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PubMed1992

Once-weekly oral doses of fluconazole 150 mg in the treatment of tinea corporis/cruris and cutaneous candidiasis.

Ninety-five adult out-patients with tinea corporis and/or tinea cruris participated in a multicentre open non-comparative study investigating the safety and efficacy of 1-4 once-weekly doses of oral fluconazole 150 mg. Trichophyton rubrum was isolated most frequently (67 of 86 mycologically evaluable patients). A mean of 2.6 doses of fluconazole was administered; patients infected with Candida albicans or Epidermophyton floccosum required an average of 2 doses compared to 3-4 doses in patients infected with other organisms. Clinical cure was obtained in 85 of 92 (92%) patients at the last post-treatment evaluation, with the remaining seven patients being substantially improved. At long-term follow-up, 28-30 days after the last dose, 80 of 91 (88%) patients were assessed as clinically cured, three (3%) patients were improved and eight (9%) patients failed. Among the long-term clinical failures, there was one diagnosis of tinea corporis (3% failure rate) and seven diagnoses of tinea cruris (12% failure rate). Mycological evidence of infection occurred in only 1 of 86 patients assessed at the last post-treatment follow-up. Mycological relapse occurred in nine (11%) patients at long-term follow-up; one patient was infected with Trichophyton mentagrophytes and eight patients were infected with T. rubrum. Relapse occurred in 2 of 29 (7%) patients with tinea corporis and eight of 57 (14%) patients with tinea cruris (one patient who relapsed had both tinea corporis and cruris). There was no correlation between the number of doses received and the mycological response or relapse rates at long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2006

Epidemiological and aetiological study on tinea pedis and onychomycosis in Algeria.

Epidemiological studies on tinea pedis and onychomycosis, common fungal infections, have been conducted in many parts of the world. There are currently no studies of tinea pedis and/or onychomycosis in Algeria. The aim of this paper was to study the epidemiology of foot diseases, including tinea pedis and onychomycosis and to identify the aetiological factors of these infections in outpatients attending the Department of Dermatology of the Central Hospital of Army in Algiers, Algeria. A total of 1300 male subjects, mean age 35.9 +/- 16 years (range: 16-80) were recruited during the period November 2003 to November 2004 and were clinically examined. A complete dermatological examination was performed on all subjects, and skin and nail specimens of the feet were taken from those patients presenting signs of tinea pedis and/or onychomycosis for microscopy and fungal culture. Clinical diagnosis for tinea pedis and onychomycosis was suspected in 249 and 72 subjects, respectively, and confirmed in 197 and 60 cases, respectively, by positive cultures, resulting in a global prevalence of tinea pedis and toenail onychomycosis of 15% and 4.6% respectively. The age groups most commonly infected were 50-59 and 20-29 years. The yeast species Candida parapsilosis and the dermatophytic species Trichophyton rubrum were shown to be the most common pathogens in both tinea pedis (C. parapsilosis 20.4%; T. rubrum 17%) and onychomycosis (T. rubrum 35%; C. parapsilosis 28.3%). This is the first investigation dealing with fungal foot diseases in Algeria. The clinical and epidemiological data collected would serve as reference for future research and may be useful in the development of preventive and educational strategies.

Adolescent↗
PubMed2003

Persistent and recurrent tinea corporis in children treated with combination antifungal/ corticosteroid agents.

