Toenail onychomycosis by Trichophyton rubrum and concurrent infestation with Tyrophagus putrescentiae

A remarkable case of onychomycosis by Trichophyton (T.) rubrum combined with nail infestation by Tyrophagus (T.) putrescentiae in an elderly diabetic farmer is described and discussed. Large numbers of eggs and mites in all development stages were present in nail debris, reflecting active reproduction on site. Treatment with ivermectin 0.1% cream and environmental decontamination cleared the mite infestation, while onychomycosis responded well to oral terbinafine and ciclopirox 8% nail lacquer. Such a combination of onychomycosis and mite infestation of the same nail is an exceptional finding reported only twice in the literature.

Pediatric Onychomycosis: The Emerging Role of Topical Therapy

Fungal infection of the nails is an increasingly recognized disease in infants and children. However, it can be difficult to distinguish clinically from other nail dystrophies. In addition, many mistakenly believe that onychomycosis does not occur in childhood. Under-recognition of this infectious disorder therefore occurs. Although many consider "nail fungus" a trivial cosmetic concern, it can lead to discomfort, risk of secondary infection, and a more significant health threat in immunocompromised or diabetic individuals. It should always be considered in the differential diagnosis of nail plate disorders in children as it is one of the more common causes.</p> <p>Here we review the latest data on prevalence of the disease, reasons for its relatively low incidence compared with adults, and important predisposing factors. It is important to confirm the clinical diagnosis of onychomycosis in children, and affected individuals should be examined for concomitant tinea pedis. As familial disease often occurs, it is important to check parents and siblings as well for onychomycosis and tinea pedis.</p> <p>Treatment of onychomycosis is challenging, and recurrence appears to be more common in children than in adults. Prolonged systemic antifungal therapy is commonly required. However, pediatric practitioners and parents alike hesitate when asked to treat young children with a systemic drug that requires laboratory monitoring and can have systemic toxicities. Due to their thinner, faster-growing nails, children are theoretically more likely to respond to topical monotherapy than adults, and therefore good candidates for topical antifungal therapy.</p> <p>The clinical data on the use of topical antifungals in pediatric onychomycosis is scarce. We review data that exist from case reports and small clinical trials. New topical antifungals are now available that afford better nail penetration and additional delivery routes to the site of infection. Pediatric trials are now on-going, and should clarify the usefulness of these agents in children.

Gyrate erythema in the setting of tinea pedis

Gyrate erythema, which also is known as erythemaannulare centrifugum (EAC), is a reactive dermatitisthat is thought to occur in response to an underlyingtrigger. The superficial form is characterized bythe typical, centrifugally-expanding, annular,erythematous patches or plaques with a distincttrailing scale. The deep form also is a centrifugallyexpanding,erythematous plaque but with induratedborders and absence of scale. These cutaneousfindings are thought to be reactive, most often inresponse to infections or drugs and, less likely, tounderlying malignant conditions.

Management of onychomycosis and co-existing tinea pedis

Onychomycosis is a common nail infection that often co-exists with tinea pedis. Surveys have suggested the diseases co-exist in at least one third of patients, although actual numbers may be a lot higher due to significant under-reporting. The importance of evaluating and treating both diseases is being increasingly recognized, however, data on improved outcomes, and the potential to minimize re-infection are limited. We review a recent post hoc analysis of two large studies treating mild to moderate onychomycosis with efinaconazole topical solution, 10%, demonstrating that complete cure rates of onychomycosis are significantly improved when any co-existing tinea pedis is also treated.

Recurrent lymphangitic cellulitis syndrome: A quintessential example of an immunocompromised district

Recurrent lymphangitic cellulitis syndrome (RLCS) occurs when a disordered lymphatic system renders a leg vulnerable to recurrent infection. The underlying immunologic defect is the result of accidental or iatrogenic penetrating wounds on the medial aspect of the thigh or lower limb overlying the greater saphenous vein, because the primary lymphatic drainage vessels are adjacent to this structure. Cracking/fissuring of the skin associated with chronic fungal infection of the feet ("athlete's foot"), most commonly mixed bacterial/fungal interdigital involvement, provides a portal of entry for opportunistic organisms. Bacteria and their products are cleared more slowly in the lymphatic-disrupted and therefore immunologically impaired limb, producing broad areas of dermatitis and around the scars quite distinct from other forms of superficial infection. This rarely develop in otherwise normal limbs. The dermatitis of RLCS and its systemic effects clear with antibiotics but recur intermittently until the tinea pedis is eradicated. The contralateral limb with normal lymphatic structures never develops clinical evidence of infection even though bilateral tinea infection is almost always present. This confirms the central role of an anatomically induced immunocompromised district (ICD) in this syndrome.

