients with diabetes in whom onychomycosis was clinically suspected (n = 101). Samples from a first toenail scraping and the fourth toe clefts were subjected to potassium hydroxide direct vision and incubated in Sabouraud and dermatophyte test medium. Fifty-eight samples were also analyzed by a pathologist using periodic acid-Schiff staining and Calcofluor white direct fluorescence microscopy. Onychomycosis was only confirmed in 41 patients (40.6%). The most frequent aetiological agent was Trichophyton rubrum, isolated in 10 patients (36%), followed by Candida parapsilosis in 7 patients (25%). Tests on the fourth toe cleft samples were only positive in 11 patients (10.9%), and in all cases, onychomycosis was also diagnosed. Neuroischemic foot was the only significant variable associated with onychomycosis in the univariate analysis (P < .01). A positive result for mycosis in the fourth toe cleft was found in 11 cases (10.9%) and was associated with a history of myocardial infarction (P< .01; odds ratio [OR]: 84.2, confidence interval [CI]: 6.8-1036.4) and neuroischemic foot (P< .01; OR: 13.7, CI: 12.6-71.6) in the multivariate model. In conclusion, the prevalence of onychomycosis and tinea pedis in patients with diabetes in whom onychomycosis was clinically suspected was 40.6% and 10.9%, respectively. In addition, onychomycosis was not always associated with tinea pedis. These results show that clinical diagnosis has low accuracy in people with diabetes mellitus, and that diagnosis should not be based on clinical toenail characteristics alone.
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16
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Tsuboi R, Mochizuki T, Ito H, Kawano S, Suzuki Y, Naka W, Hata Y, Hamaguchi T, Maruyama R. Validation of a lateral flow immunochromatographic assay for tinea unguium diagnosis. J Dermatol 2021; 48:633-637. [PMID: 33686693 DOI: 10.1111/1346-8138.15838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
Tinea unguium is a common nail disease caused by dermatophytes. Although direct potassium hydroxide (KOH) microscopy and fungal culture are considered the gold standard for diagnosing this disease, their accuracy is insufficient. A lateral flow immunochromatographic assay (LFIA) kit, using a monoclonal antibody against Trichophyton rubrum, was developed and its sensitivity was recently improved 50% in vitro relative to its earlier version. The present study aimed to validate the clinical utility of this improved LFIA kit for diagnosing tinea unguium in comparison with direct KOH microscopy. A similar trial was simultaneously performed using scale samples from patients with tinea pedis to determine the assay's diagnostic potential. Nail samples, approximately 2 mg in weight, were collected from 112 non-treated tinea unguium patients and 56 non-tinea unguium patients. Samples from 25 tinea pedis patients and 20 non-tinea pedis patients were also collected. The sensitivity and specificity of the LFIA kit for tinea unguium was 84.8% (95/112) (95% confidence interval [CI], 76.8-90.9) and 83.9% (47/56) (95% CI, 71.7-92.4), respectively. The inconsistency rate was 15.5% (26/168) (95% CI, 10.4-21.9). The sensitivity and specificity of the LFIA kit for tinea pedis was 84.0% (21/25) and 100.0% (20/20), respectively. These results suggest that for diagnosing tinea unguium, the LFIA kit is a useful supplement to, but not a replacement for, direct KOH microscopy. For definitive diagnosis of suspected cases, appropriate sampling, repeated examinations, and a combination of diagnostic techniques are essential.
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Affiliation(s)
- Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Uchinada, Japan
| | | | | | | | | | - Yasuki Hata
- Kanagawa Hata Hifuka Clinic, Yokohama, Japan
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Cantelli M, Capasso G, Costanzo L, Fabbrocini G, Gallo L. Tinea pedis in a child: How reflectance confocal microscopy can help in diagnosis of dermatophytosis. Pediatr Dermatol 2021; 38:522-523. [PMID: 33320359 DOI: 10.1111/pde.14487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
A 7-year-old girl presented with a hyperkeratotic scale on the plantar surface of her left foot. A microscopic potassium hydroxide examination was performed and negative. Reflectance confocal microscopy was performed showing fungal hyphae and an inflammatory infiltrate confirming a diagnosis of tinea pedis.
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Affiliation(s)
- Mariateresa Cantelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italia
| | - Gianmarco Capasso
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italia
| | - Luca Costanzo
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italia
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italia
| | - Lucia Gallo
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italia
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Gencer Atalay K, Giray E, Yolcu G, Yağcı İ. Meralgia paresthetica caused by inguinal lymphadenopathy related to tinea pedis infection: A case report. Turk J Phys Med Rehabil 2020; 66:473-5. [PMID: 33364569 DOI: 10.5606/tftrd.2020.4459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022] Open
Abstract
Mechanical compression at any point along the lateral femoral cutaneous nerve (LFCN) may result in meralgia paresthetica (MP). A 54-year-old male patient presented with pain and tingling on the anterolateral side of thigh. After excluding other causes of pain radiating to legs, he was diagnosed with MP. Inguinal lymphadenopathy which caused the compression of LFCN was found on ultrasonographic examination. Tinea pedis infection was also identified during the detailed investigation for lymphadenopathy. Associated MP symptoms partially resolved immediately after ultrasound-guided LFCN block and a complete recovery was achieved after the treatment of tinea pedis.