BACKGROUND: Combination antifungal/corticosteroid preparations are widely used by nondermatologists in the treatment of superficial fungal infections in patients of all ages. Over half of the prescriptions written for the most commonly used combination agent clotrimazole 1%/betamethasone diproprionate 0.05% cream (Lotrisone, Schering, Kenilworth, NJ) were prescribed for children younger than 4 years old. Our pediatric dermatology division has recently encountered a series of children with recurrent or persistent tinea corporis, especially tinea faciei, treated initially with combination antifungal/corticosteroid cream. METHODS: All children evaluated for tinea corporis in a university hospital pediatric dermatology clinic from January through June 2001 were identified from the clinic registry for a retrospective chart review. Response to therapy was confirmed by telephone survey and/or follow-up visits at least 1 month after clearing of infection. RESULTS: Six children ranging in age from 4 to 11 years were evaluated for tinea corporis in a pediatric dermatology clinic at our institution during the 6-month period. All 6 children were diagnosed clinically by their pediatrician with tinea corporis and initially treated with clotrimazole 1%/betamethasone diproprionate 0.05% cream for 2 to 12 months. In our pediatric dermatology clinic, patients had their diagnosis confirmed with a positive potassium hydroxide preparation and were treated with one of several oral or topical antifungal agents with clearing of all tinea infections. CONCLUSION: The use of combination clotrimazole 1% cream/betamethasone diproprionate 0.05% cream (Lotrisone) for the treatment of tinea corporis may be associated with persistent/recurrent infection.

Administration, Topical↗
PubMed2002

[Seven days of intermittent terbinafine 250 mg treatment in Tinea pedis].

Tinea pedis responds well to topical antifungal therapy, however, relapse of the disease is not uncommon. Long-term application of antifungals is usually necessary to control relapse. We conducted an open trial of a 7 day intermittent course of oral terbinafine treatment at 250 mg/day for plantar type and interdigital type of tinea pedis. Seventy-five patients of plantar type and 49 patients of interdigital tinea pedis were treated with a 7 day course of terbinafine 250 mg/day. Clinical assessments were made at baseline and every 4 weeks. Another 7 day course of the same amount of terbinafine were given depending on the clinical and the mycological response. Of the 75 plantar type tinea pedis with 8 patients excluded, 66 of the remaining 67 (98.5%) were evaluated as cured. Of the 49 interdigital tinea pedis (3 excluded), 43 of 46 patients (93.5%) cured. Relapse of the disease was observed in 4 of 51 patients at 1 year after treatment, 4 of 25 at 2 years, and 2 of 9 at 3 years in the plantar type, and in 4 of 30 at 1 year, 0 of 14 at 2 years, and 0 of 6 at 3 years in the interdigital tinea pedis group. Intermittent terbinafine therapy is thus effective in the treatment of tinea pedis.

Administration, Oral↗
PubMed2001

Aetiology of tinea capitis in school children.

BACKGROUND: Tinea capitis is a superficial fungal infection of the scalp and hair of the head which is common in children aged between two and eleven years. An endothrix infection is best treated using parenteral antifungal drugs while an ectothrix one may be treated by parenteral or topical antifungal drugs. The organism that commonly causes tinea capitis in the Western world is Trichophyton tonsurans while there is inadequate information on the actual causative agent in Kenya. OBJECTIVES: To determine the prevalence and the aetiology of tinea capitis and the fungal agents responsible for it and; to recommend the correct mode of treatment in school children attending a primary school near Eldoret. DESIGN: Prospective and descriptive study. SETTING: Private primary school near Eldoret town. SUBJECTS: Sixty eight primary school children aged between six and 14 years in classes 1 to 5. RESULTS: Of the 68 pupils included in the study, 60.9% and 39.1% were males and females, respectively. Prevalence of tinea capitis in the school was 33.3%. Peak age of infection was 10 years. Ratio of infected males to females was 2:1. There was a growth on culture in 76.1% of the cases all of which were endothrix. T. tonsurans was isolated in 77.8%, T. rubrum in four per cent of the cases. CONCLUSION: The prevalence of tinea capitis in this school was high. The most common cause of tinea capitis was T. tonsurans. Males were more infected than the females. RECOMMENDATIONS: Oral antifungal drugs with griseofulvin being the first line of treatment should be adopted. Health education on the aetiology, treatment and prevention of tinea capitis should be given.

