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Waki Y, Nobeyama Y, Nakagawa H, Asahina A. High prevalence of dermatophytosis of the feet in acral melanoma of the foot. J Dermatol 2024. [PMID: 38711284 DOI: 10.1111/1346-8138.17256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Abstract
The clinical characteristics and pathogenesis of acral melanoma of the foot (AMF) have not been sufficiently elucidated. Clinical or subclinical persistent inflammation of the feet is caused by dermatophytosis of the feet (DPF). Persistent inflammation is potentially associated with oncogenesis. Moreover, diabetes has been reported to be associated with the development of dermatophytosis and cancer. The present study aimed to elucidate the clinical association between DPF and AMF, with consideration of diabetes. The medical records of 114 Japanese patients were retrospectively examined and divided into an AMF group (n = 30) and a control group consisting of patients with foot diseases other than melanoma (n = 84). Microscopic DPF screening was performed on all patients who reported symptoms in the foot, with or without AMF. Patients underwent a microscopic test to detect the presence of dermatophytes, and the diagnosis of DPF was made based on a positive result. In the AMF group, 18 (60.0%) and eight (26.7%) patients had DPF and diabetes, respectively. Four patients (13.3%) had both DPF and diabetes. In the control group, 25 (29.8%) and 11 (13.1%) patients had DPF and diabetes, respectively. Five patients (6.0%) had both DPF and diabetes. Univariate analyses showed a significantly higher prevalence of DPF in the AMF group than in the control group (odds ratio, 3.540; p = 0.003, Pearson χ2 test). Furthermore, multivariate analyses of sex, body mass index, DPF, and diabetes revealed DPF as a significant factor associated with AMF (odds ratio, 4.285; p = 0.002, logistic regression analysis). The hyperkeratotic type of DPF was more frequently observed in patients with AMF than in control patients (odds ratio, 11.083; p < 0.001, Pearson χ2 test). In conclusion, the present study found a significantly higher prevalence of DPF, especially its hyperkeratotic type, in patients with AMF. DPF may be associated with AMF pathogenesis.
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Affiliation(s)
- Yuma Waki
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshimasa Nobeyama
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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2
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Spivack S, Gold JAW, Lockhart SR, Anand P, Quilter LAS, Smith DJ, Bowen B, Gould JM, Eltokhy A, Gamal A, Retuerto M, McCormick TS, Ghannoum MA. Potential Sexual Transmission of Antifungal-Resistant Trichophyton indo tineae. Emerg Infect Dis 2024; 30:807-809. [PMID: 38437706 PMCID: PMC10977831 DOI: 10.3201/eid3004.240115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
We describe a case of tinea genitalis in an immunocompetent woman in Pennsylvania, USA. Infection was caused by Trichophyton indotineae potentially acquired through sexual contact. The fungus was resistant to terbinafine (first-line antifungal) but improved with itraconazole. Clinicians should be aware of T. indotineae as a potential cause of antifungal-resistant genital lesions.
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3
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Punchihewa N, Orchard D. Combination oral antifungal therapy for paediatric fungal infection: An option to improve efficacy and overcome clinical resistance. Australas J Dermatol 2024; 65:59-62. [PMID: 37927148 DOI: 10.1111/ajd.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
There is increasing evidence of clinically resistant cutaneous fungal infections. The use of combination oral antifungals is described in adults but not in paediatric patients. We present seven paediatric cases of clinically resistant fungal infections treated successfully with combination oral antifungal therapy after inadequate response to a single agent.
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Affiliation(s)
- Nisal Punchihewa
- Department of Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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4
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Teo JWP, Cheng JWS, Chew KL, Lin RTP. Whole genome characterization of Trichophyton indo tineae isolated in Singapore. Med Mycol 2024; 62:myae012. [PMID: 38366631 DOI: 10.1093/mmy/myae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/18/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
Complete genome sequences from two Trichophyton indotineae isolates were obtained from a 23-year-old male presenting with tinea cruris after an overseas recreational water exposure and from a 53-year-old female patient with unknown travel history. Analysis of the squalene epoxidase gene and the cyp51 gene family showed an absence of mutations, correlating with phenotypic drug susceptibility. The Single Nucleotide Polymorphisms (SNPs) distance between both isolates was 92. Within the T. indotineae cluster, SNPs ranged from 7 to 182, suggesting a high genetic relatedness with other South Asian isolates. This study suggests that the prevalence of T. indotineae is under-reported and more widespread than previously thought.
