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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↗
PubMed1992

Experience with amorolfine in the treatment of dermatomycoses.

In a double-blind randomized comparative study, 75 patients were treated with amorolfine cream 0.125, 0.25 or 0.5%. At the end of treatment clinical cure rates of 80, 76 and 84%, respectively, and mycological cures of 72, 64 and 76% were obtained. At 2 months posttherapy follow-up relapse rates were 0, 12 and 12%, respectively. There was no significant difference between the three groups in terms of clinical and mycological response, duration of treatment or tolerance. In a double-blind parallel study, 40 patients were treated topically with either 0.5% amorolfine cream or 1% bifonazole cream. The percentages of combined clinical and mycological cures were 83.3 and 78.95%, respectively. There was no significant difference in terms of tolerance and clinical and mycological cure rates. All treatments were applied once daily. Posttreatment MIC values did not indicate development of resistance to either amorolfine or bifonazole.

Administration, Topical↗
PubMed1983

Treatment of dermatomycoses with topical tioconazole and miconazole.

A total of 60 patients with proven fungal infection of the skin took part in a single-blind comparative study of the efficacy, toleration and safety of tioconazole base 1% w/w and miconazole nitrate 2% creams applied twice daily for 14 days to patients with pityriasis versicolor and for 28 days to patients with dermatophyte and yeast infections. Overall assessment of the patients reviewed at the end of treatment showed that 23 of 30 patients (77%) treated with tioconazole and 19 of 30 patients (63%) treated with miconazole were clinically and mycologically cured. Tioconazole cured 80% (8 of 10) and miconazole cured 38% (5 of 13) of the infections with Trichophyton rubrum, which are the most frequent ones. At long-term follow-up, approximately 6 weeks later, results in both treatment groups were comparable. 20 of the 23 patients (87%) cured by tioconazole and 18 of the 19 patients (95%) cured by miconazole remained free from infection. Both creams were easy to apply and there were no reports of staining. No side effects were recorded during the study.

Administration, Topical↗
PubMed1975

Miconazole nitrate in the treatment of dermatomycoses.

Miconazole nitrate was used topically in 83 dermatophytic and candidal infections. Complete cure was obtained in 81% of the cases. The in vitro studies made before, during and after treatment showed no evidence of resistance to the drug. The miconazole 2% cream and powder preparations were well tolerated. Only one case of sensitization was observed.

Administration, Topical↗
PubMedDate not supplied

[Human dermatomycoses in the interior of Rio Grande do Sul in the period of 1988-1992].

The relative frequency of the dermatophytes in the central region of Rio Grande do Sul, Brazil, have changed during a survey carried out from 1988-1992. The frequency of the antropophilic species T. rubrum, T. mentagrophytes var. interdigitale and E. floccosum have decreased in comparison with the zoophilic species M. canis and T. mentagrophytes var. mentagrophytes. The relationship host/parasite and the low rate growth of dermatophytes in culture are discussed.

Adolescent↗
PubMed1988

Sulconazole. A review of its antimicrobial activity and therapeutic use in superficial dermatomycoses.

Sulconazole is a substituted imidazole antimicrobial agent structurally related to other drugs in this group. It possesses a broad spectrum of activity in vitro against dermatophytes, yeasts and some Gram-positive bacteria. The efficacy and safety of sulconazole 1% cream has been demonstrated in controlled clinical studies in patients with superficial dermatophyte or yeast infections. In these trials, sulconazole generally displayed similar efficacy to clotrimazole, econazole and miconazole, although in a few studies sulconazole produced better and/or quicker improvement than clotrimazole or miconazole in small numbers of patients with tinea pedis. Further studies in larger groups of patients are needed to confirm these encouraging preliminary findings. Thus, sulconazole is an effective and well tolerated alternative to other topical imidazole drugs in the treatment of superficial fungal infections of the skin.

Animals↗
PubMed1998

An overview of topical antifungal therapy in dermatomycoses. A North American perspective.

