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PubMedDate not supplied

Efficacy of oral fluconazole in tinea pedis of the hyperkeratotic type. Stratum corneum levels.

In this study, in addition to studying the efficacy and safety of the once-daily administration of 100-mg capsules of fluconazole over an 8-week administration period with six patients with hyperkeratotic-type tinea pedis, we also measured the serum and horny layer concentrations of fluconazole to study the mobility into the horny layer in diseased areas of the sole skin. The final overall efficacy and overall safety were both 100% (six out of six), and no side-effects, including abnormal laboratory changes, were observed in any of the patients. The drug mobility study revealed that in the horny layer of the skin a steady state was reached after 4 weeks of administration, with the mean concentration being 12.8 micrograms g-1. This concentration was a high concentration that was no less than 13 times the geometric mean MIC (0.972 microgram ml-1) for fresh clinical isolates of Trichophyton rubrum. Based on the above results, fluconazole is considered to be highly useful for treating various kinds of dermatomycosis, including hyperkeratotic-type tinea pedis.

Administration, Oral↗
PubMed2004

Pityriasis versicolor on the groin mimicking erythrasma.

Pityriasis versicolor (PV) is a widespread dermatomycosis caused by yeasts. Erythrasma is a superficial bacterial skin disease affecting the major folds of the body, particularly the groin. We report the case of a 45-year-old man, affected by PV, exclusively localized in the inguinal folds and in the inner surface of the thighs, characterized by lesions clinically reproducing erythrasma. The authors underline the possibility that PV mimics erythrasma and vice versa, especially in those countries in which both diseases are quite common, and stress the importance of performing a simple mycological examination to avoid gross diagnostic and therapeutic errors.

Antifungal Agents↗
PubMed2004

Dermatophytes in the rural area of Duzce, Turkey.

A total of 227 subjects (112 were male and 115 female), who were residents of the rural region of Duzce, were examined for dermatomycosis. A total of 120 samples (47 nail fragments, 73 skin scales) were collected from 81 patients for mycological analysis on the basis of the results of clinical evaluation. All specimens collected were analysed by direct microscopy and culture. Positive results were detected in the cultures of 53 (44.1%) of the 120 samples. About 46 (86.7%) samples also presented positive results in direct microscopy. In the cases of seven samples positive results were found in culture and negative results with direct microscopy. Both culture and direct microscopy presented negative results in 67 (55.8%) samples. The most frequently isolated aetiological agents were 33 Trichophyton rubrum (62.2%), and nine T. mentagrophytes (16.9%). In conclusion, traditional and religious habits such as cohabitation and performing ritual ablutions may affect the prevalence of dermatophyte infections. The performance of ritual ablutions is not in itself a risk factor for acquiring dermatophyte infection; rather it is not drying the extremities after ablutions, that is the main risk factor for this group. Tinea capitis was not found in any of the subjects in spite of the fact that it is one of the most common infectious conditions in children. This is the first paper to report the prevalence of fungal infections in Duzce, a western Black Sea region of Turkey.

Adolescent↗
PubMed2005

Epidemiology of dermatomycoses in children living in Northern Greece 1996-2000.

In the 5-years period, 1996-2000, 1045 children under 13 years old were examined for suspected dermatomycosis. In 611 cases fungi were isolated. Male children were mainly affected on the scalp and body area. Girls were more affected in the location of the arms and legs. There was a greater proportion of cases in the age range 2-12 years. The most prominent fungus was Microsporum canis (515 cases) followed by Trichophyton rubrum (34) and Candida albicans (20). Tinea capitis (280 cases) mainly caused by M. canis (276 cases) was the most common clinical form. Tinea corporis (109 cases) mainly caused by M. canis (88 cases), C. albicans (10 cases) and T. rubrum (seven cases) was the second most frequent clinical form.

Candida albicans↗
PubMed2005

Dermatophyte infections in the Ljubljana region, Slovenia, 1995-2002.

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.

Adolescent↗
PubMed2005

Dermatophytoses in forestry workers and farmers.