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Affiliation(s)
- Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Janet W S Cheng
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Raymond T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Montaño JI, Pineda CA, Apráez G. An outbreak of trichophytic tinea capitis in a group of schoolchildren in a rural area of the department of Cauca, Colombia. Biomedica 2023; 43:534-537. [PMID: 38109135 DOI: 10.7705/biomedica.7247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Affiliation(s)
| | | | - Giovanny Apráez
- Secretaría Departamental de Salud, Gobernación del Cauca, Popayán, Colombia; Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
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Tobeigei FH, Joseph MR, Al-Hakami A, Hamid ME. Microsporum gypseum Infection Among Two Related Families With a Zoonotic Aspect: A Prospective Case Series. Cureus 2023; 15:e51402. [PMID: 38292972 PMCID: PMC10826859 DOI: 10.7759/cureus.51402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background and purpose The Microsporum gypseum complex is a globally distributed group of geophilic dermatophytes that primarily affect animals but can also rarely cause dermatomycoses in humans. With some regional and occupational variations, tinea corporis is the most prevalent presentation of the infection. The aim of this study was to report on the diagnosis and treatment of dermatophytosis cases among related families, and their pets, from southern Saudi Arabia. Up-to-date information on dermatophytes and dermatophytosis is needed. Methods This is a prospective case series undertaken at the Dermatology Outpatient Clinic of King Khalid University, Saudi Arabia. Six patients with suspected dermatophytosis were received at our hospital in 2022 and have been followed for recovery with or without scars. Characteristics of fungal pathogens were examined phenotypically on the basis of microscopic and growth characteristics, and laboratory data were used to initiate treatment with oral fluconazole, topical terbinafine cream, or oral itraconazole. Results Clinical features and culture results confirmed tinea capitis and tinea corporis caused by M. gypseum, which was also present in a pet cat. Tinea capitis cases (n = 4) did not respond to fluconazole and terbinafine treatment, but treatment with itraconazole resulted in a full recovery. Tinea corporis cases (n = 2) were treated with terbinafine, which resulted in a full recovery within four weeks, with no signs of scarring. Conclusions M. gypseum presents with serious persistent lesions and is extremely contagious. Treatment is durable but challenging, and breaking the transmission chain is more difficult.
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Affiliation(s)
- Faisal Hassan Tobeigei
- Dermatology Division, Department of Internal Medicine, College of Medicine, King Khalid University, Abha, SAU
| | - Martin R Joseph
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
| | - Ahmed Al-Hakami
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
| | - Mohamed E Hamid
- Department of Clinical Microbiology and Parasitology, College of Medicine, King Khalid University, Abha, SAU
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Hwang JK, Gold JAW, Paller AS, Lipner SR. Low utilization of confirmatory testing for tinea capitis by pediatricians at an academic center in New York, United States, 2005-2021. Front Pediatr 2023; 11:1297339. [PMID: 38046680 PMCID: PMC10690948 DOI: 10.3389/fped.2023.1297339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
We retrospectively reviewed physician diagnostic and treatment practices for pediatric tinea capitis at an academic institution over 16 years, in assessing adherence with published guidelines. We demonstrate the need to increase utilization of confirmatory testing and systemic therapy, and call for directed pediatrician education towards these goals.