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Genatrika E, Sundhani E, Oktaviana MI. Gel Potential of Red Onion ( Allium cepa L.) Ethanol Extract as Antifungal Cause Tinea Pedis. J Pharm Bioallied Sci 2020; 12:S733-S736. [PMID: 33828369 PMCID: PMC8021042 DOI: 10.4103/jpbs.jpbs_256_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/16/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction: Tinea pedis is a dermatophyte infection of human feet, especially between the fingers and soles of the feet. Tinea pedis is caused by a fungal infection of Trichophyton rubrum. Red onion is one of the spices that has been widely known by the community and used as a traditional medicine in the prevention of fungus. The objective of this research was to determine the antifungal activity of gel produced from an extract of red onion on T. rubrum. Materials and Methods: The gel was formulated with various concentration of red onion, FI with a concentration of extract (5%), F2 (7.5%). and F3 (12.5%). Each formula tested the physical characteristics and antifungal activity toward T. rubrum. The antifungal activity was determined by the agar well-diffusion method using Saboround Dextrose Agar plates. Furthermore, the antifungal activities were assessed by the presence or absence of inhibition zones after the plates were incubated at 28oC for 7 days. Results: F3 has the greatest inhibitory power than F1 and F2 (P < 0.05). Then, F3 has the same inhibitory power as a positive control (P > 0.05). Discussion: All gel understudy at various concentrations of red onion was formulated in gel-exhibited antifungal activity. Antifungal activity of red onion occurred because it contained allicin. Therefore, the researchers can use these gels as a natural antifungal in the healing of tinea pedis caused by T. rubrum. Conclusion: The gel from an extract of red onion showed significant antifungal activity against T. rubrum.
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Affiliation(s)
- Erza Genatrika
- Department of Pharmaceutics and Technology of Pharmacy, Pharmacy Faculty, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Elza Sundhani
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Pharmacy Faculty, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Mayang I Oktaviana
- Pharmacy Faculty, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
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Iwanaga T, Ushigami T, Anzawa K, Mochizuki T. Viability of pathogenic dermatophytes during a 4-week treatment with 1% topical luliconazole for tinea pedis. Med Mycol 2020; 58:401-403. [PMID: 31111903 PMCID: PMC7108760 DOI: 10.1093/mmy/myz056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/04/2019] [Accepted: 05/03/2019] [Indexed: 12/04/2022] Open
Abstract
The viability of pathogenic fungi in the scale was investigated during topical administration of 1% luliconazole (LLCZ). Thirteen tinea pedis patients found to be positive on KOH examination were assessed by mycological examinations and quantitative real-time polymerase chain reaction (PCR) targeted internal transcribed spacer (ITS) in ribosomal RNA gene at the initial visit and after 2 and 4 weeks of treatment. Assays showed that the average copy number of ITS DNA had significantly decreased to 22.9% at 2 weeks and 4.8% at 4 weeks compared with the initial visit. LLCZ topical treatment could defeat almost pathogenic dermatophytes in the scales within 4 weeks.
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Affiliation(s)
- Tomoyuki Iwanaga
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - Tsuyoshi Ushigami
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - Kazushi Anzawa
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
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Kara Polat A, Akın Belli A, Göre Karaali M, Koku Aksu AE. The attitudes, behaviors, and opinions about non-pharmacological agents in patients with tinea pedis. Dermatol Ther 2020; 33:e14041. [PMID: 32691920 DOI: 10.1111/dth.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
Tinea pedis affects the life quality distinctly and patients those with a prolonged disease often resort to non-medical methods. We sought to evaluate patients' knowledge about tinea pedis and approaches to the non-pharmacological agents. A cross-sectional study was conducted on 152 patients with tinea pedis who answered the survey between July and November 2019. Demographic and clinical features, patients' attitudes, behaviors, and opinions about non-pharmacological treatments related to tinea pedis were evaluated. Of 152 patients, 65 (42.8%) were female and 87 (57.2%) were male. The frequency of at least one non-pharmacological agent use for tinea pedis was 55.9%. The most common non-pharmacological agent was cologne (27.0%), followed by saltwater, vinegar, and henna. The rate of non-pharmacological agent use was not significantly different between genders and patients with different education levels. Information sources for tinea pedis were dermatologists in only 42 patients (27.8%). The opinion that the disease will improve spontaneously was not significantly different between the groups according to the education level (P = .154). Tinea pedis needs awareness as a health problem particularly in Muslim populations. Patients should be prevented from applying wrong practices and informed about the risk factors, contagiousness, and treatment options by physicians.
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Affiliation(s)
- Asude Kara Polat
- Department of Dermatology, University of Health Sciences, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Aslı Akın Belli
- Department of Dermatology, Çakmak Erdem Hospital, Istanbul, Turkey
| | - Müge Göre Karaali
- Department of Dermatology, Erzincan Binali Yıldırım University, Mengücek Gazi Education and Research Hospital, Erzincan, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, University of Health Sciences, Istanbul Education and Research Hospital, Istanbul, Turkey
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22
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Bontems O, Fratti M, Salamin K, Guenova E, Monod M. Epidemiology of Dermatophytoses in Switzerland According to a Survey of Dermatophytes Isolated in Lausanne between 2001 and 2018. J Fungi (Basel) 2020; 6:jof6020095. [PMID: 32604976 PMCID: PMC7345625 DOI: 10.3390/jof6020095] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Dermatophytes are the most common pathogenic agents of superficial mycoses in humans and animals. Knowledge of their epidemiology can facilitate the prevention of dermatophytosis and improve prophylactic measures. We sought to determine the incidence of the different dermatophyte species diagnosed in Lausanne (Switzerland) from 2001 to 2018. In total, 10,958 dermatophytes were isolated from patients and 459 from pets. Overall, 99% of tinea unguium and tinea pedis were caused by Trichophyton rubrum and Trichophyton interdigitale with a prevalence ratio of 3:1. Trichophyton violaceum and Trichophyton soudanense were mainly found in tinea capitis in patients of African and Mediterranean origin. Interestingly, while Epidermophyton floccosum and Trichophyton verrucosum were prevalent 50 years ago in an epidemiological analysis carried out in the same laboratory from 1967 to 1970, these two species were rarely detected from 2001 to 2018. Trichophyton mentagrophytes, Trichophyton benhamiae and Microsporum canis were the prevalent zoophilic pathogenic species in children and young adults. Our investigation of animal samples revealed the main reservoirs of these zoophilic species to be cats and dogs for T. mentagrophytes and M. canis, and Guinea pigs for T. benhamiae. This study provides an epidemiological overview of dermatophytoses in Switzerland to improve their surveillance.