Factors Influencing Coexistence of Toenail Onychomycosis With Tinea Pedis and Other Dermatomycoses

OBJECTIVE

To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis.

DESIGN

Prospective study based on a specially designed questionnaire completed by dermatologists.

PATIENTS

A total of 2761 patients with toenail onychomycosis.

MAIN OUTCOME MEASURES

The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture.

RESULTS

In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus.

CONCLUSIONS

The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

Resolution of tinea pedis with imiquimod cream 5% in a patient with nodular basal cell carcinoma

A 73-year-old white man with nodular basal cell carcinoma (nBCC) of the toe and interdigital tinea pedis was treated with imiquimod cream 5% once daily for 4 weeks and twice daily for 10 weeks. Results of a posttreatment potassium hydroxide (KOH) preparation and biopsy confirmed clearance of both tinea pedis and nBCC, respectively.

Facteurs associés à la dysidrose palmo-plantaire ou plantaire: étude cas-témoins

BACKGROUND

Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis.

PATIENTS AND METHODS

This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo.

RESULTS

One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls.

DISCUSSION

The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.

Trichophyton eboreum sp. nov. isolated from human skin

An unusual dermatophyte was isolated from the plantar scales of a human immunodeficiency virus-positive man with tinea pedis. Morphology, physiology, and molecular data provided evidence to support the new species Trichophyton eboreum. This dermatophyte is characterized by rapid growth on common mycological media, a flat powdery off-white colony, formation of clavate microconidia, smooth- and thin-walled cylindrical or club-shaped macroconidia with two to nine cells, the presence of hook-shaped hyphae, the production of cleistothecium-like structures and spiral hyphae in older cultures, positive hair perforation, the absence of pigmentation on potato glucose agar, the absence of a requirement for vitamins, a weak positive urease reaction, no growth at 37 degrees C, resistance to 5% NaCl, resistance to fluconazole, good growth on human epidermal keratin, and the production of various enzymes on different media by the API-ZYM test. More than 5% divergence from any known species of dermatophyte was revealed by sequence analysis of the internal transcribed spacer of the rRNA gene.

Evaluation of the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis interdigitalis (dermatophytosis complex) in a randomized, double-blind, placebo-controlled trial

BACKGROUND

Ciclopirox is an antifungal agent and is effective against both Gram-positive and Gram-negative bacteria. These properties may give ciclopirox an advantage over other antifungal agents in the treatment of interdigital tinea pedis with secondary bacterial infection (dermatophytosis complex).

OBJECTIVE

To evaluate the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis interdigitalis with secondary bacterial infection in a prospective, randomized, double-blind, placebo-controlled clinical study.

SUBJECTS AND METHODS

One hundred subjects were enrolled in this 8-week study (twice-daily ciclopirox, 40 subjects; once-daily ciclopirox, 40 subjects; twice-daily vehicle, 20 subjects). Mycologic sampling, bacterial swabs, and evaluations for symptoms and signs of tinea pedis were performed on a target webspace at baseline and at weeks 2, 4, and 8. Global evaluations were made by both investigator and subject at each visit.

RESULTS

Ciclopirox gel applied once or twice daily significantly reduced the signs and symptoms at week 8, compared with vehicle (P<0.0036). The mycologic cure and complete cure rates were much higher for the ciclopirox regimens than for the vehicle regimen. Early reduction of bacterial counts was noted with the ciclopirox regimens. There was no significant difference in the adverse event rate between the ciclopirox groups and the placebo group.

CONCLUSION

Ciclopirox 0.77% gel, applied once or twice daily, is effective and safe in the treatment of tinea pedis interdigitalis with concomitant bacterial infection (dermatophytosis complex).