To assess the frequency of superficial mycoses in forestry workers and farmers in the rural region of Duzce, a total of 467 residents of the rural region were examined for dermatomycosis infection. Of these, 349 were forestry workers and 118 farmers. All specimens collected were analysed by direct microscopy and culture. Tinea pedis et manus was found in 23 (19.4%), and onycomycosis in 21 (17.7%) farmers. Tinea pedis et manus was found in 50 (14.3%), and onycomycosis in 28 (8%) forestry workers. One tinea corporis, two tinea inguinalis and two erosio interdigitalis cases were determined in the farmer group but no cases of tinea corporis, tinea inguinalis, or erosio interdigitalis were found in the forestry group. In total, five tinea versicolor cases were found in the two groups on clinical examination but no agent positivity was yielded in mycological cultures. The most frequently isolated agent in the two groups was Trichophyton rubrum. The frequencies of superficial mycosis and onychomycosis were found to be higher in the farmer group than in the forestry group, although similar aetiological agents were isolated in both groups. The farmers had greater rates of contact with pathogenic fungi present in soil as well as from infected farm animals than the foresters; furthermore, animal husbandry, and the wearing of rubber shoes and nylon socks were more frequent in the farmer group. These results suggest that habits such as the wearing of rubber shoes and nylon socks, and the practice of animal husbandry may be the most important factors in determining the frequency of superficial mycoses and aetiological agents in forestry workers and farmers. To our knowledge, there is no previous report about dermatophytoses in forestry workers.

Adolescent↗
PubMed2006

Comparison of diagnostic methods in the diagnosis of dermatomycoses and onychomycoses.

Direct microscopic examination of potassium hydroxide (KOH)-prepared specimens is the simplest, cheapest method used for the diagnosis of mycotic infections of the skin. However, KOH preparations have been reported to have 5-15% of false-negative results, possibly because of the low visibility of scant, scattered fungal material of the nail scrapings and because the detection of fungal elements depends on the skill of the observer [Arch Dermatol133 (1997) 1317; Clin Microbiol Rev8 (1995) 240]. We compared two different KOH-based staining methods in order to obtain reliable results in shorter time than expected for cultures. A total of 124 patients with suspect diagnosis of dermatomycosis or onychomycosis were enrolled. Two scrapings from the same lesion of each patient were stained with KOH-Chlorazole and KOH-Acridine Orange (AO), respectively; cultural examination of the same specimen was considered as diagnostic gold standard. The two methods showed neither significantly different sensitivity nor specificity; however, for onychomycoses, we observed a slightly higher sensitivity for KOH-Chlorazole and a higher specificity for KOH-AO. We suggest the use of both techniques in order to improve detection of fungal infection, especially for onychomycoses.

Acridine Orange↗
PubMed2002

Nucleotide structure of the Scytalidium hyalinum and Scytalidium dimidiatum 18S subunit ribosomal RNA gene: evidence for the insertion of a group IE intron in the rDNA gene of S. dimidiatum.

The molds Scytalidium dimidiatum (Nattrassia mangiferae synanamorph) and Scytalidium hyalinum are responsible for dermatomycosis in humans. We sequenced their 18S subunit ribosomal RNA gene to identify these species with molecular biology-based methods. The coding sequences differed by a single polymorphism (A in S. dimidiatum, G in S. hyalinum). Moreover, we found an insert at position 1199 in the 18S rRNA gene sequence of S. dimidiatum. Its potential secondary structure was characteristic of a group IE intron. Bioinformatic and phylogenic group IE intron analyses generated four main homogeneous clusters. The S. dimidiatum intron is original and not related with other known IE group introns.

Ascomycota↗
PubMed1997

Review of the literature and investigations on the prevalence and consequences of yeasts in reptiles.

Ninety-one reptiles were examined for the presence of yeasts by standard protocols and pathohistological methods. Yeasts were isolated from 42 of the animals. Representatives of herbivorous families (Testudinidae and Iguanidae) carried yeasts more often than animals belonging to carnivorous taxa (Boidae and Emydidae). Yeasts were most often isolated from the gastrointestinal tract, and in 24-6 per cent of cases they could be cultured from the oral cavity and/or cloaca of living animals. Postmortem examination revealed that the intestines of 80-6 per cent of the animals carried yeasts. In all, 56 isolates, belonging to the genera Candida (32), Trichosporon (11), Torulopsis (9) and Rhodotorula (3), and one perfect yeast were obtained. The species included taxa potentially pathogenic to man. However, no sufficiently reliable criteria could be established to prove that positive culture results were associated with disease. In the reptiles examined postmortem, three cases of dermatomycosis were detected histologically. No case of organ mycosis was identified.