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Affiliation(s)
- Jonathan K. Hwang
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
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Dev PP, Bansal S, Bhargava A. Revisiting the pathogenesis of dermatophytosis: A cross-sectional analytic study of serum levels of interleukins-2, 8, 10 and 17. Mycoses 2023; 66:876-881. [PMID: 37309232 DOI: 10.1111/myc.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Given the current epidemic-like scenario of dermatophyte infections, it is prudent to revisit the immunopathogenesis of dermatophytosis. Comprehending the intricate interactions among interleukins can aid in understanding the recent trends in infection. There is a paucity of literature on the various cytokine levels observed in the serum of patients suffering from various dermatophytoses. AIM To study serum cytokine levels of interleukins 2, 8, 10 and 17 in patients with dermatophytosis. METHODS A cross-sectional analytic study was conducted on 64 cases of clinical dermatophyte infections (KOH confirmed) and 64 controls. The clinico-epidemiological profile of the cases was studied. By using a solid phase sandwich ELISA (enzyme-linked immunosorbent assay), the serum levels of interleukins 2, 8, 10 and 17 were measured and compared between cases and controls. Serum interleukin-2, 8, 10 and 17 levels were studied among cases based on mode of onset, duration of illness, treatment history, site of infection and multiple other morphological characteristics of the infection. RESULTS The cases had statistically higher levels of interleukins-8, 10 and 17 in comparison with controls. The levels of interleukin-8 were significantly lower (p < .05) among those who had received oral antifungals. In cases where the lesion had scaling, the serum levels of interleukin-10 were significantly higher (p < .05). The lesional hyperpigmentation was significantly (p < .05) associated with low levels of interleukin-17. Also, interleukin-17 was significantly (p < .05) elevated in patients with lesions in the abdomen. CONCLUSION It is the first time that serum interleukin levels are studied in dermatophytosis. There is an immunological dysfunction specific to dermatophytoses initiated by their infection. Key factor in this dysfunction is the elevation of IL-10, contributing to persistent infection. In turn, causing an increase in IL-17, promoting inflammation and tissue damage. This cycle of elevated IL-10 and IL-17 can further exacerbate the infection and lead to chronicity. The activity of IL-2 and the Th1 immune pathway is reduced by two opposing immune pathways: the Th17 and Th2 axes.
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Affiliation(s)
- Prabin P Dev
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shikha Bansal
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aradhana Bhargava
- Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Tasneem Parapur S, Husain N, Khalid M, Mamdapur SAR, Kauser Khan KA. Evaluation of the efficacy of topical Terminalia chebula Retz. with vinegar in the treatment of tinea corporis: a non-inferiority randomized controlled trial. Drug Metab Pers Ther 2023; 38:237-245. [PMID: 37012894 DOI: 10.1515/dmpt-2022-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Unani physicians have suggested a wide range of anti-dermatophytic remedies, although the scientific evidence is scarce. Thus, the efficacy and safety of Terminalia chebula Retz. fruit powder mixed with vinegar was compared with terbinafine hydrochloride 1% cream in the treatment of tinea corporis in order to establish the non-inferiority of test drugs. METHODS The primary outcome measures were change in the presence or absence of hyphae on KOH mount test, change in pruritus severity assessed on 100 mm VAS and change in physician's global assessment. Secondary outcome measure was change in the dermatology life quality index (DLQI). Hemograms, serum creatinine, serum bilirubin, and random blood sugar levels were measured at the baseline and after treatment to ensure the safety of the interventions. RESULTS A per-protocol analysis was done on 40 participants (21 in the test group and 19 in the control group). The observed differences in the primary and secondary outcomes between the test and control groups were greater than the non-inferiority margin, signifying that the test drugs were not inferior. CONCLUSIONS It may be inferred that the trial drug Terminalia chebula Retz. fruit powder mixed with vinegar is not inferior to terbinafine hydrochloride cream in the treatment of tinea corporis.
