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PubMed1986

Ketoconazole treatment in superficial mycoses.

Ketoconazole is a new antifungal drug, used for oral treatment, with a broad spectrum of activity. It is a member of the imidazole series and is active in superficial and deep mycotic diseases, in candidosis and pityriasis versicolor. This new imidazole derivative has been successfully administered in several cases of dermatophytosis, yeasts and pityriasis versicolor in the authors' clinic, as well as in many other research centres. Treatment has been given to patients with tinea corporis, tinea cruris, tinea pedis, with or without location in interdigital spaces, while the cases of tinea capitis are still under investigation. The following variants of candida infections have been treated: onychomycosis, intertrigo and mucocutaneous candidosis due to prolonged immunosuppressive therapy. No remarkable haematochemical disorders have been observed after treatment.

Adolescent↗
PubMed1982

The changing clinical picture of Microsporum canis infections in Sweden.

All 22 cases of infections with Microsporum canis verified by culture during a five-year period were surveyed. Only tinea corporis was found. The clinical picture was varied and in more than half of the cases the preliminary diagnosis was other than tinea. The classical tinea capitis was not found in any case. Direct KOH-mounts showed poor correlation to the cultural findings (positive in 33%). It is concluded that mycological screening of certain dermatological disorders should be performed by culturing.

Adolescent↗
PubMed1993

Superficial tinea infections.

Dermatophytes commonly cause superficial dermatoses, especially in children, but these infections are frequently misdiagnosed as nonfungal disease. Superficial tinea infections can vary widely in appearance, ranging from a single, small, circular lesion with mild erythema and a scaling active border to multiple large areas of marked inflammation with vesicle formation. Therefore, laboratory tests, particularly the potassium hydroxide slide preparation, are often necessary to establish the diagnosis. The culture becomes particularly important if the smear is negative but a superficial dermatosis is strongly suspected. Tinea capitis is frequently diagnosed only by culture. Since many agents are available to treat superficial dermatoses, cost should be an important consideration in the selection of a topical antifungal agent. Oral agents are recommended for scalp and nail infections, as well as extensive body infections. Griseofulvin is the oral agent of choice because of its efficacy and low toxicity.

Humans↗
PubMed1997

Soil dermatophytes in Madras, India, in relation to human ringworm.

A total of 269 soil samples collected from different habitats in Madras, India, were screened for the presence of dermatophytes by the hair-baiting technique. Three strains of Trichophyton mentagrophytes and 16 strains of Microsporum gypseum complex were isolated. These strains were subjected to the mating experiment. 2/3 soil isolates of Trichophyton mentagrophytes belonged to Arthroderma vanbreuseghemii (+) mating type, and 1/3 was Arthroderma vanbreuseghemii (-) mating type. Similarly 6/70 clinical strains of Trichophyton mentagrophytes isolated in our previous study also belonged to Arthroderma vanbreuseghemii (+) mating type. These 6 strains were isolated from severe cases of tinea capitis in children belonging to rural Madras. The teleomorphic and mating type homology between the clinical and soil isolates of T. mentagrophytes suggest that soil may act as reservoir for these organisms. The incompatible clinical strains of T. mentagrophytes var. interdigitale and A. vanbreuseghemii showed DNA homology, thereby establishing the epidemiologic link which supports the above findings.

Arthrodermataceae↗
PubMed1986

Tinea in tiny tots.

Dermatophyte infections in infants and toddlers, with the exception of tinea capitis, are considered rare. We describe representative patients to illustrate the broad clinical spectrum of these infections in this age group. We review possible pathophysiologic mechanisms, diagnostic modalities, and therapeutic regimens. Our experience suggests that involvement of areas other than the scalp may be more common than current estimates suggest. Recognition of affected patients is important in view of the wide differential diagnosis and the efficacy of current treatment.

Antifungal Agents↗
PubMed1998

Common dermatophyte infections. A simple diagnostic test and current management.

Tinea pedis, onychomycosis, tinea cruris, and tinea capitis are among the most common dermatophyte infections and are seen in all socioeconomic groups. Successful treatment of these conditions depends first on accurate diagnosis, which is often quickly accomplished with a KOH examination. Culture may be needed in some cases, but results may not be available for 2 weeks or more. Immunocompromised patients are particularly susceptible to dermatophyte infection, and any deviations in presentation or failure to respond to treatment should prompt investigation for an underlying problem.

Antifungal Agents↗
PubMed1993

[Identification of dermatophytes as possible agents in clinically and microbiologically diagnosed dermatophytosis].