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Affiliation(s)
- Olympia Bontems
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (O.B.); (M.F.); (K.S.); (E.G.)
| | - Marina Fratti
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (O.B.); (M.F.); (K.S.); (E.G.)
| | - Karine Salamin
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (O.B.); (M.F.); (K.S.); (E.G.)
| | - Emmanuella Guenova
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (O.B.); (M.F.); (K.S.); (E.G.)
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Michel Monod
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (O.B.); (M.F.); (K.S.); (E.G.)
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-0376; Fax: +41-21-314-0378
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Gamage H, Sivanesan P, Hipler UC, Elsner P, Wiegand C. Superficial fungal infections in the department of dermatology, University Hospital Jena: A 7-year retrospective study on 4556 samples from 2007 to 2013. Mycoses 2020; 63:558-565. [PMID: 32187409 DOI: 10.1111/myc.13077] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Superficial fungal infections are often seen in day-to-day clinical practice, and their prevalence continues to rise worldwide. Over the years, a change in the pattern of dermatophytoses has been noted. OBJECTIVES This study aimed to determine the epidemiologic profile of dermatophytes at the Department of Dermatology, University Hospital Jena, from 2007 to 2013. METHODS The retrospective study was carried out with a total of 4556 samples collected from 3607 patients suspected of superficial fungal infections during the 7-year study period. RESULTS Among the 3607 suspected patients, 1951 (54.09%) were men and 1656 (45.91%) were women. Of 4556 samples, 703 (15.43%) samples were positive for fungal culture, which included 585 (83.21%) dermatophytes and 118 (16.79%) non-dermatophytes. Trichophyton (T.) rubrum was the most common isolated pathogen in 73.33% of the dermatophyte cases. Among dermatophyte-infected patients, men were most likely to be affected (63.48%) as well as those of higher age (61 to 80). The most commonly affected areas were nails (33.16%) and feet (33%). T rubrum was recurrently isolated in several regions with exception of the scalp where M canis (58.33%) was the most frequently isolated pathogen. About 16.04% of cases had a history of treatment taken prior to sampling. The majority of the affected individuals did not have any prior animal contact (77.26%). T benhamiae was exclusively associated with contact to guinea pigs. CONCLUSION Trichophyton rubrum was the most frequently isolated pathogen in several regions except the scalp. New dermatophyte species emerged with time especially T benhamiae.
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Affiliation(s)
- Hasanga Gamage
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | | | | | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Jena, Germany
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Boctor N, Aronowitz P. Syphilis as Athlete's Foot: "The Great Imitator" Strikes Again. J Gen Intern Med 2020; 35:350. [PMID: 31705478 DOI: 10.1007/s11606-019-05440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
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Ishizaki S, Watanabe S, Sawada M, Ninomiya J, Otani T, Tanaka M, Harada T, Kamei K. A Case of Tinea Pedis in a Child Caused by Trichophyton interdigitale with Two Different Colony Phenotypes on Primary Culture. Med Mycol J 2019; 60:91-94. [PMID: 31787732 DOI: 10.3314/mmj.19-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An otherwise healthy 3-year-old girl presented with a several-month history of scaly lesions on her palms and soles. The lesions on the palms and right sole had been successfully treated with a steroid for pompholyx by a nearby dermatology clinic, but the lesion on the left sole persisted and spread to the back of the foot. On the initial visit, the patient exhibited an itchy and scaly erythematous left foot lesion. Direct microscopic examination of the scales revealed a considerable amount of fungal elements. A diagnosis of tinea pedis was made, and antifungal treatment with a neticonazole ointment was initiated. Complete cure was achieved after 4 weeks of treatment. The primary mycological cultures from the scales simultaneously revealed two types of colonies: a white powdery flat colony and a white downy elevated colony with a reddish-yellow bottom. Although the powdery colony was identified as Trichophyton mentagrophytes complex on slide culture, the downy colonies could not be identified based on cultural and morphological characteristics. The nucleotide sequences of the internal transcribed spacer region from both colonies showed an exact match, which eventually led to their identification as Trichophyton interdigitale. Further genotyping at three points in the non-transcribed spacer region in both colonies also showed the same NTS type of D2II. It is very rare for two morphologically different colonies to be isolated from the primary culture under the same conditions in tinea cases. Genetic tests are of extreme value to identify the strain in such cases.