Tinea cruris in Routine Urology Practice

INTRODUCTION

Tinea cruris is almost exclusively a male dermatophytosis. This infection is also sexually transmitted, and may cause epidemics in public areas such as common bathing facilities, dormitories and among military recruits. It has been aimed to investigate the prevalence and the causative agents of tinea cruris and tinea pedis in patients who were admitted to the Department of Urology with various pathologies.

MATERIALS AND METHODS

Direct microscopy and cultures of the epithelial scrapings were performed to identify the causative agent in patients who were admitted to the Department of Urology.

RESULTS

Out of a total of 155 cases examined, 39 (25.1%) were mycologically proven cases of dermatomycosis. In 11 (28.2%) of the patients tinea pedis, in 3 (7.7%) tinea cruris and in 10 (25.6%) Candida intertrigo were detected. In the remaining 15 (38.5%) cases, only direct microscopic examinations were found positive. The most common causative agent was Candida albicans (33.4%) followed by Trichophyton rubrum (29.1%), Trichophyton mentagrophytes var. interdigitale (29.1%), Candida glabrata (4.2%) and Candida tropicalis (4.2%).

CONCLUSION

The investigation of genital dermatomycosis should be a part of routine urological examination and the clinical diagnosis should be confirmed by mycological methods.

Pedal dermatophyte infection in psoriasis

BACKGROUND

Dermatophyte infections have been considered rare in psoriasis. However, there are data indicating that tinea unguium is as common or even more common in psoriasis compared with healthy controls. Tinea unguium is generally a secondary event to tinea pedis infection.

OBJECTIVES

To study the prevalence of tinea pedis and tinea unguium in psoriasis compared with a control group.

METHODS

Consecutive psoriasis outpatients aged 18-64 years attending a department of dermatology were examined. Samples for direct microscopy and culture were taken from the interdigital spaces, soles and toenails. Consecutive patients without signs of psoriasis or atopic dermatitis seeking examination of moles constituted the control group.

RESULTS

In total, 239 patients with psoriasis and 245 control patients were studied. The prevalence of tinea pedis was 8.8%[95% confidence interval (CI) +/- 3.6%] in the psoriasis group and 7.8% (95% CI +/- 3.4%) in the control group. The corresponding figures for prevalence of tinea unguium were 4.6% (95% CI +/- 2.7%) and 2.4% (95% CI +/- 1.9%), respectively. The differences found in the psoriasis vs. the control groups were not statistically significant.

CONCLUSIONS

This study does not support the hypothesis that the prevalence of tinea pedis and tinea unguium in patients with psoriasis differs from that in a normal population.

Onychomycosis: the development of a clinical diagnostic aid for toenail disease. Part I. Establishing discriminating historical and clinical features

BACKGROUND

The ideal method for diagnosing onychomycosis is unclear. Mycological investigation is currently the method of choice, although there is a false-negative culture rate of at least 30%.

OBJECTIVES

To establish a clinical diagnostic aid which may be used alongside laboratory-based mycological tests and in epidemiological studies.

METHODS

Patients with nail disease (n = 209) were enrolled in the study. The examining clinician completed a questionnaire containing four historical questions and 21 questions related to the clinical findings. All patients had samples taken for mycological analysis. The gold standard for the diagnosis of onychomycosis was a positive result on both direct microscopy and culture of nail samples. Following exclusions, questionnaire responses from 169 patients were analysed using Stata. Multiple logistic regression with forward stepwise selection of variables was performed.

RESULTS

Both microscopy and culture results were positive in 32% of cases and negative in 42%. Dermatophytes formed the majority of isolates. Four parameters were found to be significantly related to positive mycology results: a history of tinea pedis in the last year, scaling on one or both soles, white crumbly patches on the nail surface, and an abnormal colour of the nail plate.

CONCLUSIONS

Our results have shown one historical feature and three clinical features to be strongly associated with onychomycosis. The questionnaire has been revised to include only these stems and is being tested further with the aim of achieving a binary definition.