Animals↗
PubMed1998

Fluconazole in the treatment of tinea corporis and tinea cruris.

BACKGROUND: Results of topical dermatomycosis treatment are often unsatisfactory, particularly in patients with extended or multiple infection sites. OBJECTIVE: Given the high fluconazole concentrations attainable in the stratum corneum and the long elimination half-life of fluconazole, we investigated whether efficacy is satisfactory when using fluconazole at once weekly doses of 150 mg. METHODS: In an open, noncomparative study, tinea corporis and cruris patients were treated with once weekly fluconazole 150 mg over 2-4 weeks. Clinical (pruritus, erythema, scaling, burning/pain, vesiculation) and mycologic (culture and microscopy) assessments were performed before treatment, at weekly intervals until the end of treatment and 3 weeks after treatment. All adverse events were recorded. RESULTS: The total severity scores of clinical symptoms were reduced from 7.1 before to 1.5 after treatment (p = 0.001, n = 100 patients). Seven patients experienced adverse events. CONCLUSIONS: Fluconazole 150 mg once weekly for 2-4 weeks is an efficacious and safe regimen in the treatment of tinea corporis and cruris.

Antifungal Agents↗
PubMed2006

Hygienic relevance and risk assessment of antimicrobial-impregnated textiles.

The antimicrobial impregnation of textiles is intended to provide protection of textiles against microbial corrosion, prevention of malodor or prophylaxis and therapy of infections, respectively. For every biocidal product a careful risk assessment for humans and the environment has to be performed. The advantage of antimicrobially active textiles has to be documented for every agent as well as for every application, and a balance has to be found between a textile's quality rating and the potential risks, e.g. sensitization, disturbance of the ecology of the skin, toxic side effects by means of systemic absorption, cytotoxicity, genotoxicity, carcinogenicity, teratogenicity and ecotoxicity. This article evaluates the applicability of silver compounds as well as the classic antimicrobials triclosan, quaternary ammonium compounds, copper and further new options like chitosan and zeolite. It has to be emphasized that there are no objections against the use of antimicrobially active textiles if their use is equal or superior to other preventive or therapeutic measures. This applies to the amelioration of the course of dermatological diseases with disturbed skin flora, in particular atopic dermatitis, the prevention and therapy of acute and chronic wound infections by wound dressings, the use of impregnated surgical suture material as well as special indications in the prevention of infection in medical facilities. The use of antimicrobial textiles for the prevention of dermatomycosis by antifungal impregnation is of questionable use; the antimicrobial impregnation of textiles for deodorization purposes has to be avoided. Presently, from a hygienic point of view, the following questions have to be clearly determined: declaration of any antimicrobial impregnation; development of international standards for in vitro testing and preclinical evaluation of efficacy and tolerance; evaluation of the advantage of the antimicrobial properties for the intended use including the risk-benefit assessment.

