Griseofulvin: therapeutic results in different dermatomycosis after 22 weeks of treatment: effect on experimental dermatomycosis in man.
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Dermatomycoses↗
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[Study of dermatomycosis and survey of pathogens in troops of Hainan area].
Subtropical area is the prevalent area of dermatomycosis with natural conditions suptable for the growth and proliferation of fungi causing suterficial dermatomycosis. Dermatomycosis not only brings about certain sufferings to the military personnel in peacetime, but also causes nonbattle loss in manpower in war time. In the present work, a survey of dermatomycosis in Hainan subtropical area of China and isolation of the pathogens were carried out. The results were as follows: The morbidity of superficial dermatomycosis was 34.1% and it was manifested clinically as tinea pedis, tinea versicolor, tinea corporis, tinea axillaris, tinea cruris, etc.; The main pathogen causing dermatomycosis in this area was Trichophyton rubrum which accounted for 50.4% of the pathogens isolated and the next was Trichophyton gypseum which accounted for 20.3%; Trichophyton rubrum could cause dermatomycosis of many sites of the body in this area, but the main lesious were tinea corporis and tinea cruris.
Adult↗
Diagnosis and management of cases of suspected dermatomycosis in The Netherlands: influence of general practice based potassium hydroxide testing.
BACKGROUND: Microscopy of a potassium hydroxide preparation of skin scrapings or nail clippings, although widely advocated as a test for dermatomycosis, is used in only a small proportion of cases. AIM: This study set out to investigate the effect of potassium hydroxide testing on the subjectively assessed probability that a dermatomycosis was present. METHOD: The study was undertaken in 1992 in Limburg, a province in the south of the Netherlands. Ten general practitioners and eight trainees completed a questionnaire and performed a potassium hydroxide preparation for each patient presenting with a skin condition that they thought might be caused by dermatomycosis. Skin or nail material was also sent to a microbiology laboratory where another potassium hydroxide preparation as well as a culture were performed, these two tests serving as a gold standard against which to judge the potassium hydroxide preparation by the general practitioners. Data from a total of 164 cases were analysed. RESULTS: The results of the potassium hydroxide test carried out in the practice had a considerable influence on the subjectively assessed probability that a dermatomycosis was present, especially if the outcome was positive. The indication for antifungal treatment was altered as a result of the test in a quarter of all cases, mostly from negative to positive. Use of the practice potassium hydroxide test could increase the proportion of correct therapeutic decisions from 54% to 69%, with 20% of cases being undertreated. Of cases that gave a positive test result in the practice 83% also had a positive laboratory test result, while of cases that gave a negative practice result 43% were positive in the laboratory. CONCLUSION: The potassium hydroxide test improves the diagnostic process in cases of possible dermatomycosis and may result in a change in management. The test can provide a confirmation of the diagnosis of dermatomycosis but is not useful in the exclusion of this diagnosis.
Clinical Laboratory Techniques↗
Diagnosing dermatomycosis in general practice.
BACKGROUND: Diagnosing dermatomycosis from a clinical image is not always easy. Microscopy of a potassium hydroxide preparation (KOH-test) and culturing are seldomly used in general practice. Cyanoacrylate surface skin scraping (CSSS) is a new diagnostic tool that may be useful and simple. OBJECTIVES: We aimed to investigate the diagnostic value of signs and symptoms, the KOH-test and the CSSS, in patients with erythematosquamous skin lesions, using the culture as the gold standard. Our goal is to formulate an optimal algorithm for the diagnosis of mycosis, based on one or more of these tests and including both optimal accuracy and costs. METHODS: Scales from 148 consecutive general practice patients were tested using a KOH-test, CSSS and culture. Clinical data were collected using a questionnaire. RESULTS: Twenty-six (18%) positive fungal cultures were identified. The sensitivity of the clinical diagnosis was 81% and its specificity 45%; for the KOH-test, these figures were 12 and 93% respectively; and for the CSSS, 62 and 88%, respectively. The positive predictive value of the clinical diagnosis was 24% and the negative predictive value 92%; for the KOH-test these figures were 25 and 83%, respectively, and for the CSSS, 52 and 92%, respectively. Determining CSSS in all patients proved to be the most accurate policy (accuracy = 83%). The likelihood ratio of CSSS in all patients was 5.17 for a positive test result and 0.43 for a negative test result. An approach in which CSSS is obtained in only those patients whom the physician considers by clinical examination to have dermatomycosis, with no testing in other patients, results in positive and negative likelihood ratios of 4.69 and 0.56, respectively. Such a policy would result in an overall sensitivity of 50%, a specificity of 89%, a positive predictive value of 50% and a negative predictive value of 89%. DISCUSSION: The clinical picture of dermatomycosis is not very reliable. The combination of a clinical judgement if this is negative and an additional CSSS in the case of a positive clinical judgement provides us with the best cost-benefit ratio, if both diagnostic accuracy and logistic considerations are taken into consideration.
