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OBJECTIVE: To evaluate the possible role of honey, olive oil and beeswax in the treatment of skin fungal infections. PATIENTS AND METHODS: Thirty-seven patients with pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei were studied. After clinical evaluation of redness, scaling, pruritus and burning/pain sensation and mycological assessment, honey mixture containing honey, olive oil and beeswax (1:1:1) was applied to the lesions three times daily for a maximum of 4 weeks. RESULTS: Clinical response was obtained in 86% of patients with pityriasis versicolor, 78% of patients with tinea cruris and in 75% of patients with tinea corporis. Mycological cure was obtained in 75, 71 and 62% of patients with PV, tinea cruris and tinea corporis, respectively. The patient with tinea faciei showed clinical and mycological cure 3 weeks after commencement of therapy. CONCLUSION: Honey mixture may have place in the management of these skin conditions and rigorous, controlled trials are justified.
Two randomized, double-blind, vehicle-controlled, multicenter studies assessed the efficacy and safety of a new terbinafine 1% solution for the treatment of interdigital tinea pedis and tinea corporis or tinea cruris (tinea corporis/cruris). Patients with interdigital tinea pedis applied terbinafine 1% solution or vehicle twice daily for 1 week with 7 weeks of follow-up (N = 153), and patients with tinea corporis/cruris applied terbinafine 1% solution or vehicle once daily for 1 week with 3 weeks of follow-up (N = 66). Efficacy was assessed mycologically and clinically at the end of treatment and throughout follow-up. In the tinea pedis study, 66% of patients were effectively treated with terbinafine compared with 4% of the group treated by vehicle (P < .001; Mantel-Haenszel test). In the tinea corporis/cruris study, treatment was effective in 65% of the terbinafine group compared with 8% of the vehicle group (P < .001). There were no significant differences in the frequency of cutaneous adverse events between the 2 groups in either study. We conclude that one week of therapy with terbinafine 1% solution is highly effective, superior to vehicle, and safe for use in superficial fungal infections.
We treated 20 patients who had tinea corporis and/or tinea cruris and 20 patients who had tinea pedis with oral fluconazole. All patients were given a single 150-mg dose of fluconazole upon entry into the study; at that time, and at each follow-up visit, clinical signs and symptoms were evaluated and mycological and laboratory examinations were performed. If clinical and/or mycological cure or significant improvement in a patient's condition was not evident at the 7-day follow-up visit, a second dose of fluconazole (150 mg) was given. A maximum of four doses, one week apart, were given. A long-term evaluation of the efficacy of fluconazole in the treatment of these infections was performed 28-30 days after the last dose was administered to each patient. For the treatment of tinea corporis and/or tinea cruris, 70% of patients required two doses, 20% required three doses, and 10% required four doses. At the long-term follow-up visit the clinical and mycological response rates were determined to be 95% cure and 5% relapse. For the treatment of tinea pedis, 20% of the patients required two doses, 20% required three doses, and 60% required four doses. For these patients, the long-term clinical response rates were 70% cure and 30% improvement; mycological response rates were 75% eradication, 10% persistence of infection, and 15% relapse. This treatment was well tolerated; no adverse effects or clinically significant laboratory abnormalities were reported.
Tinea infections are among the most common dermatologic conditions throughout the world. To avoid a misdiagnosis, identification of dermatophyte infections requires both a fungal culture on Sabouraud's agar media, and a light microscopic mycologic examination from skin scrapings. Topical antifungals may be sufficient for treatment of tinea corporis and cruris and tinea nigra, and the shaving of hair infected by piedra may also be beneficial. Systemic therapy, however, may be required when the infected areas are large, macerated with a secondary infection, or in immunocompromised individuals. Preventative measures of tinea infections include practicing good personal hygiene; keeping the skin dry and cool at all times; and avoiding sharing towels, clothing, or hair accessories with infected individuals.