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Affiliation(s)
- Sumayya Tasneem Parapur
- Department of Moalajat (Medicine), Luqman Unani Medical College, Hospital and Research Center, Bijapur, Karnataka, India
| | - Nazim Husain
- Department of Moalajat (Medicine), Luqman Unani Medical College, Hospital and Research Center, Bijapur, Karnataka, India
| | - Mohd Khalid
- Department of Moalajat (Medicine), Luqman Unani Medical College, Hospital and Research Center, Bijapur, Karnataka, India
| | - Saba Abdul Razzaq Mamdapur
- Department of Moalajat (Medicine), Luqman Unani Medical College, Hospital and Research Center, Bijapur, Karnataka, India
| | - Khan Ameer Kauser Khan
- Department of Moalajat (Medicine), Luqman Unani Medical College, Hospital and Research Center, Bijapur, Karnataka, India
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Ghosh A, Panda S. Cutaneous Dysbiosis and Dermatophytosis: The Unexplored Link. Indian J Dermatol 2023; 68:508-514. [PMID: 38099124 PMCID: PMC10718259 DOI: 10.4103/ijd.ijd_828_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The skin, besides being the largest interface between the body and the external environment, also forms an ecological niche which is populated by almost a trillion microorganisms. These, collectively known as the cutaneous microbiome, form a dynamic yet well-controlled system that resists invasion by pathogenic microorganisms, functioning as the so-called 'microbiological barrier', modulating the body's immune response, indirectly playing a crucial role in the pathogenesis of several inflammatory diseases. The composition and complexity of the microbiome are yet to be fully understood. The term 'dysbiosis' originally was coined in 1908 for a change in the gut microbiome. The potential role of 'cutaneous dysbiosis' in human dermatophytic infections, especially in the backdrop of the current epidemic of chronic, recurrent and treatment-resistant dermatophytosis, is understandably a topic of interest. The purpose of this review was to assess all studies using culture-independent methods for analysing the skin microbiome in various dermatophyte infections. The PubMed and Google Scholar databases were searched using the terms 'microbiome', 'dysbiosis', 'dermatophytes', 'dermatophytosis' and 'tinea'. All studies involving the use of standard sequencing methods for the study of the microbiome in various dermatophytoses were included. A total of four studies assessing the local skin microbiome associated with dermatophytic infections were found-one for tinea capitis, one for onychomycosis (in both psoriatic and nonpsoriatic nails) and two studying patients of tinea pedis. The studies determined the microbiological patterns in patients and compared them with healthy individuals using sequencing methods. Significant differences in the species diversity and counts of the various microorganisms between patient and control groups were demonstrated in all. However, cross-sectional design and the absence of pre- and post-treatment data along with a limited sample size were the major limitations in all of them. No data regarding other forms of tinea, most importantly, tinea cruris, corporis, faciei, etc. were found. The existing studies demonstrate a change in the microbiome or dysbiosis associated with cases of dermatophytosis, but are inadequate to determine a causal association. The changes may also be wholly or partly attributed to the effect of the infection. Further longitudinal studies from different regions of the world, also involving other forms of dermatophytosis, are required to provide a clearer insight and a more representative picture.
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Affiliation(s)
- Aparajita Ghosh
- From the Department of Dermatology, K.P.C Medical College and Hospital, Kolkata, West Bengal, India
| | - Saumya Panda
- Department of Dermatology, JIMS Hospital and Medical College, Kolkata, West Bengal, India
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Sterling NA, Rincón DA, Barrera S, Sánchez EA, Molina DY, Urán ME, Jiménez MDP. Tinea capitis outbreak and other superficial mycosis in an urban community of Medellín. Biomedica 2023; 43:245-254. [PMID: 37721904 PMCID: PMC10599352 DOI: 10.7705/biomedica.6900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/25/2023] [Indexed: 09/20/2023]
Abstract
Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.