Dermatophytes cause fungal infections of keratinised tissues, e.g. skin, hair and nails. The organisms belong to 3 genera, Trichophyton, Epidermophyton and Microsporum. Dermatophytes may be grouped into 3 categories based on host preference and natural habitat. Anthropophilic species predominantly infect humans, geophilic species are soil based and may infect both humans and animals, zoophilic species generally infect non-human mammals. It is important to confirm mycologically the clinical diagnosis of onychomycosis and other tinea infections prior to commencing therapy. The identity of the fungal organism may provide guidance about the appropriateness of a given topical antifungal agent. Special techniques may be required to obtain the best yield of fungal organisms from a given site, especially the scalp and nails. It is also important to realise the limitations of certain diagnostic aids e.g., Wood's light examination is positive in tinea capitis due to M. canis and M. audouinii (ectothrix organisms); however, Wood's light examination is negative in T. tonsurans (endothrix organism). Similarly, it is important to be aware that cicloheximide in culture medium will inhibit growth of non-dermatophytes. Appropriate media are therefore required to evaluate the growth of some significant non-dermatophyte moulds. For tinea infections other than tinea capitis and tinea unguium, topical antifungals may be considered. For effective therapy of tinea capitis an oral antifungal is generally necessary. Similarly, oral antifungals are the therapy of choice, especially if onychomycosis is moderate to severe. Furthermore, where the tinea infection involves a large area, in an immunocompromised host or if infection is recurrent with poor response to topical agents, then oral antifungal therapy may be necessary. Topical antifungal agents may be broadly divided into specific and nonspecific agents. The former group includes the polyenes, azoles, allylamines, amorolfine, ciclopirox and butenafine. Generally the topical agent is available as a cream, sometimes for use intravaginally. Less commonly, the formulation may be in the form of a powder, lacquer, spray, gel or solution. Many of these agents have a broad spectrum of activity, being effective against dermatophytes, yeasts and Malassezia furfur. For the treatment of tinea corporis, tinea cruris tinea versicolor and cutaneous candidosis, once or twice daily application may be required, the most common duration of therapy being 2 to 4 weeks. For tinea pedis the most common treatment duration is 4 to 6 weeks.

Administration, Topical↗
PubMed2000

[Epidemiology, clinic and treatment of dermatomycoses caused by zoophilic dermatophytes] .

In the last 50 years the spectrum of agents of dermatophytoses changed. The change is remarkable especially in the case of zoophilic dermatophytes. Microsporum canis has displaced Trichophyton verrucosum. In the period from 1966 to 1970 2822 dermatophytoses were registered as occupational dermatoses in the former German Democratic Republic. In the following years the number of these diseases was continuously reduced, between 1981 and 1985 down to 995 cases. This reduction is predominantly the result of active immunoprophylaxis by means of inactivated, hydrolized vaccines, mainly by the Soviet live vaccine LTF-130. The scientific basis of this vaccination was established by Kielstein and co-workers. The treatment of Microsporum canis infection of the scalp requires the administration of systemically acting antimycotics over a long period (6-8 weeks).

Animals↗
PubMedDate not supplied

Update on the safety of itraconazole pulse therapy in onychomycosis and dermatomycoses.

As the use of newer antifungal agents becomes more widespread, safety issues surrounding their use have become more important. To date, the safety profile of itraconazole has been well defined by its worldwide use in 50 million patients over the past 13 years. Data from clinical practice and clinical trials indicate that the 1-week pulse regimen of itraconazole is well tolerated and associated with a favourable safety profile. Adverse events are generally mild and transient. Furthermore, a dose increase to 400 mg in the pulse regimen has had no adverse impact on safety.

Antifungal Agents↗
PubMed2000

[What's new in diagnosis and therapy of dermatomycoses in childhood].

Mycotic infections in childhood are caused in the majority of cases by dermatophytes. If an oral treatment is indicated, itraconazole and terbinafine are superior to griseofulvin and are nowadays drugs of first choice although an official registration for treatment of children is missing in Germany. Yeasts in infections of childhood are the causative organisms in Pityrosporum-folliculitis and act as an important co-factor in diaper dermatitis.

Antifungal Agents↗
PubMed2000

[Results of the first dermatomycoses quality control study in Germany].

For the first time in the history of German mycology, a multicenter study for identification of dermatophytes, yeasts and molds was conducted under the auspices of the German Speaking Mycological Society and the German Dermatological Society. A total of 1,008 dermatological offices and dermatology hospitals as well as 106 institutes of microbiology participated in this voluntary quality control trial. They were requested to identify four pathogens: Trichophyton tonsurans, Trichophyton mentagrophytes, Aspergillus niger, and Candida glabrata. T. tonsurans was correctly determined by 749 participants (67.2%), T. mentagrophytes by 974 (87.4%), A. niger by 922 (82.8%) and C. glabrata by 973 (87.3%). Four pathogens were identified at the species level by 591 investigators (53.1%). Three species were correctly identified by 310 investigators (27.8%), two by 143 (12.8%) and 0-1 by 70 (6.3%). The first dermatomycological quality control study in Germany may therefore be considered a success. Further trials will be carried out, initially at intervals of one year.

Aspergillus niger↗