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Affiliation(s)
- Sumiko Ishizaki
- Department of Dermatology, Tokyo Women's Medical University Medical Center East
| | - Soko Watanabe
- Department of Dermatology, Tokyo Women's Medical University Medical Center East
| | - Mizuki Sawada
- Department of Dermatology, Tokyo Women's Medical University Medical Center East
| | - Junya Ninomiya
- Department of Dermatology, Tokyo Women's Medical University Medical Center East
| | - Tomoko Otani
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East
| | - Masaru Tanaka
- Department of Dermatology, Tokyo Women's Medical University Medical Center East
| | - Takashi Harada
- Department of Dermatology, Tokyo Women's Medical University Medical Center East.,Harada Dermatology Clinic
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University
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Abstract
The relation between tinea pedis and the internal environment of footwear has not been scientifically proven. This study aimed to determine whether the internal environment of footwear affects the incidence of tinea pedis and tinea unguium. This cross-sectional, observatory study involved 420 outpatients who were categorized into non-tinea, tinea pedis or tinea unguium groups based on mycological analysis. External climatic conditions, and temperature, humidity and dew points inside the patients' footwear were recorded. Univariate and multivariate analyses were used to determine independent risk factors for tinea pedis and tinea unguium. A significant correlation was found between high temperature/high humidity and dew point of the internal environment of the footwear and the season. Furthermore, those who wore footwear with internal environments characterized by high temperature, high humidity, high-temperature/high-humidity and high dew point values had a significantly higher incidence of tinea pedis. The internal dew point correlated with the incidence of tinea pedis, whereas the external temperature correlated with the incidence of tinea unguium. The internal humidity and dew point of footwear as well as the frequency with which footwear with a high-temperature/high-humidity internal environment were worn was significantly higher in men than in women. In conclusion, the internal environment of footwear is a risk factor for tinea pedis, and this environment is affected by the season. Moreover, the frequency of tinea pedis among men is related to the internal environment of footwear. The dew point is an appropriate index for evaluating temperature and humidity in relation to tinea pedis.
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Abstract
Onychomycosis is the most common affliction of the nail. It may be caused by dermatophytes, yeasts, and non-dermatophyte molds. Traditionally, oral antifungal treatments have been used to treat the fungus, although they can be accompanied by side effects and drug interactions. Topical treatments provide an alternative modality, bypassing the systemic effects of oral drugs; recent research has centered on topical drug improvement and development. Physical and laser treatments are being used in conjunction with topicals, which may help penetrate the thick nail plate. In this review, techniques from all categories are outlined: both novel experimental approaches and progress and effectiveness of recently developed treatments. More long-term studies are required to determine the efficacy of various treatments, but cure rates are improved when patients adhere to treatments and follow preventative measures to avoid disease recurrence.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | - Nadia Stec
- Mediprobe Research Inc., London, Ontario, Canada
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Reynolds TM, Morreau MWP, John L, Jeans MS. One Foot After Another-Fungal Foot Issues in Expedition Adventure Racing. Wilderness Environ Med 2019; 30:93-95. [PMID: 30718137 DOI: 10.1016/j.wem.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
Skin infections are an important issue among participants in expedition-length adventure races. Prolonged stress, scant sleep, and water exposure mean that competitors are at risk of uncommon manifestations of infections. Ulcerative tinea pedis is an example of this. We present a case with characteristic clinical manifestations, including the "sandpaper symptom." There is limited literature exploring infectious foot complaints in expedition adventure racers. Beyond this case report, more research is needed to better understand incidence rates, risk factors, diagnostic measures, treatment, and prevention options.
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Kang R, Lipner S. Consumer preferences of antifungal products for treatment and prevention of tinea pedis. J DERMATOL TREAT 2019; 30:745-749. [PMID: 30661432 DOI: 10.1080/09546634.2019.1572862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tinea pedis is a common condition seen in clinical practice and has a significant impact on quality of life. Recommendations of over-the-counter antifungal products based on consumer preferences may guide dermatologists in treating patients with tinea pedis and preventing onychomycosis recurrences. Our study aimed to determine consumer preferences of antifungal products for tinea pedis, focusing on features that may guide purchases and usage. A search was performed for antifungal products used to treat athlete's foot on Amazon.com as of 2018, and the top one percentile of over-the-counter products were sorted by rating and number of reviews. Functionality was the most cited positive feature (42% of comments) followed by cosmetic characteristics (14%). The median price of all products was $1.80 (range $0.33-$95.42), with solutions and balms associated with higher costs and soaks being the least expensive. Our study showed that the range of antifungal products available online for treatment and prevention of tinea pedis is large and variable in terms of type/vehicle, price, and ingredients. Physicians must counsel patients on the efficacy and Food and Drug Administration approval of listed ingredients, especially for those products associated with numerous supplementary claims.
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Affiliation(s)
- Rachel Kang
- Weill Cornell Medical College , New York , NY , USA
| | - Shari Lipner
- Department of Dermatology, Weill Cornell Medicine , New York , NY , USA
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Bajuk V, Leskovec NK, Ručigaj TP, Suhodolčan AB, Dolenc-Voljč M. Toenail alterations in chronic venous disease patients are not always of mycotic origin. Phlebology 2018; 34:421-426. [PMID: 30541415 DOI: 10.1177/0268355518818619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The prevalence of toenail alterations in chronic venous disease has only rarely been studied. We aimed to establish the frequency and clinical characteristics of toenail onychomycosis in chronic venous disease. Methods We included 80 adult patients, in all stages of chronic venous disease. Onychomycosis was confirmed by mycological examination. The clinical type of onychomycosis and the onychomycosis severity index were determined. Clinical characteristics of non-fungal nail changes were also analyzed. Results We included 58 women and 22 men, with a mean age of 67.0 years. Pathological toenail changes were observed in 83.8% of patients. Onychomycosis was confirmed in 33.8% of all patients and was more frequent in higher clinical stages of chronic venous disease (p = 0.009). Trichophyton rubrum was the leading causative pathogen. Disto-lateral onychomycosis was most commonly present. Average onychomycosis severity index was 23.1. Conclusion Onychomycosis accounted for 40% of all toenail alterations. Patients with chronic venous disease often have severe and difficult to treat toenail onychomycosis.