Adolescent↗
PubMed1979

Tinea versicolor and Pityrosporum orbiculare: mycological investigations, experimental infections and epidemiological surveys.

In patients with tinea versicolor, Pityrosporum orbiculare was cultured from tinea versicolor lesions in 100%, from normal-looking skin in 80%, and from apparently healed lesions in 69%. P. orbiculare was isolated from normal skin in 85% of patients with seborrheic dermatitis and in 90% of volunteers. The best substrate for isolation of P. orbiculare was a peptone-glucose-yeast extract medium containing glycerol monostearate and Tween 80, overlaid with olive oil. Germ tubes were produced when P. orbiculare was incubated in an atmosphere containing air with 7% CO2. Cultures of P. orbiculare and P. ovale did not show any fluorescence in Wood's light. The in vitro activity of miconazole, clotrimazole, econazole, sodium omadine, and sodium thiosulphate against P. orbiculare was found to correlate to the good clinical effect of these drugs in tinea versicolor. In addition several substances used as solvents or in vehicles had an inhibitory activity against P. orbiculare in vitro. Inoculation with P. orbiculare under plastic occlusion on the glabrous follicle-rich inside of the rabbit ear resulted in a tinea versicolor-like lesion after I week in 3 of 4 animals. One week after inoculation with P. orbiculare under plastic occlusion, experimental infections similar to those found clinically in tinea versicolor were seen in 10 of 12 patients with a history of tinea versicolor and in 3 of 6 normal volunteers. It was not possible to produce experimental infections without occlusion. Spontaneous healing usually occurred. In a retrospective study of 232 patients and prospective survey of 48 patients regarding susceptibility factors in tinea versicolor a higher (10.4%) than expected (3.8%) connection to seborrheic dermatitis was found.

Adolescent↗
PubMed2004

Dermatology for the practicing allergist: Tinea pedis and its complications.

Tinea pedis is a chronic fungal infection of the feet, very often observed in patients who are immuno-suppressed or have diabetes mellitus. The practicing allergist may be called upon to treat this disease for various reasons. Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease. Patients with recurrent cellulitis may be referred to the allergist/immunologist for an immune evaluation and discovered to have tinea pedis as a predisposing factor. From a molecular standpoint, superficial fungal infections may induce a type2 T helper cell response (Th2) that can aggravate atopy. Th2 cytokines may induce eosinophil recruitment and immunoglobulin E (IgE) class switching by B cells, thereby leading to exacerbation of atopic conditions. Three groups of fungal pathogens, referred to as dermatophytes, have been shown to cause tinea pedis: Trychophyton sp, Epidermophyton sp, and Microsporum sp. The disease manifests as a pruritic, erythematous, scaly eruption on the foot and depending on its location, three variants have been described: interdigital type, moccasin type, and vesiculobullous type. Tinea pedis may be associated with recurrent cellulitis, as the fungal pathogens provide a portal for bacterial invasion of subcutaneous tissues. In some cases of refractory asthma, treatment of the associated tinea pedis infection may induce remission in airway disease. Very often, protracted topical and/or oral antifungal agents are required to treat this often frustrating and morbid disease. An evaluation for underlying immuno-suppression or diabetes may be indicated in patients with refractory disease.

Journal Article↗
PubMed2006

An experience from an outbreak of tinea capitis gladiatorum due to Trichophyton tonsurans.

'Tinea corporis gladiatorum' describes a dermatophytosis transmitted mainly from close skin contact among wrestlers. Although tinea corporis is well recognized, no data are available for tinea capitis infections in wrestlers. After finding tinea capitis infection in a student wrestler, we aimed to search for possible ringworm infections among wrestlers in a wrestling boarding-school. Of the 32 wrestlers, 29, aged 12-18 years, were affected, of whom 22 had scalp involvement. Trichophyton tonsurans was isolated from 20 of the patients, and T. mentagrophytes from the remaining two. Isolated strains of dermatophytes were susceptible to terbinafine and itraconazole. The patients with tinea capitis received oral terbinafine for 4 weeks, and patients with more than two lesions but without scalp involvement received oral terbinafine for 2 weeks. Overall clinical and mycological cure rate was 72.4% and 70%, respectively, at assessment at week 6. The asymptomatic dermatophyte carrier rate was negative 1 year after control of the epidemic. Terbinafine seems to be an alternative drug for the treatment of tinea capitis caused by T. tonsurans; however, control of an outbreak may be very difficult and effective preventive measures should be considered.