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Affiliation(s)
| | | | - Sebastián Barrera
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Erika Andrea Sánchez
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Diana Yuledi Molina
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Martha Eugenia Urán
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - María Del Pilar Jiménez
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Khan S, Farabi B, Zufall A, Truong T, Safai B, Rao B, Mir A. Rapid diagnosis and clinical management of kerion in a pediatric patient with reflectance confocal microscopy. JAAD Case Rep 2023; 38:48-50. [PMID: 37456511 PMCID: PMC10338897 DOI: 10.1016/j.jdcr.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Samavia Khan
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Banu Farabi
- Dermatology Department, New York Medical College, Valhalla, New York
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York
- Dermatology Department, NYC Health + Hospital/Coney Island, Brooklyn, New York
| | - Alina Zufall
- Dermatology Department, New York Medical College, Valhalla, New York
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York
- Dermatology Department, NYC Health + Hospital/Coney Island, Brooklyn, New York
| | - Thu Truong
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Bijan Safai
- Dermatology Department, New York Medical College, Valhalla, New York
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York
- Dermatology Department, NYC Health + Hospital/Coney Island, Brooklyn, New York
| | - Babar Rao
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Adnan Mir
- Dermatology Department, New York Medical College, Valhalla, New York
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York
- Dermpath Diagnostics, White Plains, New York
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Chanyachailert P, Leeyaphan C, Bunyaratavej S. Cutaneous Fungal Infections Caused by Dermatophytes and Non-Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing. J Fungi (Basel) 2023; 9:669. [PMID: 37367605 DOI: 10.3390/jof9060669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Cutaneous fungal infection of the skin and nails poses a significant global public health challenge. Dermatophyte infection, mainly caused by Trichophyton spp., is the primary pathogenic agent responsible for skin, hair, and nail infections worldwide. The epidemiology of these infections varies depending on the geographic location and specific population. However, epidemiological pattern changes have occurred over the past decade. The widespread availability of antimicrobials has led to an increased risk of promoting resistant strains through inappropriate treatment. The escalating prevalence of resistant Trichophyton spp. infections in the past decade has raised serious healthcare concerns on a global scale. Non-dermatophyte infections, on the other hand, present even greater challenges in terms of treatment due to the high failure rate of antifungal therapy. These organisms primarily target the nails, feet, and hands. The diagnosis of cutaneous fungal infections relies on clinical presentation, laboratory investigations, and other ancillary tools available in an outpatient care setting. This review aims to present an updated and comprehensive analysis of the epidemiology, clinical manifestations, and diagnostic testing methods for cutaneous fungal infections caused by dermatophytes and non-dermatophytes. An accurate diagnosis is crucial for effective management and minimizing the risk of antifungal resistance.
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Affiliation(s)
- Pattriya Chanyachailert
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
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Anderson BJ, Wilz L, Peterson A. The Identification and Treatment of Common Skin Infections. J Athl Train 2023; 58:502-510. [PMID: 35984712 PMCID: PMC10496455 DOI: 10.4085/1062-6050-0142.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.
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Affiliation(s)
- B. J. Anderson
- Boynton Health Service, University of Minnesota, Minneapolis
- Medical Director of Sports Medicine, Augsburg University, Minneapolis, MN
| | - Logan Wilz
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | - Andrew Peterson
- Carver College of Medicine, University of Iowa, Iowa City
- Stead Family Department of Pediatrics, University of Iowa, Iowa City
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City
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15
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Bhat RM, Madhumita M, Jayaraman J. Dermatophytoses Severity Score - A novel point-of-care scoring tool to assess the severity of dermatophytosis. Mycoses 2023; 66:354-361. [PMID: 36564986 DOI: 10.1111/myc.13560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
The rising prevalence of dermatophytosis in tropical countries coupled with drug resistance necessitates an objective scoring system to define the severity, monitor therapeutic response and predict prognoses. We attempted to establish and validate a new scoring system - Dermatophytoses Severity Score (DSS), for dermatophytoses affecting non-glabrous skin. A consensus group was convened to develop an objective and reproducible scoring system to describe the extent and severity of dermatophytosis of 200 consecutive patients with dermatophytosis. A second assessment entailed independent DSS scoring of the same patients by dermatologists and residents who were not part of the consensus group. The main outcome measured was index reliability, assessed in two steps, between the observers. A two-step assessment and DSS grading of 200 consecutive patients with clinically diagnosed dermatophytoses showed high reliability (Cronbach's α test and intraclass correlation coefficient). The DSS has demonstrated high reliability, and it could serve as a novel, reproducible and objective scoring tool for dermatophytosis.