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Affiliation(s)
- Vid Bajuk
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nada Kecelj Leskovec
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Planinšek Ručigaj
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mateja Dolenc-Voljč
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Stasko N, McHale K, Hollenbach SJ, Martin M, Doxey R. Nitric Oxide-Releasing Macromolecule Exhibits Broad-Spectrum Antifungal Activity and Utility as a Topical Treatment for Superficial Fungal Infections. Antimicrob Agents Chemother 2018; 62:e01026-17. [PMID: 29760128 DOI: 10.1128/AAC.01026-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 04/30/2018] [Indexed: 11/20/2022] Open
Abstract
Cutaneous and superficial fungal infections affecting the skin, nails, and hair of humans are caused primarily by dermatophytes of the genera Trichophyton and Epidermophyton or by yeasts of the genera Candida and Malassezia. Onychomycosis is a common fungal infection of the nail that frequently coexists with tinea pedis, the most prevalent mycotic skin infection. Efficacy rates for current topical onychomycosis therapies are hampered by low drug penetration across the nail plate, which is theoretically obviated with nitric oxide (NO)-based topical therapies. The Nitricil technology platform is comprised of polysiloxane-based macromolecules that stably release therapeutic levels of NO. In the reported studies, NVN1000, the lead candidate of the platform, was assessed for its spectrum of in vitro activity against a broad range of filamentous fungi and yeast species commonly associated with cutaneous fungal infections. Time-kill assays demonstrated that NVN1000 exhibited fungicidal activity as early as 4 h. Additionally, the penetration of several unique NVN1000 NO-releasing drug product formulations (gel, cream, and lacquer) was evaluated following a single topical application in an in vitro infected human nail assay, with all formulations showing similar inhibition of fungal growth. Repeated topical application in this model demonstrated that a lower-strength dose of NO could achieve the same efficacy as a higher-strength dose after 7 days. Together, these in vitro results demonstrate that NO-releasing treatments rapidly penetrate the nail plate and eradicate the fungal infection, representing promising novel topical therapies for the treatment of onychomycosis and other cutaneous fungal infections.
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Pchelin IM, Azarov DV, Chilina GA, Dmitriev KA, Vasilyeva NV, Taraskina AE. Single-nucleotide polymorphism in a local population of Trichophyton rubrum. Med Mycol 2018; 56:125-128. [PMID: 28204589 DOI: 10.1093/mmy/myx009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/20/2017] [Indexed: 11/15/2022] Open
Abstract
Trichophyton rubrum is an important causative agent of superficial mycoses worldwide. To uncover a genetic composition of a local population of this fungus, we sequenced A7C99_6411 and A7C99_6714 loci, coding for hypothetical proteins and revealed two complex genotypes, differing by a single missense mutation in each locus. One of the two A7C99_6411/6714 genotypes was not found in tinea pedis cases and demonstrated mostly longer TRS-1 elements when compared to another genotype. Thus, we present a description of nucleotide polymorphism in protein-coding loci in T. rubrum and provide evidence for ecological preferences of T. rubrum genotypes at a local scale.
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Affiliation(s)
- Ivan M Pchelin
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Daniil V Azarov
- Department of Epidemiology, Parasitology and Disinfectology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Galina A Chilina
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Kirill A Dmitriev
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Natalya V Vasilyeva
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Anastasia E Taraskina
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
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Toukabri N, Corpologno S, Bougnoux ME, El Euch D, Sadfi-Zouaoui N, Simonetti G. In vitro biofilms and antifungal susceptibility of dermatophyte and non-dermatophyte moulds involved in foot mycosis. Mycoses 2017; 61:79-87. [PMID: 28940733 DOI: 10.1111/myc.12706] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
Tinea pedis and onychomycosis are among the commonest fungal diseases in the world. Dermatophytes and, less frequently, non-dermatophyte moulds are aetiological agents of foot mycosis and are capable of forming biofilms. Fungal biofilm has demonstrated increasing drug resistance. This work aims to evaluate, in vitro, the ability to form biofilm and the susceptibility to antifungal drugs of sessile dermatophytes and non-dermatophyte moulds involved in foot mycosis. Thirty-six dermatophytes and non-dermatophyte moulds isolated from Tunisian patients with foot mycoses, and identified with MALDI-TOF have been tested. MICs of fluconazole, econazole, itraconazole, terbinafine and griseofulvin were carried out using CLSI broth microdilution method. The ability to form biofilm and antifungal activities of drugs against fungal biofilm formation has been quantified by Crystal Violet and Safranin Red staining. Biomass quantification revealed that all species studied were able to form biofilms in vitro after 72 hours. Fluconazole, econazole, itraconazole and terbinafine inhibited fungal growth with MIC values ranging from 0.031 to >64 μg mL-1 . The best antifungal activity has been obtained with terbinafine against Fusarium solani. Econazole showed the highest activity against fungal biofilm formation. These findings can help clinicians to develop the appropriate therapy of foot mycosis.
