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Ketoconazole 2 percent cream in the treatment of tinea pedis, tinea cruris, and tinea corporis.

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.

Administration, Cutaneous↗

Efficacy and safety of butenafine in superficial dermatophytoses (tinea pedis, tinea cruris, tinea corporis).

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.

Administration, Topical↗

Topical antifungal drugs in the treatment of tinea pedis, tinea cruris, and tinea corporis.

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.

Antifungal Agents↗

Studies in the epidemiology of tinea pedis. IX. Tinea pedis and erythrasma in new patients at a chiropody clinic.

The feet of 259 new patients at a chiropody clinic were examined for tinea pedis, onychomycosis, and erythrasma: 23% of men and 4% of women were infected by dermatophytes, and the nails of seven males were infected by non-dermatophytes. Of 200 patients examined under Wood's light 37% showed the coral-red fluorescence of erythrasma.Of the 259 patients, 9.7% were infected by Trichophyton interdigitale, 2.7% by T. rubrum, and 1.5% by Epidermophyton floccosum. Reasons are given, based on the method of selection of the patients, for supposing that T. interdigitale is still the dominant cause of tinea pedis in the population at large, despite figures from dermatological clinics suggesting the dominance of T. rubrum. The high incidence of infection in males compared with females corresponds with similar findings in school-children.

Adult↗

[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↗

The prevalence of common skin conditions in Australian school students: 4 Tinea pedis.

Tinea pedis is a condition that is common, often undiagnosed and frequently inadequately treated. It is reported as being rare in young children, but there are relatively few population-based reports of prevalence. A randomized sample of 2491 students from schools throughout the State of Victoria, Australia, were examined by dermatologists and dermatology registrars, who recorded clinical signs suggestive of tinea pedis, which were then confirmed by fungal culture. The age- and sex-adjusted prevalence of culture-proven tinea pedis was 5.2% [95% confidence interval (CI) 3.58-6.82] increasing with age from 2.1% (95% CI 0.95-3.28) in 4-6 year olds to 9.7% (95% CI 5.21-14.26) in 16-18 year olds. A higher proportion of males (6.0%) had tinea pedis than females (4.3%). Trichophyton mentagrophytes and T. rubrum were the most common dermatophytes isolated on culture. Less than 40% of those with a positive diagnosis had reported on the questionnaire that they had tinea. Of those who reported correctly that they had tinea, 75% had used one or more products to treat their condition, of which more than 40% were classified as unlikely to have any therapeutic effect on tinea pedis. These data confirm that tinea pedis, a potentially transmissible disease, is common in Australian schoolchildren, including those in primary school. There is a need for education programmes in schools on the nature of tinea pedis, the treatment available, and the public health approach to infection control within the school and home environment.

Adolescent↗

Importance of mycological confirmation of clinically suspected cases of tinea corporis, tinea pedis and tinea cruris.

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven (positive by one or both methods). Most of tinea corporis, tinea pedis and tinea cruris cases (68.9%, 79.1%& 83.9% respectively) were diagnosed by both methods (P>0.05). For cases of tinea corporis and tinea cruris, males were more than females (51.4%, 48.6% and 58.1%, 41.9% respectively) while females exceeded males (72.1%, 27.9% respectively) in cases with tinea pedis (P<0.05). Trichophyton rubrum (T. rubrum) was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4 %, for tinea pedis and 64.6% for tinea cruris. T. mentagrophytes var. interdigitale was mostly isolated from cases of tinea pedis (23.3%). The majority of T. violaceum was isolated from cases of tinea corporis (12.2%). The main isolation of E. floccosum was from cases of tinea cruris (16.1%) Microsporum canis (M. canis) was only isolated from one case (1.4%) of tinea corporis while Candida albicans (C. albicans) alone (9.3%) or with T. rubrum (7.0%) was isolated only from cases of interdigital tinea pedis. (P<0.05). The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions (78.4%, 76.7% and 54.8% respectively) (P<0.05) and received prior therapy for the condition (79.7%, 76.7% and 58.1% respectively, (P>0.05). In conclusion, early accurate diagnosis (on mycological basis) is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control.

Arthrodermataceae↗

[Epidemiology, physiopathology and treatment of a frequent ailment: tinea pedis].