Superficial dermatophytoses of skin are very common infections seen in clinical practice. Besides topical imidazoles, triazoles and allylamines, topical butenafine (a benzylamine derivative) is a novel agent with broad antifungal activity. One hundred and eleven patients with tinea infections were enrolled in this multicentric, randomised, single-blind non-comparative study, which involved application of butenafine (1%) cream in tinea pedis (4 weeks) and tinea cruris and tinea corporis (2 weeks) cases. The results showed that butenafine causes rapid resolution of signs and symptoms (erythema itching, burning, crusting, scaling, etc), with good patient and physician acceptability of treatment. The broader spectrum fungicidal activity and better drug retention in superficial skin layers may be responsible for this beneficial effect.
Thirty-five dermatologists enrolled 256 patients to assess the safety and efficacy of ketoconazole 2 percent cream, applied once daily, in the treatment of tinea pedis, tinea cruris, and tinea corporis. Of these, 232 were eligible for efficacy evaluation based on mycologic evidence. Symptoms were assessed after four and eight weeks of treatment; relapse was assessed four weeks after the end of treatment. Total symptom scores decreased significantly during the treatment period. A marked or excellent response to treatment was observed in 82 percent of the cases. At the end of treatment 113 patients had all of their symptoms scored as absent or mild. Of these, three patients relapsed (2.7 percent) and had at least one symptom scored as moderate or severe at the follow-up visit. Only 7.2 percent (six of eighty-three) of the patients with negative findings on potassium hydroxide examination at the end of treatment showed positive findings at the follow-up visit. Three patients reported local irritant reactions to ketoconazole, two of whom discontinued treatment.
A retrospective study was undertaken of 192 cases of culture proven tinea capitis occurring between 1979 and 1988 in a predominantly white population of children in New South Wales (NSW). The aim of the study was to identify whether Trichophyton tonsurans was increasing in importance in the causation of this condition in Australia as it was in many other parts of the world. The results of our study were compared with those of earlier Australian studies. Our study demonstrated that Trichophyton tonsurans is now equal in importance to Microsporum canis which was previously the strongly predominant organism.
The authors studied 31 patients with Tinea cruris, corporis or pedis interdigital. The patients were treated with 100 mg of itraconazole, once a day, during the lunch, for 15 days. Mycological and clinical evaluations were performed at the pre-treatment, by the end of treatment and 2 weeks after finishing the treatment. The results showed that itraconazole is effective for the treatment of dermatophytosis, at the studied posology, with 100% of mycological cure. Clinical evaluation showed a significant reduction (Friedman test--p less than 0.001) of signs and symptoms.
BACKGROUND: Although dermatophytoses can appear at any age, some types are particularly prevalent in children. There are no prior data on the prevalence of tinea capitis and tinea pedis in Barcelona, Spain. To identify the prevalence of tinea in school children in the area with the highest immigrant population in this city, a cross-sectional study was performed. A second objective was to identify the etiologic agent to study the possibility of the introduction of foreign dermatophyte species and to evaluate the possibility of encountering healthy hosts. METHODS: From October 2002 until June 2003, we evaluated 1305 schoolchildren, ages 3-15 years, belonging to 21 schools located in the inner city of Barcelona to determine the prevalence of tinea capitis and pedis in school children. Cultures of scalp and feet were done in each child. RESULTS: 36(2.8%) children had tinea pedis and 3 (0.23%) had tinea capitis. One child had tinea capitis and tinea pedis, caused by different species (t. capitis caused by Trichophyton mentagrophytes and tinea pedis caused by Trichophyton rubrum). Of the 39 positive cases for dermatophytes, the etiologic agent in 18 (46.1%) was T. mentagrophytes, 17 (43.5%) T. rubrum, 2 (5.5%) Epidermophyton floccosum and 2 (5.5%) Trichophyton tonsurans. Of these 39 cases of tinea, 15 (38.5%) were Spanish natives and 22 (56.4%) were immigrants. CONCLUSION: The prevalence of tinea capitis was lower that we had expected, and it was noted that there was a greater prevalence of tinea pedis among schoolchildren 13-15 years of age (64.10%), the great majority of them male. The number of cases of tinea was significantly greater in immigrants.