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Affiliation(s)
- Nourchéne Toukabri
- Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Serena Corpologno
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Marie-Elisabeth Bougnoux
- Department of Microbiology, Hôpital Necker-Enfants Malades AP-HP, University Paris-Descartes, Paris, France
| | - Dalenda El Euch
- Department of Dermatology and Venereology, Hôpital La Rabta, Tunis, Tunisia
| | - Najla Sadfi-Zouaoui
- Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Giovanna Simonetti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
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34
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Goto T, Nakagami G, Takehara K, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities. J Wound Care 2017; 26:179-183. [PMID: 28379097 DOI: 10.12968/jowc.2017.26.4.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to examine the accuracy of visual diagnosis of tinea pedis (Athlete's foot) and tinea unguium (fungal nail infection), as well as to provide information on skin abnormalities that could help identify these diseases in aged care facilities (long-term care facilities (LTCFs) and nursing homes). METHOD A multicentre, cross-sectional observational study was conducted in a LTCF and two nursing homes. A dermatologist observed the skin abnormalities in the participants' interdigital and plantar areas, to screen for tinea pedis, and in the participants' toenails, to screen for tinea unguium. If abnormalities were noted, samples such as scales or toenails were collected and examined using direct microscopy. The accuracy of the macroscopic observation for each skin abnormality was examined. RESULTS A total of 173 residents were recruited. The accuracy of clinical diagnosis using macroscopic observation was relatively low. The sensitivities and specificities for clinical diagnosis were 0.37 and 0.95 for tinea pedis in the interdigital areas, 0.47 and 0.94 for tinea pedis in the plantar areas, and 0.80 and 0.61 for tinea unguium in toenails, respectively. Scales in the plantar areas and discoloration of the toenails were more frequently observed in residents with tinea pedis and tinea unguium than in those without them. CONCLUSION Several skin abnormalities were observed in the residents recruited in this study, but there was insufficient correlation with tinea pedis and tinea unguium to be used for screening.
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Affiliation(s)
- T Goto
- PhD student, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Tokyo, Japan
| | - G Nakagami
- Lecturer, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Takehara
- Lecturer, Department of Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Nakamura
- Physician, Shukokai Medical Corporation, Tokyo, Japan
| | - M Kawashima
- Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Tsunemi
- Associate Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Sanada
- Professor, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
Onychomycosis and tinea pedis are common fungal infections affecting the nails and feet, respectively. Two newly approved topical agents for onychomycosis are efinaconazole and tavaborole, both of which have demonstrated respectable cure rates in clinical studies. For tinea pedis, naftifine 2% and luliconazole 1% are new agents, both administered for relatively short courses, that may foster greater adherence Semin Cutan Med Surg 35(supp6):S110-S113.
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Affiliation(s)
- Theodore Rosen
- Professor of Dermatology Baylor College of Medicine Houston, Texas
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36
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Abstract
The prevalence of superficial mycotic infection worldwide is 20–25% of which dermatophytes are the most common agents. Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. Hence, a lack of delayed hypersensitivity reaction in presence of a positive immediate hypersensitivity (IH) response to trichophytin antigen points toward the chronicity of disease. Diagnosis, though essentially clinical should be confirmed by laboratory-based investigations. Several new techniques such as polymerase chain reaction (PCR) and mass spectroscopy can help to identify the different dermatophyte strains. Management involves the use of topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. However, due to the lack of updated national or international guidelines on the management of tinea corporis, cruris, and pedis, treatment with systemic antifungals is often empirical. The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedia while highlighting the lack of clarity of certain management issues.
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Affiliation(s)
- Alok Kumar Sahoo
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Adams C, Athanasoula E, Lee W, Mahmudova N, Vlahovic TC. Environmental and Genetic Factors on the Development of Onychomycosis. J Fungi (Basel) 2015; 1:211-6. [PMID: 29376909 DOI: 10.3390/jof1020211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/15/2015] [Accepted: 08/19/2015] [Indexed: 11/17/2022] Open
Abstract
Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the United States. Even though onychomycosis has a high prevalence in the US, other parts of the world including Canada, West Africa, Southeast Asia, Northern Australia, and Europe have been well documented with cases of fungal toenail infection in their environments. Trichophyton rubrum (T. rubrum) is the major dermatophyte responsible for toenail fungal infection and is typically diagnosed in conjunction with tinea pedis, especially in individuals older than 60 years. Gender roles, age, cultural habits, shoe gear, sports activities, and genetic predisposition all contribute to the different presentation of onychomycosis in these areas where organisms like dermatophytes, candida, and molds were isolated in a variety of cases. Despite the differences in isolated pathogens, treatment outcomes remained consistent. This literature review discusses the influence of tinea pedis, genetics, shoe gear, sports, and age on the development of onychomycosis.
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Blutfield MS, Lohre JM, Pawich DA, Vlahovic TC. The Immunologic Response to Trichophyton Rubrum in Lower Extremity Fungal Infections. J Fungi (Basel) 2015; 1:130-137. [PMID: 29376904 PMCID: PMC5753105 DOI: 10.3390/jof1020130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/30/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022] Open
Abstract
Manifestations of Trichophyton rubrum infestations, such as tinea pedis, tinea cruris, and tinea corporis, are among the most common human skin diseases seen throughout the world. About 80% of patients presenting with acute dermatophytosis respond well to topical antifungal treatment. However, the remaining 20% of patients progress into a chronic state of dermatophytosis, which is resistant to antifungal treatment. Therefore, it is necessary to have a better understanding and appreciation for the diverse immune responses to Trichophyton as this is critical for the development of therapeutic strategies for those individuals who suffer from a chronic manifestation of Trichophyton rubrum (T. rubrum) infection. As a result, a comprehensive literature review was conducted to review and discuss previous studies that evaluated the human body’s defense to T. rubrum infections and to understand why and how these fungal infections invade the host defense system. Our research revealed that a cell-mediated immune response is critical in defending the body against T. rubrum. However, this organism has mechanisms that enable it to evade the immune system. Therefore, a more successful treatment for chronic T. rubrum infection would involve targeting the mechanisms of T. rubrum that diminish the immune response, while restoring the cell-mediated immune response.