Tinea pedis is an infection of the stratum corneum caused by dermatophytes. Nowadays, fitness centers, saunas, subtropical swimming pools and sport-shoes are more and more fashionable and are certainly responsible for the increase of cases of tinea pedis as dermatophytes grow preferentially in warm and humid environments. The clinical aspect is affected by several factors such as the host reaction to the infection, the virulence of the infective strain, species, and some local and environmental factors. If a dermatophytosis is suspected, it is mandatory to validate the provisional diagnosis by demonstration of the fungus (by culture or/and microscopic examination) to avoid useless and expensive treatments. The new antifungal molecules are very effective, well tolerated and allow short course of therapy improving the compliance of the patient in clinical practice. Relapse of tinea pedis is very common but could be avoided by several simple preventive measures of hygiene.

Antifungal Agents↗

Efficacy and safety of terbinafine 1% solution in the treatment of interdigital tinea pedis and tinea corporis or tinea cruris.

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.

Administration, Cutaneous↗

KP-103, a novel triazole derivative, is effective in preventing relapse and successfully treating experimental interdigital tinea pedis and tinea corporis in guinea pigs.

The therapeutic efficacy of KP-103, a triazole derivative, for 10 guinea pigs with interdigital tinea pedis or tinea corporis was investigated. Topical KP-103 solution (0.25 to 1%) was dose-dependently effective in treating both dermatophytoses. A 1% KP-103-treatment rendered all infected skins culture-negative on day-2 posttreatment. A high negative-culture rate was obtained with 1% solutions of butenafine and lanoconazole but not with 1% neticonazole solution. The follow up study performed on day-30 and day-9 posttreatment demonstrated that the relapse rates for 1% KP-103-treated animals with tinea pedis and for those with tinea corporis were 20 and 30%, respectively, and that these values were the same as those for 1% butenafine-treated animals, but lower than those for 1% lanoconazole-treated animals (55 and 80%, respectively). When a single dose of 1% KP-103 was applied to the back skin 48 hr before fungal inoculation, 9 of the 10 animals were protected from the dermatophytosis, suggesting that active KP-103 is retained in skin tissue for at least 48 hr after dosing. Moreover, it was suggested that KP-103 retains a high activity in the horny layer because of its lower keratin-affinity. The effectiveness of KP-103 against dermatophytoses may be due to the favorable pharmacokinetic properties in the skin tissues, together with its potent antifungal activity.

Animals↗

A double blind study of itraconazole vs griseofulvin in patients with tinea pedis and tinea manus.

AIM: To compare the efficacy and safety of itraconazole and griseofulvin in a double-blind parallel study of 20 patients with microscopically and/or culturally proven tinea pedis and/or tinea manus. METHODS: A 4 week study was undertaken with patients randomised to receive either itraconazole 100 mg or griseofulvin 500 mg once daily for 4 weeks. Microscopy and cultures were performed prior to and at the end of the treatment and 2 weeks posttreatment. RESULTS: After 4 weeks therapy, 50% of itraconazole-treated patients and 30% of griseofulvin-treated patients had negative microscopy; 70% and 50% of these patients, respectively, had negative microscopy at follow up 2 weeks later. A combined score of all clinical assessments showed a statistically significant (p < 0.05) difference at the follow up visit in favour of itraconazole. There was no statistically significant difference with regard to haematological or biochemical measurements, or in urinalysis results, either within or between treatment groups. Six patients reported mild adverse effects (itraconazole = 5, griseofulvin = 1), none of which warranted treatment withdrawal. CONCLUSION: The findings of this study suggest that itraconazole is more effective than griseofulvin in the symptomatic treatment of tinea pedis and/or manus.

Adult↗

The proteolytic activity of strains of T. mentagrophytes and T. rubrum isolated from tinea pedis and tinea unguium infections.