In this study we have investigated the distribution of dermatophyte species clinically and microbiologically on 110 patients with dermatophytosis. The distribution of the dermatophytes according to the localization sites are: Tinea Capitis 13 (11.8%), T. Corporis 12 (10.9%), T. Inguinalis 22 (20%), T. Pedis et Manum 47 (42.7%), T. Unguinum 16 (14.5%). The species of dermatophytes which have been cultured were, Trichophyton rubrum 32 (29%), T. mentagrophytes 32 (29%), T. schoenleini 4 (3.6%), T. tonsurans 1 (0.9%), Epidermophyton floccosum 16 (14.5%), Microsporum canis 1 (0.9%), M. audouini 1 (0.9%), various molds 3 (2.7%) and also number of negative cultures obtained were 20 (18.1%).

Adolescent↗
PubMed1993

The ringworm riddle: an outbreak of Microsporum canis in the nursery.

Tinea capitis, the most common fungal infection in children, is rare in neonates. We report six patients in a Level II intermediate care nursery who developed nosocomial dermatophyte infections caused by Microsporum canis. The investigation, which led to the identification of a nurse as the common source, is described. The nurse had an indolent infection with M. canis. Human to human transmission is exceedingly rare for M. canis. The literature regarding neonatal dermatophyte infections is discussed in relation to the reported outbreak.

Antifungal Agents↗
PubMed2006

Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients.

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.

Adolescent↗
PubMed1984

Dermatophytes in Portugal (1972-1981).

For the years 1972-1981, 7 333 isolates of dermatophytes belonging to 14 species were obtained from glabrous skin (32%), feet (28%), groin (19%), scalp (8%), toenails (7%), fingernails (3%) and beard (1%). T. rubrum represented 50% of all the isolates and was the most frequent species on glabrous skin, groin and nails. T. mentagrophytes (24%) was mainly obtained from the feet, E. floccosum (9%) from the groin and T. megninii (4%) from uncovered areas of the skin, fingernail and beard. These 4 species predominated in men. M. canis was the commonest agent on the scalp and in children up to 11 years. T. violaceum, previously the main cause of tinea capitis, and T. tonsurans have been decreasing for the period of this study, just as T. schoenleinii for the years 1962-71. The rising prevalence of T. rubrum was observed since 1962. In the whole it seems stable after 1969, but the analysis of the main sites involved shows that in the glabrous skin this species increased from 1962 to 1974; in the groin it was gone up from 30% during 1962-1965, to 64% in the years 1969-1971; in the feet the evolution was slower and only in 1980 T. rubrum became more frequent than T. mentagrophytes. The increase in certain species, whereas others become rare, lacks a satisfactory explanation.

Adolescent↗
PubMed1985

[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↗
PubMed2005

Mycoses in Thailand: current concerns.

Scytalidium dimidiatum is the leading cause of fungal foot diseases in Thailand, in contrast to similar studies in which dermatophytes have been identified as the predominant pathogens. By contrast, the prevalence of Candida albicans in our study was only 2.6 approximately 3.0%. Scytalidium fungal foot infection is clinically indistinguishable from that caused by dermatophytes and should be included as a possible cause of treatment failure in tinea pedis and onychomycosis. Without proper culture identification, clinically diagnosed patients would be treated with a standard antifungal regimen leading to minimal response and be interpreted as drug resistant cases resulting in switching of drugs and more aggressive management procedures. Tinea capitis is another health problem in young children. However, for Microsporum canis and some ectothrix organisms, the effectiveness of treatment may be less than endothrix infection. Griseofulvin is still the mainstay antifungal although itraconazole and terbinafine are as effective. Pulse regimen may be another option with advantages of increased compliance and convenience. Two pulses of terbinafine may be sufficient for treating most cases of Microsporum infection, although additional treatment may be needed if clinical improvement is not evident at week 8 after initiating therapy. Chromoblastomycosis is another subcutaneous infection that requires long treatment duration with costly antifungal drugs. The most common pathogen in Thailand is Fonsecaea pedrosoi. Preliminary study of pulse itraconazole 400 mg/d 1 week monthly for 9-12 consecutive months showed promising results. The prevalence of Penicillium marneffei infection is alarming in HIV infected patients living in endemic areas. Diagnosis relies on direct examination of the specimens and confirmation by culture. Treatment regimens include systemic amphotericin B or itraconazole followed by long-term prophylaxis. Treatment outcome depends on the immune status of the patient.

Chromoblastomycosis↗
PubMed2000

[Two cases of Trichophyton mentagrophytes infection contracted from a hamster and a chinchilla].

