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[Fungal intertrigo and lymphangitis (author's transl)].

The pathogenic agents are normal parasites of the epidermis but which may cause local signs and microbial secondary infection. Two types of fungus are distinguished: -- dermatophytes, which develop in the 4th interdigital space and may become exacerbated. -- yeasts, which develop from the digestive and genital mucosal surfaces. Laboratory diagnosis must be as precise as possible. Treatment consists of aeration, drying of skinfolds, alkalinization for yeasts, antiseptics and antifungal agents. Such fungal infections may represent the starting point of lymphangitis and erysipelas.

Antifungal Agents↗

Intertrigo: a practical approach.

Although the precise diagnosis of intertriginous dermatosis is hampered by the unique conditions of the skin folds, there are a few common rules to be considered in the therapeutic approach. Dryness must be reached by changing occlusive conditions, astringent compresses, and absorbing powders. To improve the primary dermatosis, superimposed infection must be treated. With rare exceptions, fluorinated steroids should not be used in occlusive areas. Finally, the skills of a dermatologist may be required to optimize the care of patients with complex dermatoses involving the flexural skin.

Algorithms↗

[Calcified intertrigo, a rare cause of cutaneous calcinosis].

INTRODUCTION: Calcinosis cutis is classically described in patients presenting chronic renal failure with secondary hyperparathyroidism. There are three clinical types described in the literature: cutaneous necrosis (secondary to vascular calcification), panniculitis with calcification of the adipose tissue and necrosis of the skin and dermo-hypodermic calcinosis without necrosis usually called metastatic calcinosis. The latter can affect all tissues but skin involvement is rare. CASE REPORT: A case of calcinosis cutis is presented in a 50 years old woman with moderate secondary hyperparathyroidism and chronic renal failure caused by renal amyloidosis. She was referred by the renal unit to our service for erythematous, woody-hard, infiltrated plaques with petechial purpura satellite lesions, involving the flexural areas, that appeared within a few weeks. DISCUSSION: This observation is original by the topography of the cutaneous lesions the involvement of the fexural areas is unusual and by the histologic aspect of pseudoxanthome elastic-like. We must notice that the hyperparathyroidism had always been very moderate (normal parathormonemia) compared to the rapid development of an important dermic calcinosis.

Aged↗

[Intertrigo in patients with lower limb lymphedema. Clinical and laboratory correlation].

Cutaneous lesions in the interdigital spaces are commonly seen in lymphedema patients and their prevention and suitable care is one of the cornerstones of any successful treatment, by preventing acute inflammations and additional worsening in limb volume and fibrosis. We obtained swab specimens from the interdigital area from 21 patients followed in the Lymphedema Unit of the Department of Vascular Surgery of the University of São Paulo; thirteen of them had lesions suggestive of tinea pedis. The pathological agent could be identified in 11 out of these 13 patients: fungal infection alone was responsible for seven lesions, Corynebacterium minutissimum for another two and both agents were isolated from two patients. Although two patients had evident clinical lesion of the skin, no fungal or bacterial species could be isolated. From the eight patients without interdigital lesions, Candida and Corynebacterium was found in one. We concluded that clinical examination has a high sensibility (84%) and specificity (91%) but the high prevalence of Corynebacterium minutissimum suggests that adequate treatment should follow careful laboratory examination.

Adult↗

[Reticular pigmented anomaly of the flexures. Dowling-Degos disease of the intertrigo type in association with acne inversa].

Reticulated pigmented anomaly of the flexures (Dowling-Degos disease) is a rare autosomal-dominant genodermatosis with variable penetrance that is characterized by reticulated hyperpigmentation of the flexures. Acne inversa has been previously described in the literature under several synonyms, such as acne triad, acne tetrad and hidradenitis suppurativa. Acne inversa is an inflammation affecting the pilosebaceous units of the flexures. We report a case of Dowling-Degos disease in association with acne inversa. The association of these diseases has been described several times and it appears not to be coincidental. Pathogenetic mechanisms leading to this coincidence are discussed.

Acne Vulgaris↗

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.

Administration, Topical↗

Skin and nail infections due to Fusarium oxysporum in Tuscany, Italy.

Nine cases of skin and nail infection due to Fusarium oxysporum, diagnosed in Tuscany in the period 1985-97, are described. Two manifested as interdigital intertrigo of the feet and seven as onychomycosis. All were diagnosed on the basis of repeated mycological examination, direct microscope observation and culture, as well as histological examination of biopsy specimens in two cases of intertrigo. Fragments of the fungal colonies were examined by scanning electron microscopy (SEM) for more detailed observation of fungal morphology. All patients had normal immune status and a history of the infection extending several years. Four of the patients with onychomycosis were treated with oral itraconazole, and clinical and mycological recovery was achieved in three cases. Two others were treated with cyclopyrox nail lacquer, successfully in one case. One patient with intertrigo was treated with oral itraconazole and one with oral terbinafine; both were also treated and with topical drugs, however clinical recovery was not confirmed by the mycological results.

Adolescent↗

Intertriginous drug eruption.

Presented are two patients who developed an unusual, and as yet unreported eruption due to amoxycillin. They exhibited an eruption confined to the intertriginous areas, which mimicked intertrigo. Although drug eruption can mimic a variety of idiopathic skin diseases, intertrigo is easily distinguished from drug eruption and has not been mentioned in the differential diagnosis of this reaction. It is suggested that drug reactions should be considered in the differential diagnosis of intertrigo, in particular of atypical and therapy-resistant cases. Early detection of these cases has practical importance since the elimination of the causative drug is essential for therapy success. Case 2 showed a response of the toxic epidermal neurolysis (TEN) type, which could have been very severe and dangerous had the diagnosis not been made in an early stage before the development of generalized TEN.

Adult↗

[Industrial dermatoses among the Bełthatów brown coal miners].

443 subjects were examined, 235 applying to the physician due to the occurrence of skin dermatoses (group I) and 208 workers referred for periodic examinations (group II). In group I skin dermatoses were found in 100, i.e. 85%, of the subjects and in group II in 99 i.e. 48% of the subjects. In both groups the most frequent dermatosis was feet skin inflammation, especially interdigital intertrigo. Oil acne was diagnosed in 15, ordinary acne in 23, pityriasis versicolor in 19. erythrasma in 10, and eczema and contact dermatitis in 7 subjects of the first group and 3 subjects of the other group. 204 subjects with feet skin pathologies underwent mycologic examinations and 36 subjects--also bacteriologic examinations. The results of those studies indicate that in 23% of the subjects, feet interdigital intertrigo results from mycologic infections. Bacterial infections may contribute to etiopathogenesis. Imidazole compounds are useful for the treatment and prevention of interdigital intertrigo.

Adolescent↗