Topical treatment of fungal infections took a step forward in the 1960s with the introduction of biologically active agents with specific antifungal mechanisms of action. Most modern broad-spectrum antifungal agents act by blocking specific steps in the synthesis of fungal cell membrane components. The broad-spectrum topical antifungal drugs now in use include the imidazoles (e.g. clotrimazole and miconazole), a pyridone-ethanolamine salt, dimethylmorpholines, and the newest class, the allylamines (e.g., naftifine and terbinafine). The topical allylamines have been shown in comparative studies to produce higher cure rates and more rapid responses in dermatophyte infections than many of the older agents.
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This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified as Trichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) and Trichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes (44.8%), followed by Epidermophyton floccosum (7%) and T. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).
The precise mechanism of the host defense that protects the nail from dermatophyte invasion is not known. Recent immunological findings in dermatophytosis suggest the hypothesis that the T helper 1 (Th1) response may play a role in protecting the nail from dermatophyte invasion. Our present study focused on interferon-gamma (IFN-gamma) release in patients with tinea pedis with or without tinea unguium, and pathogenesis of tinea unguium is discussed in relation to the association with a possible deficiency of Th1 response in the host defense mechanism. The production of IFN-gamma by peripheral blood mononuclear cells from the patients with tinea unguium in response to stimulation with trichophytin was not impaired in contrast to that from the patients without tinea unguium. Comparable lymphocyte proliferation to trichophytin was observed in both groups. Normal healthy persons with no clinical evidence of tinea could be divided into two groups based on lymphocyte proliferation and IFN-gamma production in response to trichophytin: high responder and low responder, with high responders being correlated with a clinical history of previous tinea pedis. In this study, a lack of a Th1 response to dermatophyte antigen was not shown in patients with tinea unguium by measuring the release of IFN-gamma, which plays a role in the effector phase of the delayed-type hypersensitivity reaction. A deficiency in the Th1 response to dermatophyte antigen, therefore, does not appear to play an important role in the establishment of tinea unguium.
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BACKGROUND: Tinea corporis and tinea cruris are usually treated with a topical antifungal agent unless the infection is unresponsive, involves an extensive area, is chronic, or is in a difficult-to-access area. In these cases oral antifungals are frequently used. OBJECTIVE: This double-blind study was undertaken to determine whether a 2-week course of oral itraconazole would produce statistically significant clinical and mycologic improvement in the treatment of tinea corporis, tinea cruris, or both, over the results obtained with placebo. A second objective was to determine the safety of itraconazole, through routine measurements of serum chemistry profiles. METHODS: Sixty-seven patients were entered into a double-blind, multicenter study to compare the clinical and mycologic effects of itraconazole, 100 mg daily (45 patients), and placebo (22 patients) on tinea corporis and/or tinea cruris. The duration of treatment was 2 weeks. The investigators assessed signs and symptoms and performed a potassium hydroxide examination and culture at baseline, at termination of therapy, and 2 weeks after completion of treatment. RESULTS: Twenty-two (96%) of 23 evaluable patients in the itraconazole group had healed or markedly improved lesions, as compared with 5 of 13 (39%) in the placebo group (p < or = 0.01). Similarly, the condition in 13 of 23 patients (57%) in the itraconazole group was mycologically cleared at the end of treatment whereas this result occurred in only 2 (17%) of 12 patients in the placebo group (p = 0.02). The prevalence of adverse side effects was lower for the itraconazole-treated group (20%) than for the placebo-treated group (36%). CONCLUSION: Itraconazole 100 mg once daily is an effective agent for the treatment of tinea cruris and tinea corporis.