Trichophyton rubrum in the external auditory meatus. Fallbericht. Trichophyton rubrum im ausseren Gehorgang

We report the case of a 28-year-old immunocompetent male suffering from otitis externa. The right external auditory meatus was filled with cerumen and detritus, the tympanic membrane covered wallpaper-like with layers of fungi. Mycological analysis revealed Trichophyton rubrum. With further examination tinea pedis of plantar and interdigital type and concomitant onychomycosis of the toenails due to T. rubrum could be detected. The auditory meatus was cleaned and treated topically with clotrimazole. Two weeks later the auditory meatus and the tympanic membrane were bare of fungi and the inflammation was resolved. Treatment of tinea pedis and onychomycosis with terbinafine (systemically and topically) is still lasting.

Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy

The aetiology of vesicular eruptions on the palms and on the sides of the fingers (pompholyx) is unclear. The present study was undertaken to establish whether tinea pedis, atopic dermatitis or nickel allergy is a risk factor for development of vesicular eruptions. Three-hundred-and-ninety-eight individuals (included from an ongoing population study on hand eczema in twins) were included. A history of previous hand eczema and atopic dermatitis was taken, and a clinical examination including a patch test with nickel was performed. A test sample for tinea pedis was taken from the fourth interdigital space on the right foot. The relative risk for vesicular eruptions present in individuals with tinea pedis was 3.58 (confidence limits 1.19-10.82, p < 0.05). For individuals with atopic dermatitis, relative risk was 1.44 (confidence limits 0.34-6.07, n.s.) and for those with nickel allergy it was 0.45 (confidence limits 0.06-3.36, n.s.). A relationship between tinea pedis and vesicular eruptions on the hands was statistically confirmed in the present study. In this part of the population study material, no association with atopic dermatitis or nickel allergy was observed.

Treatment of acquired syndactyly by gauze-fixed epidermal graft after radiosurgery

BACKGROUND

Acquired syndactyly is a rare disease that occurs mostly after disease, trauma, or other inflammatory conditions. It is usually treated by surgical incision with a flap or full-thickness skin graft, which is very invasive and requires hospitalization.

OBJECTIVE

The objective was to treat acquired syndactyly with an epidermal graft by suction blister after radiosurgery, because this procedure is much less invasive and can be performed in an outpatient base.

METHODS

A 65-year-old Korean woman had acquired syndactyly after various traditional treatments for tinea pedis. Five days after separation of syndactyly with radiosurgery, we prepared an epidermal sheet by suction blister, placed it on sterile meshed gauze, and applied it to the separated lesion.

RESULTS

The patient's lesion was completely healed after 7 days.

CONCLUSION

Gauze-fixed epidermal graft after radiosurgery is a very effective and simple treatment for shallow acquired syndactyly.

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

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

Asthma, rhinitis and dermatitis triggered by fungal infection: therapeutic effects of terbinafine

We report 2 atopic patients suffering from tinea unguium caused by Trichophyton rubrum. In addition, both patients had symptoms of allergies: one had perennial rhinoconjunctivitis and bronchial asthma, the other had chronic dermatitis of the face and neck. In both cases, their allergy symptoms improved dramatically during oral therapy with the antifungal agent terbinafine (250 mg/day) and relapsed after its discontinuation.

Short-duration oral terbinafine for the treatment of tinea pedis in HIV-positive patients

Management of tinea pedis in patients who have the human immunodeficiency virus (HIV) is problematic; in those patients, dermatophytoses may be more difficult to treat than in the general population. This prospective, open-label, multicenter, randomized study evaluated the efficacy and safety of a short course of oral terbinafine for tinea pedis in patients who are HIV positive. Twenty-seven patients were randomized to receive oral terbinafine 250 mg once daily for 2 or 4 weeks; 17 patients with positive initial cultures and follow-up cultures were evaluable for efficacy at week 8. Mycological cure (defined as negative potassium hydroxide [KOH] microscopy and culture results) occurred in 47% (8) of patients; and modified mycological cure (defined as negative follow-up cultures) occurred in 65% (11) of patients. All 27 patients were evaluated for safety. Clinical cure (defined as minimal residual signs and symptoms) occurred in 82% (14) of patients. Oral terbinafine was well tolerated, indicating that regimens of 2 or 4 weeks are safe and effective for the treatment of tinea pedis in patients who are HIV positive.