Anti-Infective Agents↗
PubMed1997

Oral terbinafine: a new antifungal agent.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adverse effects, drug interactions, and dosage guidelines of terbinafine. Available comparative data of terbinafine and other antimycotic agents are described for understanding the potential role of terbinafine in patient care. DATA SOURCES: A MEDLINE search restricted to English language during 1966-1996 and extensive review of journals was conducted to prepare this article. MeSH headings included allylamines, terbinafine, SF 86-327, dermatophytosis, dermatomycosis. DATA EXTRACTION: The data on pharmacokinetics, adverse effects, and drug interactions were obtained from open-label and controlled studies and case reports. Controlled single- or double-blind studies were evaluated to describe the efficacy of terbinafine in the treatment of various fungal infections. DATA SYNTHESIS: Terbinafine is the first oral antimycotic in the allylamines class: a fungicidal agent that inhibits ergosterol synthesis at the stage of squalene epoxidation. Terbinafine demonstrates excellent in vitro activity against the majority of dermatophyte species including Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum; less activity is seen against Dematiaceae and the filamentous fungi. It is least active against the pathogenic yeast and this correlates with the relatively poor efficacy against these organisms in vivo. High concentrations of terbinafine are achieved in keratinous tissues, the site of superficial infections, and these concentrations are maintained for up to 3 months. The clinical efficacy of terbinafine against a number of dermatophyte infections exceeds that of the current standard of therapy, griseofulvin. The efficacy of terbinafine may be as good or better than that of the azole antifungals. Additional studies are required to confirm these observations. Terbinafine demonstrates a good safety profile, and relatively few drug interactions have been identified. CONCLUSIONS: Terbinafine is more effective than the gold standard, griseofulvin, in the treatment of tinea pedis and tinea unguinum, with considerably shorter treatment duration in the latter. It has been proven as effective as griseofulvin in the treatment of tinea capitis, tinea corporis, and tinea cruris. Terbinafine does not appear to offer any advantage in the treatment of nondermatophyte infections; its utility in the treatment of systemic infections has yet to be established. Depending on individual institutional costs, terbinafine may be a front-line drug for some superficial infections responding poorly to the current standard of therapy.

Antifungal Agents↗
PubMed1984

Occurrence and impact of zoonoses in pet dogs and cats at US Air Force bases.

A descriptive epidemiologic study was conducted to quantitate the occurrence of zoonoses in pet animals (almost exclusively dogs and cats) at 30 Air Force bases in nine regions of the United States during 1980 and 1981. Reviews of reported cases of pet-associated zoonoses in humans at these bases were included. Occurrence of a zoonotic disease in dogs and cats was expressed as a ratio of reported cases per 100 rabies vaccinations (cs/Crv). Overall, the four zoonoses reported most frequently from these pets were hookworms, roundworms, tapeworms, and fleas. Annual ratios revealed geographic variations: for example, hookworms in dogs and cats in the southeast ranged from 12.3 to 9.4 cs/Crv; in the northern Great Plains, hookworms ranged from 0.9 to 0.4 cs/Crv. Dermatomycoses in the southeast ranged from 1.3 to 1.1 cs/Crv, and in Alaska from 0.3 to 0.2 cs/Crv. Quarterly zoonoses occurrence revealed seasonal variations in several regions. Reports of zoonoses in people from these bases indicated that five less frequent zoonoses in dogs and cats (Microsporum canis dermatomycosis, fleas, Sarcoptes scabiei var canis, Gram-positive bacterial infections, and rabies) presented greater acute threats to humans than did the four most frequent zoonoses reported from their pets.

Adult↗
PubMed1988

Diflucortolone valerate. Asian experience.

More than 10 years ago, diflucortolone valerate (Nerisone, Nerisona) was introduced in Germany and soon after in Asian countries in a concentration of 0.1% in cream, ointment and fatty ointment bases. 897 patients were included in the first Southeast Asian multicentre trial with these 3 formulations, and good efficacy and tolerability combined with a rapid onset of effect were shown. These results were confirmed later in Indonesia in an extended follow-up trial which included 1295 patients. A combination of 0.1% diflucortolone valerate with 1.0% chlorquinaldol was introduced after a multicentre Southeast Asian trial involving 8668 patients with inflammatory or allergic skin conditions for which a supplementary anti-infective treatment, for prophylaxis or therapy, was considered to be indicated. Excellent results were obtained in terms of efficacy, tolerability and cosmetic properties. A randomised double-blind trial comparing this preparation with a so-called 'shotgun' combination containing 0.05% betamethasone 17-valerate, 0.1% gentamicin, 1.0% tolnaftate and 1.0% clioquinol in 288 patients in the Philippines resulted in a better efficacy for the diflucortolone preparation in the 80 patients with bacterially or mycotically infected skin diseases. A 0.3% concentration of diflucortolone valerate was developed and introduced as a high potency topical corticosteroid. A trial in the Philippines which involved 143 patients with mostly severe chronic recurrent and resistant corticosteroid-responsive skin disease confirmed a pronounced clinical efficacy with a low incidence of side effects. For the treatment of inflammatory or eczematised dermatomycosis. 0.1% diflucortolone was combined with 1.0% isoconazole nitrate (Travocort). In a randomised double-blind study of 294 patients in Thailand, this preparation was compared with a plain 1.0% clotrimazole formulation. The results were significantly better for the diflucortolone plus isoconazole nitrate combination in terms of remission of symptoms, and after 1 week the mycological cure rates were also better, as shown in potassium hydroxide and culture investigations. It is concluded, therefore, that diflucortolone valerate in the available galenic bases and in effective combinations with other agents has been proven in extensive clinical trials to be a valuable therapeutic tool in dermatological practice.