Belgium↗
Continuous itraconazole treatment for onychomycosis and dermatomycosis: an overview of safety.
Over the past 10 years, itraconazole has been used to treat more than 34 million patients worldwide. We present a review of the safety of various continuous itraconazole schedules used in the treatment of dermatomycosis and onychomycosis. Data from controlled clinical trials and extensive post-marketing surveillance show that itraconazole has an impressive safety profile at a dose of 50-200 mg/day for 1-4 weeks for dermatomycosis and 200 mg/day for 3 months for onychomycosis. In addition, itraconazole is safe to use in diabetic patients with dermatomycosis or onychomycosis. Short-term, intermittent itraconazole regimens, which may offer additional benefits in terms of safety and cost, have now been introduced.
Antifungal Agents↗
Epidemiology of dermatomycosis in the eastern Croatia--today and yesterday.
The aim of our investigation was to compare the distribution of dermatomycosis species in Eastern Croatia between two different periods: first period from 1997-2001 year, and second period from 1986-88 year. The outpatients from Department of Dermatovenerology University Hospital "Osijek" with confirmed diagnosis infection. Tinea, were selected on the basis o age, gender, localization and dermatomycosis species. During the first period (1997-2001) among 75,691 outpatients Tinea infection was confirmed in 558 (0.73%), while in the second period among 47,832 outpatients there were 126 (0.26%) cases with Tinea, what showed significant increase of fungal infections among population this region. According the age and gender in both periods predominant population were under of the age 16(40.14%: 41.26%), and female population was predominant (58.60% and 57.14%) in comparison to males (41.39% and 42.85%). The most frequent localization of lesions in period I were cutis glabrae (47.31%), palms and soles (31.36%), capitis (17.38%) and unguis (9.31%) and isolated species were as followed: Trichophyton (39.06%), Microsporum (31.72%) and Candida (28.13%) species. In period II the most frequent localization were palms and soles (40.47%), cutis glabrae (36.50%), capitis (12.69%) and unguis (10.31%). The isolated species in this period were: Trichophyton (80.15%), Candida (12.69%) and Microsporum (4.76%) species. From the data collected during two different periods we can observe 1) increase of fungal infection generally in our region; 2) significant changes in causative species (increase of Microsporum and Candida species infection, but Trichophyton spp still remain the first causative agent); and 3) changes in the localization of lesions.
Adolescent↗
Four cases of dermatomycosis: superficial cutaneous infection by Alternaria or Bipolaris.
Invasive dermal infections in immunosuppressed patients by a wide variety of opportunistic fungi are well described in the literature; however, superficial infections (dermatomycosis) are more rarely described. We report 4 cases of dermatomycosis by Alternaria or Bipolaris species. All but one of the patients had predisposing conditions including topical corticosteroid use, atopic or seborrheic dermatitis, and nail dystrophy. All 4 patients were otherwise immunocompetent. These cases represent some of the very few reports of Bipolaris in a primary stratum corneum infection and the first report of Bipolaris in an otherwise healthy person. We also describe what may be the first report of Bipolaris onychomycosis. All of our patients responded to topical or oral imidazole antifungal therapy. We discuss the significance of Alternaria and Bipolaris as contaminants or irrelevant organisms grown in some cultures of skin scrapings.
Administration, Oral↗
Patient noncompliance in dermatomycosis. Results of a survey among dermatologists and general practitioners and patients.