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Affiliation(s)
- Matthew S Blutfield
- Temple University School of Podiatric Medicine, 148 N. 8th St., Philadelphia, PA 19107, USA.
| | - Jenna M Lohre
- Temple University School of Podiatric Medicine, 148 N. 8th St., Philadelphia, PA 19107, USA.
| | - Derek A Pawich
- Temple University School of Podiatric Medicine, 148 N. 8th St., Philadelphia, PA 19107, USA.
| | - Tracey C Vlahovic
- Temple University School of Podiatric Medicine, 148 N. 8th St., Philadelphia, PA 19107, USA.
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Arai S, Yoshino T, Fujimura T, Maruyama S, Nakano T, Mukuno A, Sato N, Katsuoka K. Mycostatic effect of recombinant dermcidin against Trichophyton rubrum and reduced dermcidin expression in the sweat of tinea pedis patients. J Dermatol 2014; 42:70-6. [PMID: 25384912 DOI: 10.1111/1346-8138.12664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/08/2014] [Indexed: 11/29/2022]
Abstract
Trichophytosis, a common dermatophytosis, affects nearly 20-25% of the world's population. However, little is known about mechanisms for preventing colonization of Trichophyton on the skin. Dermcidin, an antimicrobial peptide that provides innate immunity to the skin and is constitutively secreted even in the absence of inflammatory stimulation, was studied to elucidate its antimycotic activity against Trichophyton. Recombinant dermcidin was determined to have antimycotic activity against Trichophyton rubrum, as evaluated by colony-forming unit (CFU) assays. The killing rate of dermcidin was 40.5% and 93.4% at 50 μg/mL (the average dermcidin concentration in healthy subjects) and 270 μg/mL, respectively. An effect of dermcidin treatment was found to be a reduction of the metabolic activity of Trichophyton as determined by nicotinamide adenine dinucleotide assay. Further, dermcidin concentrations in sweat of tinea pedis patients were found to be lower than those of healthy subjects. These findings suggest a mycostatic role for dermcidin, at normal sweat concentrations. Accordingly, we suspect that dermcidin, at normal sweat concentrations, inhibits growth of Trichophyton, where Trichophyton is subsequently eliminated in conjunction with epidermis turnover. Dermcidin, therefore, appears to play a role in the skin protection mechanism that prevents colonization of tinea pedis.
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Affiliation(s)
- Satoru Arai
- Department of Dermatology, Kitasato University School of Medicine, Sagamihara, Japan
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Sanada H, Nakagami G, Takehara K, Goto T, Ishii N, Yoshida S, Ryu M, Tsunemi Y. Antifungal Effect of Non-Woven Textiles Containing Polyhexamethylene Biguanide with Sophorolipid: A Potential Method for Tinea Pedis Prevention. Healthcare (Basel) 2014; 2:183-91. [PMID: 27429269 DOI: 10.3390/healthcare2020183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/03/2014] [Accepted: 03/21/2014] [Indexed: 11/16/2022] Open
Abstract
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal invasion. This study investigates the antifungal effects, cytotoxicity, permeability, and efficacy of non-woven textiles containing polyhexamethylene biguanide (PHMB) mixed with sophorolipid. Permeability of PHMB with varying concentrations of sophorolipid was assessed via a cultured skin model. Stratum corneum PHMB concentration was quantified by polyvinylsulphuric acid potassium salt titration and cytotoxicity was assayed via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. Antifungal effects were evaluated via a new cultured skin/Trichophytonmentagrophytes model, with varying PHMB exposure duration. Clinically-isolated Trichophyton were applied to the feet of four healthy volunteers and then immediately treated with the following methods: washing with soap, a non-woven textile with PHMB, the textile without PHMB, or without washing. Fungal colony forming units (CFUs) were evaluated after one of these treatments were performed. Sophorolipid with various concentrations significantly facilitated PHMB permeation into the stratum corneum, which was not in a dose-dependent manner. Significant PHMB antifungal effects were achieved at 30 min, with low cytotoxicity. Textiles containing PHMB significantly reduced CFU of fungi in healthy volunteers to levels comparable to soap washing. Our results indicate the utility of this product for tinea pedis prevention in clinical settings.
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Shi TW, Zhang JA, Zhang XW, Yu HX, Tang YB, Yu JB. Combination treatment of oral terbinafine with topical terbinafine and 10% urea ointment in hyperkeratotic type tinea pedis. Mycoses 2014; 57:560-4. [PMID: 24697872 DOI: 10.1111/myc.12198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/07/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
Abstract
Hyperkeratotic-type tinea pedis is chronic and recalcitrant to topical antifungal agents. Some topical antifungal agents are effective; however, long duration of therapy is required, which often reduce the treatment compliance of patients. To seek for short period therapy of hyperkeratotic type tinea pedis, in this study, we observed the efficacy and safety of treatment of topical terbinafine and 10% urea ointment combined oral terbinafine. Participants with hyperkeratotic type tinea pedis were randomly assigned to two groups. Patients in group I were treated with oral terbinafine for 2 weeks and topical terbinafine and 10% urea ointment for 4 weeks, whereas in group II, only the above topical agents were applied for 12 weeks. Clinical improvement rates and fungal eradication rates were compared between the two groups at 24 weeks after the initiation of treatment. The group I had stopped the topical therapy 8 weeks earlier than group II. There were no significant differences in mycological eradication rates and clinical improvement rates between the two groups, besides, no major side effects were noted in both groups. The short combination therapy with oral terbinafine was effective and safe; it should be a valuable option for patients with hyperkeratotic type tinea pedis.