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Affiliation(s)
- Ramesh M Bhat
- Department of Dermatology and Venereology, Father Muller Medical College, Mangalore, India
| | - Monisha Madhumita
- Department of Dermatology and Venereology, Saveetha Medical College, Chennai, India
| | - Jyothi Jayaraman
- Department of Dermatology and Venereology, Father Muller Medical College, Mangalore, India
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16
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Bhalavi H, Shaw D, Mehta H, Narang T, Sachdeva N, Shafiq N, Rudramurthy SM, Dogra S. Correlation of plasma levels of itraconazole with treatment response at 4 weeks in chronic dermatophytosis: Results of a randomised controlled trial. Mycoses 2023; 66:281-288. [PMID: 36457207 DOI: 10.1111/myc.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Itraconazole in varying doses and duration is being frequently used for the management of dermatophytosis. There is a scarcity of studies on the bioavailability of various itraconazole brands available in the market. AIMS AND OBJECTIVES The aim of this study was to determine the plasma concentration of itraconazole of various brands and its correlation with clinical efficacy in chronic dermatophytosis. MATERIALS AND METHODS One hundred patients with chronic dermatophytosis with age >18 years were studied at the outpatient clinic of our tertiary care hospital. Plasma itraconazole level was estimated on Week 2 and Week 4 after randomly dividing the patients into Groups A, B and C who received cap itraconazole 100 mg twice a day of innovator, multinational and local generic brands, respectively, for 4 weeks. Both efficacy (cure, partial cure or no cure), safety and recurrence were compared between the three groups. RESULTS At 4 weeks, number of patients classified as 'cured' were 10/26 (38.4%) in Group A, 5/22 in Group B (22.7%) and 3/21 (14.2%) in Group C (p = .002). Mycological cure rates at Week 4 in Groups A, B and C were 21 (80.8%), 17 (81.0%) and 5 (26.3%), respectively (p = .006). Plasma levels of itraconazole were comparable between the three groups at Week 2 and Week 4. No statistically significant correlation was found between itraconazole levels and treatment response in any of the groups at 4 weeks. Incidence of adverse effects and recurrence rates was also similar among the three groups. CONCLUSION Cure rates for chronic dermatophytosis were poor with all three itraconazole brands at 4 weeks of treatment. Higher cure rates were obtained with innovator drug as compared to multinational and local generic brands at 4 weeks. Plasma levels of the three drugs were however similar, indicating that factors other than serum bioavailability are at play in determining response of chronic dermatophyte infections to oral itraconazole.
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Affiliation(s)
- Hitesh Bhalavi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Shaw
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Clinical Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Heckler I, Sabalza M, Bojmehrani A, Venkataraman I, Thompson C. The need for fast and accurate detection of dermatomycosis. Med Mycol 2023; 61:7093406. [PMID: 36990677 DOI: 10.1093/mmy/myad037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Dermatomycosis of the hair, skin or nails are one of the most common fungal infection worldwide. Beyond permanent damage to the affected area, the risk of severe dermatomycosis in immunocompromised people can be life-threatening. The potential risk of delayed or improper treatment highlights the need for a rapid and accurate diagnosis. However, with traditional methods of fungal diagnostics such as culture, a diagnosis can take several weeks. Alternative diagnostic technologies have been developed which allow for an appropriate and timely selection of an antifungal treatment, preventing nonspecific over-the-counter self-medication. Such techniques include molecular methods such as PCR, real-time PCR, DNA microarray, next-generation sequencing, in addition to matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Molecular methods can help close the 'diagnostic gap' observed with traditional cultures and microscopy and allow for a rapid detection of dermatomycosis with increased sensitivity and specificity.