Noncompliance among dermatomycosis patients exists in many forms and is widespread. Patients are noncompliant in two major areas: they reduce the number of necessary daily applications of the antifungal drug and they prematurely stop the therapy. A survey among 35 dermatologists and general practitioners as well as 230 dermatomycosis patients in Germany in 1982 showed that noncompliance is widespread: a total of 48% of patients neglected the proper daily dosage schedule, 44% reduced the number of daily applications, whereas 4% increased them. 25% of patients stopped treatment after the symptoms had disappeared. However, there is no such thing like the noncompliant patients personality. Depending on the kind of noncompliance, different personality structures appear. And based on the patient's overall attitude towards noncompliance - one third confesses to be noncompliant - the psychological picture becomes even more complex and multifaceted. Improving patient compliance seems to be most promising by better, i.e. more thorough, doctor-patient communication and antifungal drugs that minimize the risks of noncompliant behavior by requiring less daily applications and a shorter time of treatment.
Adult↗
[Dermatomycosis caused by Trichophyton verrucosum in mother and child].
In recent years, there has been an epidemiological renaissance of zoophilic dermatophytoses caused by a variety of factors. At present, the most important causative organisms are Microsporum canis, Trichophyton mentagrophytes var. granulosum and, as in the present case, Trichophyton verrucosum. These are formerly notifiable pathogens which are highly virulent and contagious. The example of an extensive, originally unrecognized tinea corporis et faciei in mother and child presented here shows the current importance of Trichophyton verrucosum, but also the diagnostic difficulties in dealing with a formerly rare infection disease. The inflammatory symptoms of deep trichophytosis with imminent danger of scar formation was the basis of synergistic combination therapy in the two patients. The source of infection for zoophilic dermatomycosis at the beginning of the epidemiological increase were looked for almost exclusively in Mediterranean countries. However, there are now increased indications of indigenous pools. In view of the neglect of consistent immunization of livestock and the lack of a requirement to notify the disease, a further rise in the number of cases in humans is to be expected.
Adult↗
Ketoconazole in the treatment of dermatomycosis in cats and dogs.
Ketoconazole (Nizoral, Janssen Pharmaceutica) a new systemic antimycotic was tested in dermatomycosis in cats and dogs. The daily dose (10 mg/kg body weight) was administered for 10 or 20 days without any other measures being taken. After the 20-day treatments new hair growth was observed in 96.7 per cent of the cats and 89.9 per cent of the dogs. Clinical cure was complete in 96.8 per cent of the cats and 90.5 per cent of the dogs. Particularly the good tolerance in the cat was appreciated. There were practically no side-effects in dogs (except vomiting in two pups) or in cats.
Animals↗
Fenticonazole cream once daily in dermatomycosis, a double-blind controlled trial versus bifonazole.
A randomized, double-blind clinical trial was undertaken in 41 patients with dermatomycosis to compare topical 2% fenticonazole cream (group A: 21 patients) with topical 1% bifonazole cream (group B: 20 patients). Treatment was performed as a once daily application. Mycological and clinical parameters were assessed before treatment and after 7, 14, 21 and 28 days. At the control visits the clinical investigator also expressed an overall judgement on the patient's state of disease. This parameter was based on a combined clinical and mycological assessment by the physician; laboratory screening investigations were undertaken before and at the end of treatments. All patients were checked for their state of disease 3-4 weeks after the end of treatment. All assessment criteria showed fenticonazole to be at least as efficacious as bifonazole. Several trends in favor of fenticonazole were also found: fenticonazole achieved superior results in the overall clinical evaluation, and after 3 weeks of treatment 15 patients out of 21 on fenticonazole were cured in mycological and clinical terms, whereas treatment with bifonazole resulted in complete healing of only 7 patients out of 20. This difference is statistically significant (p = 0.021) and indicates a more rapid therapeutic activity of fenticonazole. At the posttreatment rechecks no recurrent disease was registered, irrespective of whether patients had received fenticonazole or bifonazole. Laboratory screening investigations revealed no evidence of significant treatment-related changes or abnormalities in both treatments. No adverse events were noted for either treatment.
Administration, Cutaneous↗
The pros and cons of an oral treatment of dermatomycosis.
The advantages and disadvantages of oral treatment of dermatomycosis is discussed, particularly with regard to griseofulvin and ketoconazole as examples. The advantages versus topical treatment are better efficacy, better compliance, and oral treatment is possibly more economical. Disadvantages are toxicity, development of resistant strains, interaction with other drugs and time- and cost consuming regular supervision of the patients.