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Affiliation(s)
- Tian-Wei Shi
- Department of Dermatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Department of Dermatology, People's Hospital of Zhengzhou, Zhengzhou, China
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Abstract
BACKGROUND About 15% of the world population have fungal infections of the feet (tinea pedis or athlete's foot). There are many clinical presentations of tinea pedis, and most commonly, tinea pedis is seen between the toes (interdigital) and on the soles, heels, and sides of the foot (plantar). Plantar tinea pedis is known as moccasin foot. Once acquired, the infection can spread to other sites including the nails, which can be a source of re-infection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES To assess the effects of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH METHODS For this update we searched the following databases to July 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and CINAHL (from 1981). We checked the bibliographies of retrieved trials for further references to relevant trials, and we searched online trials registers. SELECTION CRITERIA Randomised controlled trials of oral treatments in participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes (fungi) in culture. DATA COLLECTION AND ANALYSIS Two review authors independently undertook study selection, 'Risk of bias' assessment, and data extraction. MAIN RESULTS We included 15 trials, involving 1438 participants. The 2 trials (71 participants) comparing terbinafine and griseofulvin produced a pooled risk ratio (RR) of 2.26 (95% confidence interval (CI) 1.49 to 3.44) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole, fluconazole and itraconazole, fluconazole and ketoconazole, or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo: terbinafine (31 participants, RR 24.54, 95% CI 1.57 to 384.32) and itraconazole (72 participants, RR 6.67, 95% CI 2.17 to 20.48). All drugs reported adverse effects, with gastrointestinal effects most commonly reported. Ten of the trials were published over 15 years ago, and this is reflected by the poor reporting of information from which to make a clear 'Risk of bias' assessment. Only one trial was at low risk of bias overall. The majority of the remaining trials were judged as 'unclear' risk of bias because of the lack of clear statements with respect to methods of generating the randomisation sequence and allocation concealment. More trials achieved blinding of participants and personnel than blinding of the outcome assessors, which was again poorly reported. AUTHORS' CONCLUSIONS The evidence suggests that terbinafine is more effective than griseofulvin, and terbinafine and itraconazole are more effective than no treatment. In order to produce more reliable data, a rigorous evaluation of different drug therapies needs to be undertaken with larger sample sizes to ensure they are large enough to show any real difference when two treatments are being compared. It is also important to continue to follow up and collect data, preferably for six months after the end of the intervention period, to establish whether or not the infection recurred.
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Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res 2011; 4:26. [PMID: 22136082 PMCID: PMC3248359 DOI: 10.1186/1757-1146-4-26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/04/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Effective treatment of tinea pedis and onychomycosis is crucial for patients with diabetes as these infections may lead to foot ulcers and secondary bacterial infections resulting in eventual lower limb amputation. Although numerous studies have assessed the effectiveness of antifungal drug and treatment regimens, most exclude patients with diabetes and examine otherwise healthy individuals. While these studies are useful, results cannot necessarily be extrapolated to patients with diabetes. The purpose of this study was to therefore identify the best evidence-based treatment interventions for tinea pedis or onychomycosis in people with diabetes. METHODS The question for this systemic review was: 'what evidence is there for the safety and/or efficacy of all treatment interventions for adults with tinea pedis and/or onychomycosis in people with diabetes'? A systematic literature search of four electronic databases (Scopus, EbscoHost, Ovid, Web of Science) was undertaken (6/1/11). The primary outcome measure for safety was self-reported adverse events likely to be drug-related, while the primary outcome measures assessed for 'efficacy' were mycological, clinical and complete cure. RESULTS The systematic review identified six studies that examined the safety and/or efficacy of treatment interventions for onychomycosis in people with diabetes. No studies were identified that examined treatment for tinea pedis. Of the studies identified, two were randomised controlled trials (RCTs) and four were case series. Based on the best available evidence identified, it can be suggested that oral terbinafine is as safe and effective as oral itraconazole therapy for the treatment of onychomycosis in people with diabetes. However, efficacy results were found to be poor. CONCLUSIONS This review indicates that there is good evidence (Level II) to suggest oral terbinafine is as safe and effective as itraconazole therapy for the treatment of onychomycosis in people with diabetes. Further research is needed to establish the evidence for other treatment modalities and treatment for tinea pedis for people with diabetes. Future efforts are needed to improve the efficacy of treatment intervention.
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Affiliation(s)
- Lisa Matricciani
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Kerwin Talbot
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Sara Jones
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
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Abstract
Coaches and athletic team physicians have provided anecdotal information and case studies to support their beliefs that athletes may be unusually prone to illness during strenuous training or competition. Many athletes, in contrast, believe that physical activity improves their resistance to infectious disease. However, it is generally agreed that the stress of competition may make athletes temporarily more susceptible to infectious illness. A review of the literature shows that upper respiratory tract infections and skin infections are more prevalent in top level athletes than in the general population, particularly during periods of intensive training. Exercise induced changes occur in both the innate and adaptive components of the immune system; however, the relative importance of each component is unknown. Strenuous exertion and contact sports may compromise host defence both by reducing physical protection and by impairing immunosurveillance. Skin lacerations, vigorous sweating and maceration of the dermis impair the defence normally provided by the skin surface. In addition, adverse changes in soluble and cellular components of the immune system can increase susceptibility to infection. Persistence with strenuous training during an infectious illness can have deleterious effects; not only is athletic performance impaired, but the severity of the disease process can be augmented.
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Affiliation(s)
- I K Brenner
- School of Physical and Health Education, Division of Community Health, University of Toronto, Ontario, Canada
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