Aspects cliniques et étiologiques des intertrigos d’origine fongique à Abidjan (Côte d'Ivoire)

Introduction

l'épidémiologie de ces affections surtout d'origine mycosique est peu connue en Côte d'Ivoire. Cette étude avait pour objectif de déterminer les différents aspects cliniques et fongiques des intertrigos.

Méthodes

D'avril à octobre 2012, une étude transversale a été conduite dans le service de dermatologie clinique du Centre Hospitalier et Universitaire de Yopougon (Abidjan-Côte d'Ivoire). Elle a concerné les patients vus en consultation et présentant des lésions des plis, évocatrices d'une atteinte mycosique. Les prélèvements de sérosités par écouvillonnage ou de squames par raclage à la lame de Bistouri ont été réalisés au niveau des lésions. Les agents fongiques responsables de ces lésions ont été identifiés après culture du produit biologique.

Résultats

Au total, 200 patients ont présenté des lésions évocatrices d'intertrigo d'origine fongique. L'âge moyen des patients était de 29,8 ans (écart type = 11,1 ans). Les intertrigos mycosiques ont représenté 6,7 % des motifs de consultation. Une prédominance féminine a été observée (76,7%). Les lésions siégeaient majoritairement au niveau de l'aine (40,8%) et des plis inter-fessiers (36,9%). Les symptomatologies les plus observées étaient la macération (52,4%) suivie de la brûlure (18,4%). Les intertrigos étaient causés dans 89,3% des cas par les levures, parmi lesquelles Candida albicans (33%) et Candida parapsilosis (19,4%) étaient prédominants.

Conclusion

Les intertrigos d'origine mycosique affectent principalement les adultes jeunes de sexe féminin. Les lésions siègent préférentiellement au niveau des plis inguinaux et inter-fessiers. Les principaux agents étiologiques sont représentés par des levures du genre Candida.

A randomised trial of honey barrier cream versus zinc oxide ointment

In this single-blind multicentre, intervention study, 31 patients with symmetrical intertrigo in large skin folds were included to study the clinical effect of two topical treatments, i.e. standard therapy with zinc oxide ointment versus honey barrier cream. Patients were treated twice daily for 21 days, and the severity of intertrigo was scored in an observation period of 21 days. Patients were used as their own controls by treating symmetrical skin folds, on the left and right side. There was no significant difference in treatment effect between intervention groups. For the majority of patients, both treatments were effective. However, the use of honey barrier cream showed lower pruritus complaints (12.9% versus 29.0%). Honey barrier cream is a suitable alternative in the treatment of intertrigo, and promotes patient comfort.

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.

Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy

BACKGROUND

Foot intertrigo is mostly caused by dermatophytes and yeasts, less frequently by gram-positive and gram-negative bacteria. Nevertheless, the importance of polymicrobial infections and especially colonizations of Pseudomonas aeruginosa can cause therapy problems in relation to antibiotic resistance and the risk of potentially lethal complications.

OBJECTIVE

The aim of this study was to evaluate the main epidemiologic and clinical features of intertrigo from gram-negative bacteria, the function of promoting factors, and the measures taken to treat and prevent this disorder.

METHODS

Between 1989 and 1998, 123 cases of intertrigo from gram-negative bacteria were observed at the Cagliari University Dermatology Department. Routine clinical and blood examinations, repeated bacterioscopic and mycologic examinations, cultures aimed at identifying the responsible bacteria, and antibiograms were performed.

RESULTS

P aeruginosa was found to be the prevailing pathogen, both alone and associated with other gram-negative bacteria (such as Escherichia coli, Proteus mirabilis, Morganella morganii) and gram-positive bacteria. Clinical manifestations were similar in the majority of patients: erythema, vesicopustules, erosions, and marked maceration caused by abundant, malodorous exudate. Lesions affected the interdigital spaces of both feet and frequently extended to the planta and the back of the toes. Patients complained of burning and pain. Successful therapies were achieved with combined topical and systemic treatment; to avoid the risk of antimicrobial resistance, the choice of the active antibiotic was guided by antibiograms.

CONCLUSION

In all symptomatic toe web infections, the presence of gram-negative germs, such as P aeruginosa, should be investigated to avoid the risk of treatment failures and more severe local or systemic complications.

Etiology of toe-web disease in Al-Ain, United Arab Emirates: bacteriological and mycological studies

We examined and sampled 45 patients with toe-web intertrigo for bacteriological and mycological studies. Prominent isolated pathogens were the genus Candida (57.7%), genus Aspergillus (28.8%), Pseudomonas aeruginosa (26.7%) and coliforms (24.4%). Dermatophytes scored 4.4% (Trichophyton rubrum). There were 43 patents (95.5%) who presented with marked hyperkeratosis and maceration of the toe-webs involved. The tradition of the Emirati population of sitting cross-legged may, over time, induce in the toe-webs of overweight individuals a macerated pressure-reaction hyperkeratosis that is colonized by environmental germs. T. rubrum and T. mentagrophytes are uncommon in the Al-Ain environment and this may explain the rarity of dermatophytes in toe-web intertrigo in our study.

Skin problems beneath the breasts of in-patients: the knowledge, opinions and practice of nurses

A survey of knowledge and nursing practice in relation to sub-mammary skin problems was conducted among ward sisters and primary nurses in one district health authority. Respondents identified a number of characteristics as predisposing factors, with obesity and poor hygiene being mentioned most frequently. A very wide selection of nursing interventions was recommended, with nurses who mentioned pharmacologically active topical preparations reporting a significantly greater number of recurrences among patients than those who relied on less sophisticated regimes. Nurses expressed a variety of opinions about the effect that this condition has on patients, ranging from no effect at all to pain and discomfort. These findings highlight the lack of a coherent strategy for treating this problem and support the continuation of a research programme examining sub-mammary skin problems and the nursing response to them.

The prevalence of skin problems beneath the breasts of in-patients

The prevalence of sore skin beneath the breasts has not been evaluated previously. One hundred and thirty-one wards in one district were visited, and 11.2% of all adult female patients either had an active lesion or one that had healed during her current admission. The patients tended to be in wards for the elderly or mentally ill, often suffering illnesses which affected their functional ability. It is estimated that approximately 2% of all senile admissions will develop this problem in the first six days.

Cutaneous trichosporosis

Of 269 patients with cutaneous trichosporosis a majority of 170 (63.2%) showed the infection as intertrigo in the genitocrural and perianal areas. The predominant symptoms were itching and burning. Trichosporosis has been found to be less common in the other sites. Trichosporosis due to Trichosporon beigelii should be kept in mind as one of the differential diagnosis in cases of genitocrural intertrigo and other cutaneous infections by fungi and bacteria in the tropics.