Asia↗
PubMed1994

Toxic epidermal necrolysis and erythema multiforme following therapy with terbinafine.

We report two cases with severe skin reactions following oral terbinafine (Lamisil) therapy. The first case was a 49-year-old woman with onychomycosis of the toe nails. She had suffered from diabetes for 3 years, but it was well controlled on insulin. Five days after start of terbinafine 250 mg once daily she developed erythema. The treatment was continued for 2 days, but the skin eruption progressed, and a clinical diagnosis of toxic epidermal necrolysis was confirmed histologically. The second case was a 51-year-old woman with dermatomycosis on the right foot. She developed a papular eruption in the second week after taking terbinafine 250 mg once daily. Despite this eruption she continued treatment for 6 days. Generalized erythema multiforme developed in the following days. Terbinafine is a recently introduced efficacious fungicidal drug. This is the first report of toxic epidermal necrolysis following terbinafine.

Administration, Oral↗
PubMed2005

Changing morbidity patterns in children in Dutch general practice: 1987-2001.

OBJECTIVES: To examine the presentation and pattern of childhood morbidity in general practice compared with 14 years ago. METHODS: We used data of all children aged 0-17 years from two cross-sectional surveys performed in 1987 and 2001 in general practice in the Netherlands. The total number of children in the practices participating in these surveys were 86,577 children in 1987 and 82,053 children in 2001. First of all, we compared consultation rates of children in general practice. Secondly, childhood morbidity was assessed by episodes of disease, coded according to the International Classification of Primary Care (ICPC). We compared childhood morbidity in 1987 and 2001 by assessing the distribution of episodes among ICPC chapters stratified by ethnicity, and by comparing incidence rates of most frequently presented diseases. RESULTS: Childhood consultation rates have decreased from 2.7 visits a year per child in 1987 to 2.1 in 2001. The distribution of episodes among ICPC chapters had also changed. Respiratory problems are still the most frequently presented health problem in children but the proportion has decreased from 25.5% in 1987 to 23.3% in 2001. Skin problems were presented more often (23.0% in 2001 versus 17.8 in 1987), and Western children more often presented with skin problems than with respiratory problems in 2001. Incidence rates of most respiratory diseases have decreased and specific skin diseases (dermatomycosis, impetigo and eczema) were diagnosed more often. CONCLUSION: In the Netherlands, childhood morbidity has changed. Skin diseases have become more important in general practice and respiratory problems are declining.

Adolescent↗
PubMed1999

[Present state and future direction of topical antifungals].

Topical agents are generally better than oral medicine with respect to systemic side effects. Even if an antifungal drug causes severe systemic side effects, the drug, if it has excellent antifungal activity, can be used for topical treatment. In addition, because most causative fungi in dermatomycosis are usually located in the horny cell layers of the epidermis (superficial layers of the skin), topical antifungals are the first choice of treatment for most dermatomycoses. Many topical antifungals with excellent antifungal activity have recently been developed and once a day topical application is presently possible. In spite of these new agents, however, clinical efficacy and mycological eradication rates have not shown significant improvement and there are still many patients with tinea pedis. One reason that no significant improvement has been observed in the topical antifungal therapy may be due to poor compliance with the treatment. That is, because it is difficult for most patients to continue regular topical application for a long period, most usually stop treatment after clinical symptoms disappear, even though no mycological cure may yet have been achieved. In addition, topical antifungals are not effective for the treatment of hyperkeratotic skin lesions or nail and hair infection. Therefore, the goal of new topical antifungals should be good compliance, which means shortening of the treatment period, high penetration of the drug into horny cell layers, nails, and hair, and high affinity to horny cell layers in order to keep a high concentration of the drug within the lesions.

Administration, Topical↗