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[Dermatomycoses and an antifungal diet].

Treatment of dermatomycoses and some other dermatoses, e.g. seborrheic eczema, is more effective if the intestinal tract is free of pathogenic fungi. In order to reduce the yeast colonies between the intestinal villi and to avoid the persorption of living yeast cells into the lymph-tract and the blood circulation it is recommendable to perform the so-called antifungal diet: less sugar of all kind and much more vegetable fibres in the food.

Dermatomycoses↗

[Dermatomycoses relevant to general practice and their treatment].

Dermatomycoses probably form the biggest group in dermatological diseases. To an increasing extent even children and juveniles are affected. Choosing the right antimycotic, e.g. Cielopiroxolamine, with a broad spectrum and a high antimycotic activity in each localisation as well as good tolerability, will strongly influence therapeutic results. Whenever the dermatophytoses are deeply situated in the skin or cover large areas Griseofulvin should be used. The combination of the latter with a local antimycotic might shorten therapeutic therapy and might lead to a lower frequency of relapse.

Administration, Topical↗

[Occupational dermatomycoses of zoophilic origin in Bulgaria].

The relative proportion of zoophilic dermatomycoses is increased in comparison with Tinea capitis et pedum. The most frequent zoophilic species now is not only T. mentagrophytes, but T. verrucosum as well. Occupational mycoses caused by T. mentagrophytes and T. quinckeanum in vivaria put forward new problems for experimental medicine. The author states his arguments in favour of T. quinckeanum as a separate, specialized species with reduced morphology, forming scutula. T. verrucosum is phylogenetically the most highly differentiated monoreceptive zoophilic on cattle. With its physiological, parasitological and epidemiological characteristics it is primarily the object of veterinary medicine and also of human medicine. The measures for fighting those mycotic infections are described in detail. Because of cattle-farm expansion the combat of cattle trichophytosis presents in itself a tough problem. The number of the infected is thus also increased. Immunisation with the LFT-130 vaccine and therapy with griseofulvin products containing medicinal feed, according to Kielstein, is recommended.

Adolescent↗

[Once daily administration of isoconazole as a cream, solution and spray: comparative studies of patients with dermatomycoses].

In 3 controlled multi-center studies, 372 patients suffering from dermatomycoses were treated with isoconazole as cream, solution, and spray either once or twice daily. Neither with regard to the duration of healing nor the healing rates were observed statistically significant differences between the two modes of treatment. As to the forms of preparation, there were no differences of efficacy either. At the end of treatment, the cure rates amounted to 90-94%. Follow-up examinations carried out two weeks later gave no indications of relapses.

Clinical Trials as Topic↗

Epidemiology and clinical features of dermatomycoses and dermatophytoses.

Dermatophytosis, candidosis and pityriasis versicolor account for the majority of fungal skin diseases in Denmark and are seen in 8% of patients with dermato-venerological problems. In children, zoophilic species like Microsporum canis (from cats), Trichophyton (T) verrucosum (from cattle) and T. mentagrophytes granulare (from rodents) are the common causes of dermatophytosis and are seen in approximately 15% of all cases. Anthropophilic species are the main cause of dermatophytosis in adults and are isolated more often in males than in females. T. rubrum (48%), T. mentagrophytes interdigitale (14%) and Epidermophyton floccosum (10%) are the species usually involved. The feet are the site of infection in about 50% of the cases, toenails, glabrous skin and inguinal folds equally often in 42%, palms in 6% and the scalp in 2%. The prevalence of tinea pedis in 15-year-old school children and 20-year-old males was found to be 4% and 6%, respectively. A relative risk of 3.1 for contracting tinea pedis when being an atopic or having an atopic family was demonstrated in the former group. Pityriasis versicolor and candidosis of skin and mucosal membranes are both secondary dermatomycoses caused by endosaphrophytic yeasts. Local or systemic predisposing disorders are usually required for the development of symptoms.

Adolescent↗

Topical ketoconazole (2% dermatological cream) for the treatment of superficial dermatomycoses.

A total of 48 patients with superficial dermatomycoses took part in an open trial to study the efficacy, acceptability and tolerance of topical ketoconazole (2% dermatological cream) applied twice daily. Forty patients (23 women and 17 men) were available for review upon completion of therapy. After 30 days of therapy, 11 patients were cured clinically and mycologically and 5 patients were cured clinically but had positive mycological findings. One of the patients in this group relapsed one month later. After 60 days of treatment, 22 patients were clinically and mycologically cured. Two patients did not respond to treatment. Only 2 patients in this group relapsed one month later.

Administration, Topical↗

A multicenter double-blind evaluation of ketoconazole in the treatment of dermatomycoses.

A multicenter double-blind study was conducted on the use of ketoconazole and griseofulvin for the treatment of dermatomycoses. Of one hundred thirty cases (one hundred twenty-seven patients) for which efficacy data were available, sixty-six were treated with a single daily dose of 200 mg ketoconazole, and sixty-four were treated with a single daily dose of 250 mg griseofulvin for periods of two to sixteen weeks. The proportion of remissions observed with ketoconazole (61 percent) was significantly greater (p = 0.02) than that observed with griseofulvin (39 percent). The proportion of relapses within two months was significantly less (p less than 0.01) in the ketoconazole group (9 percent) than in the griseofulvin group (43 percent). The frequency and severity of side effects were comparable in the two groups.

Adolescent↗

A comparative multicentre trial of halometasone/triclosan cream and diflucortolone valerate/chlorquinaldol cream in the treatment of acute dermatomycoses.