Adolescent↗
PubMed1983

New data on the epidemiology of Tinea cruris in Israel.

Among 250 patients with tinea cruris (160 males, 90 females) lesions of both tinea pedis and tinea unguium were found in 221 and lesions of only tinea pedis in another 25. The four children were free of associated dermatophytic lesions. The predominant causative agent was T. rubrum, which was also found to be responsible for the hairy area invasion of the beard and pubis in 12 patients and for the widespread lesions of tinea corporis in 10 patients with lymphoma. None of these patients had noticed the discrete nail and foot involvement. It is therefore recommended that all patients with tinea cruris be subjected to careful examination of all possible mycotic foci, particularly the feet and nails.

Adult↗
PubMed2005

[Hyperhidrosis as risk factor for tinea pedis].

BACKGROUND: The purpose of this study was to evaluate a possible association between tinea pedis (interdigital mycosis) and hyperhidrosis by a case-control-study. PATIENTS AND METHODS: 30 otherwise healthy patients (age 22-56 years, 30% female) with mycologically proven tinea pedis and 51 control patients were included. RESULTS: 53.3% of the patients with tinea pedis and 33.3% of the control-patients had focal hyperhidrosis defined by gravimetry (definition as > or =30 mg sweat/min) (p-value=0.08). To control for possible confounding variables a multivariate analysis was performed including possible risk factors such as gender, regular visits in sauna and/or swimming pools. Multivariate analysis found a 3.5-fold increased risk for patients with tinea pedis to have hyperhidrosis. CONCLUSION: The study supports an association between tinea pedis or interdigital mycosis and focal plantar hyperhidrosis and therefore lends credence to the treatment of hyperhidrosis in patients with tinea pedis.

Adult↗
PubMed1998

Itraconazole oral solution for the treatment of tinea capitis.

Twenty-seven children (12 boys, 15 girls, age range 3-11 years, weight range 10-40 kg) were treated with itraconazole oral solution 10 mg/mL given as pulse therapy for tinea capitis. The dosage regimen was 3 mg/kg per day given once daily in a fasting state with each pulse lasting 1 week. The first two pulses were separated by a 2-week off-drug period, and the second and third pulses had a 3-week period without drug between them. For each patient a second and third pulse were administered if there was clinical evidence of tinea capitis at the time-point when the next pulse was due. The overall severity of tinea capitis at pretherapy was classified as mild, moderate or severe with the aetiology being: Trichophyton tonsurans, 24 patients; T. violaceum, two patients and Microsporum canis, one patient. In 19 evaluable patients, 12 weeks after starting therapy, the numbers of pulses of itraconazole oral solution required to produce complete cure were, according to the severity of disease, mild tinea capitis (one pulse: four patients; two pulses: five), moderate disease (one pulse: two patients; two pulses: two; three pulses: two), and severe disease (three pulses: three patients). One patient with moderate severity tinea capitis was clinically clear after three pulses of therapy but mycological examination was positive. Seven patients were lost to follow-up and one discontinued therapy because of nausea. Itraconazole oral solution 3 mg/kg per day was generally well tolerated. Three children developed gastrointestinal adverse effects which were considered to be minor or 'nuisance' effects. The data from this preliminary report need to be confirmed in a larger group of patients. It remains to be seen whether itraconazole oral solution will become a practical alternative to the antifungal agents available in a liquid preparation for the treatment of tinea capitis.