Prevalence of dermatophytic skin and nail infections in diabetic patients

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

Erysipelas and tinea pedis

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

Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year follow-up

BACKGROUND

Data about relapses of onychomycosis after treatment with the new systemic antifungals vary among the different studies, with figures ranging from 3 to 20% for terbinafine and from 21 to 27% for itraconazole, depending on the follow-up duration.

OBJECTIVE

To determine the prevalence of relapses of onychomycosis cured by terbinafine compared with that of onychomycosis cured by itraconazole.

METHODS

We followed up 47 patients whose toenail onychomycosis had been mycologically cured in an open randomized study comparing intermittent itraconazole treatment with continuous terbinafine treatment and intermittent terbinafine therapy. Patients were examined every 3 months for up to 3 years after the end of therapy. At each visit clinical and mycologic (direct microscopy and cultures) evaluations were performed.

RESULTS

Eight of the 36 patients (22.2%) who completed the study had a relapse of onychomycosis during the follow-up period, including 2 patients of the terbinafine 250 mg group, 2 patients of the terbinafine 500 mg group and 4 patients in the itraconazole 400 mg group. As the original infection, the relapse was caused in all cases by Trichophyton rubrum.

CONCLUSIONS

This study shows that 22.2% of patients with onychomycosis successfully treated with systemic antifungals experienced a relapse. The relapse rate increased from 8. 3% at month 12 to 19.4% at month 24 and to 22.2% at month 36. Relapses were more common in patients treated with pulse itraconazole (4/11) than in patients treated with continuous (2/12) or intermittent (2/13) terbinafine. Statistical analysis did not reveal any significant difference between relapse rates in the three groups.

Acute infection with Trichophyton rubrum associated with flares of atopic dermatitis

Trichophyton rubrum has been implicated as a potential trigger in flares of atopic dermatitis. We describe a patient with atopic dermatitis who presented with a history of multiple flares and concurrent acute tinea pedis and onychomycosis. Symptoms of atopic dermatitis and culture-positive acute infection with T. rubrum resolved during each flare using systemic antifungals. Flares of atopic dermatitis may be triggered by acute T. rubrum infections. Antifungal therapy should be considered in these patients.

Management and morbidity of cellulitis of the leg

Ascending cellulitis of the leg is a common emergency. An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy. Case notes were reviewed for 92 patients admitted to hospital under adult specialties. Mean duration of inpatient therapy was 10 days. A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis. Pathogens were rarely identified, group G streptococci being the single most frequent organism. Benzylpenicillin was administered in only 43 cases. Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently. Ascending cellulitis of the leg has substantial short-term and long-term morbidity. Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect. The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful.

Bipolar affective disorder, stress fractures, fungal dermopathy and 'tree frog fingers'

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Treatment of onychomycosis and tinea pedis with intermittent itraconazole therapy

A 40-year-old woman had a 10-year history of dermatophyte-related toenail onychomycosis (tinea unguium) and dry-type tinea pedis, which had failed to respond to previous therapy with topical antifungal agents or oral griseofulvin. The patient was successfully treated with four cycles of intermittent itraconazole therapy (that is, 400 mg/d for 1 week per month for 4 months). At the end of this time, the tinea pedis had resolved and the onychomycosis improved significantly after four cycles were completed. Twelve months after the onset of therapy, both conditions had resolved completely according to both clinical and mycologic criteria. Itraconazole was well tolerated, with no side effects reported. These observations suggest that itraconazole intermittent dosing is a highly effective therapy for the treatment of onychomycosis caused by dermatophyte organisms, because it provides a high cure rate after only a short course of therapy.

Cellulitis secondary to web space dermatophytosis

Cellulitis occurring in the lower extremity is encountered frequently and results from a breach of the skin and inoculation of opportunistic bacteria. It has been shown that when web space dermatophytosis is present, changes may occur in normal skin morphology and bacterial flora that can result in severe infection. Knowledge of the pathophysiology of interdigital dermatophytosis allows the clinician to choose the most appropriate empiric antibiotic therapy when treating a secondarily caused cellulitis of the lower extremity.

[Swimmer's eczema: intertrigo, erythrasma or a yeast or fungus infection?]