Administration, Oral↗
Tolciclate versus miconazole, a double-blind trial in patients with dermatomycosis.
Eighty-one patients with dermatomycosis such as tinea corporis, tinea cruris, tinea pedis and pityriasis versicolor were treated with tolciclate 1% cream or miconazole 2% cream. Parasitological cure was obtained in 100% of the patients given tolciclate and in 97.4% of those given miconazole. Patients and investigator considered tolciclate treatment as excellent, respectively, in 76.2% and 73.8% of the cases. The corresponding figures for miconazole were 74.4% and 66.7%. Both treatments were well tolerated.
Administration, Topical↗
[Dermatomycosis in human and animals].
Dermatomycosis including dermatophytosis, sporotrichosis and cryptococcosis commonly occurs in humans and animals all and are considered to be zoonotic diseases. Recently, human cases of dermatophytosis transmitted from animals are increasing in number due to changes in the environments of human and animal life. Three species of dermatophytes, Microsporum canis, Trichophyton mentagrophytes and T. verrucosum are the most important pathogens from animal to human, respectively. Therefore, it is necessary to understand their biological and ecological characteristics to correctly diagnose and treat the disease. Some human cases of sporotrichosis and cryptococcosis were reported to be transmitted from animals in Europe and America, suggesting that medical doctors should be careful in taking the history of human patients with reference to their contacts with animals. Close cooperation between medical and veterinary doctors is required in clinical studies on mycotic infection.
Animals↗
Occurrence of dermatomycosis (ringworm) due to Trichophyton verrucosum in dairy calves and its spread to animal attendants.
Persistent dermatomycosis (ringworm) caused by Trichophyton verrucosum affected 20 dairy calves aged between 3 months and 1 year and housed together. The infection also spread to 2 animal attendants working among the calves. The major clinical lesions observed on the affected calves were extensive alopecia and/or circumscribed thick hairless skin patches affecting the head, neck, flanks and limbs. The observed lesions persisted for more than 17 weeks and most of the calves did not respond to topical treatment with various anti-fungal drugs within the anticipated period of 9 weeks. Two animal attendants developed skin lesions that were circumscribed and itchy and there was good response to treatment following the application of anti-fungal skin ointment. Although ringworm in dairy animals in Kenya has not previously been associated with spread to humans, the potential is evident from this report.
Animal Technicians↗
Some systemic effects of superficial dermatomycosis.
A baffling case of systemic dermatomycosis is presented and the course of therapy instituted for 12 months described. There has been marked improvement in the patient, both subjectively and objectively, the first in his five-year history. Thirty-five additional and comparative patients were identified during the 12-month time period. These patients were placed on therapy and their responses to treatment were equally impressive.
Dermatomycoses↗
[Dermatomycosis in sheep caused by a rare strain of Trichophyton verrucosum].
In the group of sheep reared for blood collections the enzootic occurrence of dermatomycosis was found affecting the hair on the head and back. From the pathological material obtained from the lesions of twelve animals an identical strain of Trichophyton verrucosum was cultivated which differed from common isolates of this type macromorphologically. By its ability to grow in the medium without vitamin and by its thermotolerance this isolate resembled the physiological variety T. verrucosum Bodin 1902, var. autotrophicum Scott 1976. On the example of trichophytosis in the described sheep flock epizootological importance of foci of this infection is demonstrated in flocks where no immunopreventive precautions are taken.
Animals↗
Antifungal activity of fenticonazole in experimental dermatomycosis and candidiasis.
The antifungal activity of alpha-(2,4-dichlorophenyl)-beta,N-imidazolylethyl 4-phenylthiobenzyl ether nitrate (fenticonazole, Rec 15/1476) in experimental dermatomycosis and candidiasis in guinea pigs was studied. Fenticonazole proved to be a very active drug with a healing capacity generally higher than that of the reference compounds. The adequate range of activity was from 1% to 3%, giving complete healing without relapses in 100% of cases treated. Fenticonazole is presently undergoing further experimental studies and on the basis of our results a clinical trial would therefore seem to be essential.
Animals↗