Administration, Oral↗
PubMed2001

Pigmentary changes of tinea versicolor in dark-skinned patients.

BACKGROUND: Tinea versicolor causes scaly macular lesions which vary in color from white to brown. In patients with dark skin, tinea versicolor is thought to have a tendency to be hypopigmented. This view has not been formally documented. OBJECTIVE: Our objective was to determine the pigmentary changes of lesions of tinea versicolor in patients with skin types IV and V. METHODS: One hundred cases of tinea versicolor in persons with skin types IV and V were studied. The pigmentary changes and their correlation with the age and sex of the patients and the duration, recurrence, site, and symptomatology of the lesions were determined. RESULTS: There was no correlation between the pigmentary variations of tinea versicolor and the type of skin, sex, and age of our patients or the duration, recurrence, site, and symptomatology of the lesions. CONCLUSIONS: In dark-skinned individuals, tinea versicolor does not tend to be significantly hypopigmented.

Adolescent↗
PubMed2002

Tinea capitis in schoolchildren from lvory Coast (western Africa). A 1998-1999 cross-sectional study.

BACKGROUND: Tinea capitis is a worldwide public health problem that poses specific therapeutic challenges. This dermatophytosis of the scalp is endemic in Africa. The objectives of this study were to determine the prevalence, the associated demographic factors, causative species, and clinical types of tinea capitis in Abidjan, Ivory Coast. METHODS: From June 1998 to March 1999, 1913 children aged between 4 and 15 years, and schooling in seven urban primary schools of Abidjan (Ivory Coast), were examined clinically for tinea capitis. Among all children showing symptoms suggestive of scalp ringworm, hair stumps and scales were collected and exposed to direct microscopic examination using 30% potassium hydroxide solution, and cultivation on Sabouraud's dextrose agar with or without actidione. RESULTS: Among 227 symptomatic children, cultures positive for fungi were found in 217, yielding an overall tinea capitis prevalence of 11.34% [95% Confidence Interval (CI), 9.97-12.85]. By univariate analysis, tinea capitis was significantly associated with boys [odds ratio (OR) 7.85; CI 5.22-11.81] and in children belonging to the intermediate 8-11 years age group (OR 1.93; CI 1.29-2.90). Trichophyton soudanense and Microsporum langeronii were the most prevalent etiologic agents (63.6% and 31.3%, respectively), whereas a mixture of both T. soudanense and M. langeronii was observed in a 2.8% proportion. Finally, 2.3% of isolated species were represented by T. violaceum. CONCLUSIONS: Our survey provided evidence that tinea capitis is endemic in Ivory Coast, constituting a substantial infectious dermatological disturbance. T. soudanense was the most frequent causative agent, whereas T. violaceum was isolated for the first time in this sub-Saharan western African country.

Adolescent↗
PubMed2000

Erysipelas and tinea pedis.

During a 2-year period 30 adults were selected out of a group of patients diagnosed with erysipelas, who, except for tinea pedis, were apparently otherwise healthy patients. Clinical and epidemiological studies were performed to establish how tinea pedis and erysipelas are related. Thirteen of 30 patients with a diagnosis of erysipelas were found to have tinea pedis due to Trichophyton mentagrophytes and Trichophyton rubrum. In seven of the patients (23%) tinea pedis was found to be the unique predisposing factor for erysipelas. Tinea pedis may be a risk factor for streptococcal infections such as erysipelas, mainly in tropical countries, where tinea pedis is a frequent disease.

Erysipelas↗
PubMed2003

Presence of dermatophytes on the nails of tinea capitis patients. Prospective study in the area of Sfax (Tunisia).