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Affiliation(s)
- Ilana Heckler
- EUROIMMUN US, 1 Bloomfield Ave, Mountain Lakes, NJ 07046
| | - Maite Sabalza
- EUROIMMUN US, 1 Bloomfield Ave, Mountain Lakes, NJ 07046
| | | | | | - Curtis Thompson
- CTA Pathology and Departments of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon, USA
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18
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Powell J, Porter E, Rafferty S, Field S, O'Connell NH, Dunne CP. Dermatology mycology diagnostics in Ireland: National deficits identified in 2022 that are relevant internationally. Mycoses 2023; 66:249-257. [PMID: 36448403 PMCID: PMC10107536 DOI: 10.1111/myc.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Conventional testing methods for dermatophytes are time-consuming, and resource limitations in our institution have prompted curtailed access to these diagnostics. OBJECTIVES Evaluation of our hospital's dermatological mycology diagnostic services and similar services nationally. METHODS This was a retrospective observational study on skin, hair and nail mycology samples in our institution comparing twenty five-year periods (2011-2015 and 2016-2021), including analysis of dermatology clinic data and correspondence related to fungal infection. A survey of national public hospitals' laboratories was conducted to evaluate their mycology testing capabilities. RESULTS The total 5 year test count prior to curtailment was 4851 specimens comprising 90% (n = 4344) from general practice and 6% (n = 290) from dermatology clinics. For the 5 years post curtailment, 64.5% (582/903) of specimens were from dermatology clinics. Dermatology clinic data demonstrated doubling of attendances (for all conditions) and of correspondence related to fungal infection. During this time also, national dermatological antifungal purchasing increased 11%. Ten of 28 Irish public hospital laboratories reported the provision of in-house dermatological mycology testing, and none had routine availability of susceptibility or molecular testing of dermatophytes. CONCLUSION This study is the first to report an appraisal of dermatological fungal diagnostic services in Ireland. Insufficient testing capacity implies that patients are either being treated for fungal infection without appropriate diagnostic confirmation, or being left untreated because of the lack of access to diagnostics. The introduction of molecular detection methods and susceptibility systems would enhance testing capabilities and reduce the requirement for the external referral.
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Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Emma Porter
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Siobhan Rafferty
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Sinead Field
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
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19
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Medeiros Silva RN, Nóbrega da Rocha MA, Silva EP, Moura-Mendes J, Ribeiro-Filho J, de Sousa GR, de Souza-Ferrari J, Barbosa-Filho JM, de Oliveira Pereira F. In vitro and ex vivo antibiofilm activity of riparin 1, and its nor and dinor homologs, against dermatophytes. Mycologia 2023; 115:206-215. [PMID: 36848618 DOI: 10.1080/00275514.2023.2170209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Dermatophytosis is one of the most frequent superficial mycoses in the world. They are mainly caused by the dermatophytes Trichophyton rubrum and Microsporum canis. Biofilm production is an essential factor in the pathogenesis of dermatophytes; it confers drug resistance and significantly impairs antifungal effectiveness. Therefore, we evaluated the antibiofilm activity of an alkamide-type alkaloid called riparin 1 (RIP1) against clinically relevant dermatophytes. We also produced synthetic nor (NOR1) and dinor (DINOR1) homologs for pharmacological evaluation, with a 61-70% yield. We used in vitro (96-well polystyrene plates) and ex vivo (hair fragments) models to verify the effects of these compounds on the formation and viability of biofilms. RIP1 and NOR1 showed antifungal activity against strains of T. rubrum and M. canis, but DINOR1 showed no significant antifungal activity against the dermatophytes. Furthermore, RIP1 and NOR1 significantly reduced the viability of biofilms in vitro and ex vivo (P < 0.05). RIP1 was more potent than NOR1, possibly due to the distance between the p-methoxyphenyl and the phenylamide moieties in these compounds. Due to the significant antifungal and antibiofilm activities observed for RIP1 and NOR1, we suggest that they could be useful in the treatment of dermatophytosis.
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Affiliation(s)
- Risley Nikael Medeiros Silva
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Marcelo Antônio Nóbrega da Rocha
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Emanuel Pereira Silva
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Juliana Moura-Mendes
- Centro Multidisciplinario de Investigaciones Tecnológicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Gabriela Ribeiro de Sousa
- Postgraduate Program in Natural and Synthetic Bioactive Products, Department of Pharmaceutical Sciences, Federal University of Paraiba, João Pessoa, Brazil
| | | | - José Maria Barbosa-Filho
- Postgraduate Program in Natural and Synthetic Bioactive Products, Department of Pharmaceutical Sciences, Federal University of Paraiba, João Pessoa, Brazil
| | - Fillipe de Oliveira Pereira
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
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20
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Benedict K, Gold JAW, Wu K, Lipner SR. High Frequency of Self-Diagnosis and Self-Treatment in a Nationally Representative Survey about Superficial Fungal Infections in Adults-United States, 2022. J Fungi (Basel) 2022; 9. [PMID: 36675840 DOI: 10.3390/jof9010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Data about the prevalence, diagnosis, treatment, and public knowledge of superficial fungal infections in the United States are scarce. These infections are a growing concern given the emergence of antifungal drug resistance. We analyzed data from a national survey of nearly 6000 U.S. adults. Overall, 114 (2.7%) participants reported having ringworm and 415 (10.0%) reported a fungal nail infection in the past 12 months; 61.4% of participants with any superficial fungal infection were self-diagnosed. Most patients (55.5%) used over-the-counter antifungals. The common nature of superficial fungal infections and the high rates of self-diagnosis and treatment indicate that community education about these infections should be considered a public health priority.