To understand the significance of proteolytic enzymes in the pathogenesis of dermatophyte infections, we have studied the expression of proteolytic activity in vitro. Cultures were extracted after 1, 2, 3, 4 and 5 weeks of growth and the proteolytic activity measured by a peptide release assay using human stratum corneum as a substrate. Maximum activity was noted at 3 weeks which corresponded to the dissolution of the stratum corneum particles. Isolates of Trichophyton mentagrophytes and Trichophyton rubrum from 42 patients with tinea pedis or tinea unguium were established on 2% glucose peptone plates. Using the peptide release assay it was found that after 3 weeks culture, T. mentagrophytes showed higher activity that T. rubrum in tinea pedis (2044 +/- 1067 micrograms protein released h-1 mg-1, n = 13 compared to 828 +/- 614 micrograms protein released h-1 mg-1, n = 13). In tinea unguium, the values at 3 weeks were generally lower. Trichophyton mentagrophytes activity was 837 +/- 121 micrograms protein released h-1 mg-1 (n = 3) compared to 470 +/- 271 micrograms protein released h-1 mg-1 (n = 13) for T. rubrum. Thus, as well as a variation in activity between the two species, there appears to be a variation in site in terms of expression of activity.

Female↗

Clinical and mycological study of occult tinea pedis and tinea unguium in dermatological patients from Tokyo.

An epidemiological investigation was conducted to determine the prevalence and circumstances of untreated, unsuspected tinea pedis and tinea unguium, morbid conditions that could be termed occult athlete's foot, in patients visiting a dermatology clinic in Tokyo, Japan, for the first time, for other complaints. All subjects completed a questionnaire covering comprehensive anamnestic details, and were examined for disposition of toes, presence of signs suggestive of tinea pedis, other diseases of the foot, score of clinical signs and symptoms, potassium hydroxide (KOH) test, severity score, and mycological culture. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as age, disposition of toes, and predisposing disease.

Adolescent↗

Cell-mediated reactivity in dermatophytosis: differences in skin responses to purified trichophytin in tinea pedis and tinea cruris.

Cell-mediated immune responses were measured in 91 patients with dermatophytosis by means of delayed-type skin hypersensitivity to a purified trichophytin preparation (ethylene glycol method) and to tuberculin (purified protein derivative, PPD). The findings indicate that dermatophytes differ in their sensitizing capacity as measured by trichophytin skin sensitivity. Trichophyton mentagrophytes appeared to be a potent sensitizer compared with Trichophyton rubrum (p < 0.01), whereas Epidermophyton floccosum appeared as a moderate sensitizer. The localization of infection also affected the cell-mediated response to trichophytin, i.e. the frequency of reactions was 44% in tinea cruris and 33% in tinea pedis, while tinea pedis with nail infections elicited delayed-type reactivity in 60% of cases. On the basis of the significant difference (p < 0.001) in cell-mediated reactivity between chronically and non-chronically infected subjects as measured with trichophytin, it is concluded that the cell-mediated response is of importance for the development of host resistance to dermatophytic infections. This study provides further evidenced in support of the view that a partial defect in the cell-mediated system may be responsible for establishment of chronic dermatophytosis.

Adult↗

Tinea pedis.

Tinea pedis is a term used to encompass several clinically distinctive infections of the skin of the foot. Dermatophytic fungi are primarily responsible for these infections. Several nondermatophytes have been implicated in some patients, particularly for nail infections. The major clinical variants are (1) interdigital infections in which dermatophytes initiate the process by damaging the stratum corneum while the subsequent maceration and leukokeratosis results from overgrowth of bacteria such as Micrococcus sedantarius, Brevibacterium epidermidis, Corynebacterium minutissimum and gram-negative organisms; (2) plantar mocasin type of hyperkeratosis due to T rubrum and found primarily in those with an atopic background; (3) vesiculo-bullous infections in the arch and side of the foot due to an immune response of delayed hypersensitivity to T mentagrophytes.

Antifungal Agents↗

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea pedis and tinea manuum.

In the period between April 1984 and April 1988 a total of 4294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 680 were suspected as tinea pedis and tinea manuum. These cases belonged to 21 different nationalities. Both sexes were represented and 649 cases (95.4%) were adults while 31 (4.6%) were prepubertals. Clinical diagnosis was confirmed by direct microscopy in 505 cases or 74.4% (485 adults and 20 prepubertal children). Out of these, 504 cases were positive on culture and yielded 516 isolates. Candida species and other yeasts were responsible for 88.9% and dermatophytes for 11.1% of these infections. The interdigital type of lesions was the most common type (91.9% of all infections) followed by the hyperkeratotic scaling type (6.9%) while the acute inflammatory type was only 1.2% of infections. Treatment showed satisfactory results in most of the cases.

Adult↗