Between January 1995 and December 2000, 512 cases with mycologically confirmed tinea capitis have been diagnosed in our laboratory. In addition, finger nail samples have been taken from 211 patients out of 512. The culture of the nail samples taken was positive for 80 patients (38%). The isolated dermatophytes were the same in the nails and the scalp. Microsporum canis was isolated in 82% of nail samples. Trichophyton violaceum grew only in 18% and Trichophyton quinckeanum in one case. A T. violaceum onychomycosis was found in two patients with tinea capitis. Twenty-one cases of tinea were resistant to 6 weeks treatment with griseofulvin. Thirty per cent of them have had fungal elements in nails. Dermatophyte colonization of the nails in tinea patients could be a factor of tinea capitis transmission and could explain some recurrent tinea capitis cases and therapy resistance.

Antifungal Agents↗
PubMed2001

Tinea due to Trichophyton violaceum and Trichophyton soudanense in Hamilton, New Zealand.

Between 1994 and 2000, 63 isolates of Trichophyton violaceum and five isolates of Trichophyton soudanense were recorded in both private and public laboratories in Hamilton, New Zealand. A retrospective analysis of medical records of these patients was performed. From these 68 isolates, 58 were recovered from scalp specimens and 10 were recovered from other body sites. There were 51 patients with tinea capitis and nine patients in the tinea corporis group. Six patients had more than one isolate reported at different laboratories. As expected, the vast majority of scalp infections (46/51 patients) were children, with an overall median age of 6 years (range 8 months to 66 years). All patients in the tinea capitis group, except one, were refugee immigrants from East Africa. Of nine patients in the tinea corporis group, six were refugees from the same area. For tinea capitis, 31 patients received systemic antifungal therapy for at least 4 weeks, with either terbinafine (21 patients), griseofulvin (four patients) or itraconazole (six patients). Five patients received topical antifungal creams or shampoo as monotherapy only. The remainder (15 patients) received either no therapy or no record was available. The emergence of these two pathogens as causes of tinea capitis in Hamilton closely correlates with the increasing number of refugees from endemic areas. There is a high rate of person-to-person transmission with these anthropophilic organisms in children as well as adults in the family. Transmission of infection to the local population has been observed, but there is no evidence to date to suggest that these organisms have become endemic in the local population.

Adolescent↗
PubMed2002

Tinea capitis: focus on African American women.

Tinea capitis is a common cutaneous fungal infection in US school children, but adults may be carriers of tinea pathogens in the scalp. However, few cases of actual tinea capitis in adults have been reported in the literature. A retrospective analysis of all adult patients with positive scalp fungal cultures from June 1997 to March 2000 were reviewed. Seventy-nine cases of tinea capitis were identified. Nine (11.4%) were adults, 7 of whom were African American women, who were an average of 46 years old (range, 25 to 64 years). Three of these patients had prior exposure to a child with tinea capitis. These results suggest that tinea capitis affects adult African Americans, particularly women. Widespread scalp culture is indicated for papulosquamous disease and alopecia in this segment of the population.

Adult↗
PubMed1994

Tinea versicolor and visceral leishmaniasis.

BACKGROUND: Visceral leishmaniasis (VL) is endemic in several areas in the Sudan. The disease is associated with depressed cellular immunity. Tinea versicolor is a normal commensal of the skin which can become pathogenic particularly in patients with depressed cell-mediated immunity. Patients with VL have a high prevalence of tinea versicolor. METHODS: One hundred and thirty patients with parasitologic confirmation of VL were screened for tinea versicolor infection. In the suspected cases the diagnosis was made by demonstrating the fungal hyphae and spores in skin scrapings. All patients were treated with sodium stibogluconate. RESULTS: Of the 130 patients with VL, 10.8% were found to have severe tinea versicolor. The fungal infection developed or became worse with the start of VL. After successful treatment of VL, the tinea lesions disappeared completely or decreased in severity. CONCLUSIONS: Depressed cell-mediated immunity that is a feature of VL is the probable underlying cause for fungal infection. Tinea infection during the course of VL is to be distinguished from lesions of post-kala-azar dermal leishmaniasis.

Adolescent↗