In this multicentre, between-patient trial the efficacy and tolerability of a cream, containing 0.05% halometasone and 1% triclosan, was compared with those of Nerisona C cream, containing 0.1% diflucortolone valerate and 1% chlorquinaldol, in 183 patients with acute dermatomycoses. Halometasone/triclosan cream and the comparative cream showed closely similar results with respect to good to very good therapeutic effects (60% versus 57%). However, halometasone/triclosan cream proved superior to the comparative preparation with regard to very good (cured) results (53% versus 46%), an early cure in less than 30 days (41% versus 34%) and onset of action within 3 days of starting the treatment (32% versus 18%). Mycological findings were positive on direct microscopy in 36% and 43% and in culture in 19% and 17% of the patients following treatment with halometasone/triclosan cream and the comparative cream preparation, respectively. Adverse effects were reported in seven out of 108 patients treated with halometasone/triclosan cream and in five out of 107 patients treated with the comparative preparation.

Acute Disease↗

Tolerability and efficacy of bifonazole in dermatomycoses.

1-[(4-Biphenylyl)-phenylmethyl]-1-H-imidazole (bifonazole, Bay h 4502, Mycospor) is a broad spectrum antifungal agent for the topical treatment of dermatomycoses. In addition to tolerability studies, a report is given on the results of 43 clinical studies of efficacy and tolerability involving 1129 patients in various countries. These were placebo-controlled double-blind studies, randomised comparative studies with reference preparations and open studies. They were carried out with bifonazole cream 1%, solution 1%, gel 1% and powder 1%. 58.6% of the patients tested suffered from dermatophytoses, 21.9% cutaneous candidoses, 14.3% from pityriasis versicolor and 5% from other skin infections. The therapeutic efficacy of bifonazole, assessed according to mycological and clinical findings proved good for the indications studied and administered once daily for a treatment period of 2 or 3 weeks. Tolerability - local and systemic - was good. There was no evidence of substance-related side effects.

Adolescent↗

[Dermatomycoses in the tropical rain forest of Nigeria (author's transl)].

This paper reports upon an examination of 312 Nigerians with regard to dermatomycoses. The Tinea versicolor alba presented the largest part of verified infections (5.5%), 57% of which were localized at the head. 16 to 20 year old patients were especially affected; women showed the infection 2.5 times more often than men did. Two out of 12 children revealed tinea capitis. Tinea manus et pedis proved to be rare. 60.5% of the patients showed nail alterations. Apart from dermatophytes, yeast and hyphomycetes grew in facultative pathogenicity. These are discussed to be, especially with males, causative organism of secondary mycoses and indicators of dirt.

Adolescent↗

Occurrence of dermatomycoses and in-vitro therapeutic efficacy of three antifungal drugs on the growth of Epidermophyton floccosum.

The occurrence of dermatomycoses and the in-vitro therapeutic efficacy of some antifungal agents on dermatomycotic organisms were investigated. Of the 550 primary school children screened, the incidence was one hundred (18%), 70 were males (representing 20% of the males screened) and 30 females (15% of the females sampled). The differences between male and female prevalence were insignificant. Three species of dermatophytes were isolated and identified. These were Microsporum canis, Trichophyton tonsurans and Epidermophyton floccosum. The antifungal agents tested on E. floccosum were griseofulvin, terbinafine and ketoconazole. They produced different sized zones of inhibition against the growth of E. floccosum. Griseofulvin exhibited a 50% inhibition of growth on E. floccosum at 63.00 mg/L. Terbinafine on the other hand exhibited varying levels of inhibition of growth at varying concentrations, at 0.07 mg/L, terbinafine achieved 46% inhibition of growth on E. floccosum. The drug achieved 100% inhibition of growth on the isolate at 61.81 mg/L. In the case of ketoconazole, 50% inhibition of growth was achieved at 100 mg/L while 100% inhibition of growth was achieved at 200 mg/L. The antifungal effects of the three drugs were confirmed by broth dilution tests where terbinafine was found to be fungistatic on the growth of E. floccosum at concentrations ranging from 0.013-1.700 mg/L and was fungicidal at concentrations ranging from 0.027-1.700 mg/L. Ketoconazole was found to inhibit the growth of E. floccosum at 0.003-1.700 mg/L and was fungicidal at concentrations ranging from 0.027-1.700 mg/L. It however did not succeed in killing the isolate under the same range of concentrations. Griseofulvin exhibited fungistatic effects on the growth of E. floccusum at 0.013-1.700 mg/L. In conclusion, ketoconazole and griseofulvin were found to be fungistatic and not fungicidal while terbinafine was both fungistatic and fungicidal on the pathogen. Terbinafine was found to be the most effective drug in inhibiting E. floccosum.

Antifungal Agents↗

Allylamines: topical and oral treatment of dermatomycoses with a new class of antifungal agents.

A new class of synthetic antifungal agents, characterized by an allylamine function as the essential structural feature, is reviewed. Two members of this class, identified by the generic name Naftifine and the code number SF 86-327 respectively, which were selected for further development from among several hundred analogous, are described in greater detail. As a class, the allylamines are highly active against dermatophytes and moulds, and moderately active against yeasts. Naftifine has been developed as an agent for the topical treatment of dermatomycoses, while SF 86-327 is under development in both topical and oral formulations, being the first orally applicable antifungal agent with a primarily fungicidal mode of action.

Administration, Oral↗