We report two cases of Trichophyton mentagrophytes infection. Case 1: A 10-year-old girl visited Tokyo Electric Power Hospital in June 1994 for evaluation of an erythematous lesion on her head. Three months of topical steroid therapy exacerbated the lesion with pustular formation. Histopathological and mycological examination revealed that the patient had tinea capitis caused by T. mentagrophytes. T. mentagrophytes was also isolated from her pet, a hamster. Case 2: A-14-year-old girl was referred to Shonan Clinic in January 1996 with scaly erythema on her face. She had been treated with neticonazole hydrochloride at another clinic, but the lesion became worse. Direct microscopic examination of the scale was negative at that time, so treatment with topical steroid was started. After 10 days, the lesion was almost cured, but one month later it recurred with an annular distribution. KOH preparation of the scale revealed mycelia and T. mentagrophytes was isolated on culture. T. mentagrophytes was also isolated from her pet, a chinchilla. In both cases, the oral administration of itraconazole at 50 mg/day was effective. The isolated pathogen was identified as Arthroderma vanbreuseghemii with species-specific primers of chitin synthase 1 gene. T. mentagrophytes is one of the most common dermatophytes isolated from man and animals. Rodents like the hamster and the chinchilla have recently become popular as pets in Japan. We should be aware that rodents may carry this kind of fungal pathogen as they become even more popular as pets.

Adolescent↗
PubMed2003

Genetic Heterogeneity in the rRNA Gene Locus of Trichophyton tonsurans.

Trichophyton tonsurans is the major pediatric pathogen in tinea capitis, causing disparate disease presentations. Little is known about genetic variation, which may ultimately be linked to divergent disease status. This investigation was aimed at identifying genetic variants of T. tonsurans by methods that can facilitate strain discrimination in population-based studies. Ninety-two isolates were acquired from six U.S. microbiology laboratories, and genomic DNA was isolated from mature colonies. The nontranscribed spacer (NTS) was amplified by PCR, and products from isolates with various amplicon sizes were fully sequenced. Nested amplification, targeting a variable internal repeat (VIR) region, allowed assignment of variant type by fragment size. Subvariant type was assigned by a combination of PCR-restriction fragment length polymorphism-based assays. Five variants differing in size (348 to 700 bp) and sequence were identified within the VIR region comprised of several large repeats (104, 140, and 194 bp) arranged in tandem. Seven single-nucleotide polymorphisms (SNPs) were detected across the NTS, with five occurring in the constant regions flanking the VIR region and two occurring in the VIR region. Additionally, a 10-bp insertion and a 14-bp deletion were identified upstream of the VIR region. The combination of SNPs revealed seven haplotype patterns which were stable upon serial passage over 1 year. No sequence variations were identified within the internal transcribed spacer regions. Unique NTS sequences were utilized to develop a duplex PCR assay that discriminated T. tonsurans from other dermatophytes. Of the 92 isolates evaluated, this genotyping scheme distinguished 12 distinct strains, providing evidence of genetic heterogeneity in T. tonsurans.

Base Sequence↗
PubMed1990

Facial reconstruction for radiation-induced skin cancer.

Radiation-induced skin cancers can be difficult to diagnose and treat. Typically, a patient who has received orthovoltage radiotherapy for disorders such as acne, eczema, tinea capitis, skin tuberculosis, and skin cancer can expect that aggressive skin cancers and chronic radiodermatitis may develop subsequently. Cryptic facial cancers can lead to metastases and death. Prophylactic widefield excision of previously irradiated facial skin that has been subject to multiple recurrent skin cancers is suggested as a method of deterring future cutaneous malignancy and metastases. The use of tissue expanders and full-thickness skin grafts offers an expedient and successful method of subsequent reconstruction.

Acne Vulgaris↗
PubMed1983

Cutaneous disease in black children.

Understanding cutaneous disease in the black races requires that the physician first be able to discern normal from abnormal pigmentary patterns and second be able mentally to add or subtract the patient's color, so that classic textbook descriptions of disease become applicable. Blacks tend to have four exaggerated pathologic reaction patterns: (1) pigment lability (frequent hyperpigmentation and hypopigmentation), (2) follicular responses and follicular diseases, (3) mesenchymal responses (fibroplastic and granulomatous), and (4) bullous responses. Social patterns in black communities aimed at masking hypopigmentation by use of emollients produce a wide spectrum of folliculitides rarely seen in whites. Methods of hair care commonly cause alopecias. Tinea capitis, which mimics four other varied scalp diseases, is now almost exclusively seen in blacks. Infesations, such as scabies and pediculosis capitis, are almost unheard of in American blacks.

Adolescent↗