OBJECTIVE

To determine the proportional contributions of tinea pedis, intertrigo, erythrasma and Candida to 'swimmer's eczema.'

DESIGN

Descriptive.

SETTING

Department of Dermatology, University Hospital Leiden, the Netherlands.

METHOD

General practitioners were encouraged to refer every patient with clinical signs of foot mycosis. Mycological tests (culture and microscopy) were performed.

RESULTS

A total of 296 patients with interdigital mycosis and 30 with tinea pedis of the moccasin type were included. In 56% of the patients with swimmer's eczema dermatophytes were recognised, 10% showed erythrasma and in 30% no cause could be found. Candida only played a minor role. Trichophyton mentagrophytes was found more often in swimmer's eczema than in tinea pedis of the moccasin type.

CONCLUSION

Swimmer's eczema has several causes, which can be determined with mycological tests. Microscopy is the most sensitive method in regard to demonstrating dermatophytes and erythrasma.

Plantar Trichophyton rubrum infections may cause dermatophytids on the hands

Over a 2-year period, we saw 37 patients with a diagnosis of dermatophytid on the hands based on 1) culture-proven dermatophytosis on one or both feet; 2) symmetrical, secondary vesicular eruptions on the fingers and/or palmar aspects of the hands; and 3) a resolution in both areas of involvement after treatment of the dermatophytosis on the foot. During the study period, 128 patients had culture-proven dermatophytosis of the feet caused by Trichophyton rubrum. Nine of these (7%) developed dermatophytid. Seventy-eight patients had dermatophytosis of the feet caused by Trichophyton mentagrophytes. Twenty-seven of these (35%) developed dermatophytid. One of 6 patients infected on the feet with Epidermophyton floccosum developed dermatophytid.

The incidence of skin manifestations by dermatophytes in patients with psoriasis

Thirty-four psoriatic patients (23 males, 11 females) were found to have skin manifestations of dermatophyte infection. Tinea pedis was observed in 20 cases, tinea cruris in 6 and tinea manuum in 2. T. rubrum was the causative agent in all of these with the exception of 2 cases caused by E. floccosum. Lesions of tinea corporis were found intermingled with psoriatic plaques in various areas of the body skin in 6 patients (4 males, 2 females); T. rubrum was isolated from 5 of these and M. canis from one. Twenty-one of these psoriatic patients also had lesions caused by C. albicans in the toe-webs and interdigital aspects of the fingers, the latter being associated with paronychia in 9 cases. These findings indicate that we should remain aware of the possibility of fungus manifestations in patients with psoriasis, which would not appear to be an exceptional occurrence.

Tinea pedis and erythrasma in Danish recruits. Clinical signs, prevalence, incidence, and correlation to atopy

Prior to military service, 665 recruits were examined clinically and microbiologically for tinea pedis and erythrasma and 546 of these were reexamined at the end of military service. The prevalence of clinical signs, erythrasma, and dermatophyte infection at the first investigation was 58.8%, 51.3%, and 6.2%, respectively, and at the second investigation, 81.1%, 77.1%, and 7.0%, respectively. The incidence of tinea pedis was 4.2% during the 9 months of military service. Of those infected at the first visit 41% had persistent infection mainly due to Trichophyton rubrum, whereas new infections were largely caused by Trichophyton mentagrophytes. Some of those persistently infected had signs of chronicity at the follow-up visit, indicating that chronic dermatophytosis may become established in the early twenties. The prevalence of atopy was 15.0% in all the recruits but was almost 50% in those with persistent tinea pedis.

Disuse contractures in a patient with tinea manuum and irritant contact dermatitis

Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.

Amino acid analysis of the horny layer of the soles of patients with hereditary palmoplantar keratoderma

The amino acid composition of keratin from soles of patients suffering from hereditary palmoplantar keratoderma of the Unna Thost variety was investigated. Patients were divided into two groups: those without dermatophytosis and those whose hereditary palmoplantar keratoderma was complicated with a dermatophyte infection. The amino acid composition of the horny layer was compared to that of control individuals and to a previously performed analysis of mammalian hair. However, no difference was found between the groups nor was any explanation as to why Trichophyton mentagrophytes occurred significantly more often in soles of patients with hereditary palmoplantar keratoderma made apparent.