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21
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Vestergaard-Jensen S, Mansouri A, Jensen LH, Jemec GBE, Saunte DML. Systematic review of the prevalence of onychomycosis in children. Pediatr Dermatol 2022; 39:855-865. [PMID: 36130720 PMCID: PMC10087489 DOI: 10.1111/pde.15100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
Onychomycosis is one of the most common nail diseases in adults but is described as infrequent in children. Data are, however, scattered and diverse. Studies have nevertheless suggested that the prevalence of onychomycosis is increasing in children lately and the aim of this review was therefore to examine this problem. Two authors individually searched PubMed, Embase, and Cochrane Library for articles on epidemiology and prevalence of onychomycosis in children. The literature search was conducted in accordance per PRISMA guidelines. In total 1042 articles were identified of which 23 were eligible for inclusion. One of the articles presented two studies and a total of 24 studies were therefore included. Seventeen studies presented data of the prevalence of onychomycosis in children in the general population and seven studies among children visiting a dermatological and pediatric department or clinic. The prevalence ranged from 0% to 7.66% with an overall discrete increase of 0.66% during the period 1972 to 2014 in population studies (not statistically significant). This review supports a trend towards an increased prevalence of onychomycosis in children, albeit based on a paucity of studies. The data suggests an increasing prevalence of onychomycosis with age, and co-infection with tinea pedis (reported in 25% of the studies). The most common pathogen reported was Trichophyton rubrum and onychomycosis was more prevalent in toenails compared to fingernails. The general characteristics of onychomycosis in children are thus similar to those described in adults.
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Affiliation(s)
| | - Abdullah Mansouri
- Department of Pediatrics, Zealand University Hospital, Roskilde, Denmark
| | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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22
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Nazir ZH, Marghoob AA. The corkscrew and comma-shaped hairs of tinea capitis. JAAD Case Rep 2022; 27:151-152. [PMID: 36046808 PMCID: PMC9420876 DOI: 10.1016/j.jdcr.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Zaeem H Nazir
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
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23
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Patel N, Padhiyar J, Singh R, Bloch A, Babaria S. Comparative evaluation of host immune response and cytokine signature pertaining to Th1 and Th2 immune arms in serum and tissue among patients of acute localised vs. chronic disseminated dermatophytosis. Mycoses 2022; 65:877-886. [PMID: 35673954 DOI: 10.1111/myc.13479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross-sectional comparative study to determine the difference in Th1 (IFN-γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. METHODS Patients (18-60 years) were divided in two groups-group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL-4 and IFN-γ and expression of IL4 and IFN-γ in dermal infiltrate were compared between group. RESULTS Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A-539.2, B-2901.0, p < .001) whereas levels IL-4(median A-21.3, B-20.4, p < .001) and IFN-γ(median A-9.6, B-5.1, p < .001) were significantly lower in chronic cases. Expression of IL-4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN-γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p = .001), ↓IFN-γ (OR:4.683, CI:1.634, 13.418; p = .004) correlated significantly and independently with chronic dermatophytosis. CONCLUSION Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN-γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN-γ cannot be established in our study.
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Affiliation(s)
- Nayan Patel
- Department of DVL, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, India
| | - Jigna Padhiyar
- Department of DVL, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, India
| | - Ragini Singh
- Department of Biochemistry, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, India.,All India Institute of Medical Sciences, Rajkot, India
| | - Afroz Bloch
- Department of Microbiology, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, India
| | - Sneha Babaria
- Department of Pathology, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, India
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24
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Powell J, Porter E, Field S, O'Connell N, Carty K, Dunne CP. Epidemiology of dermatomycoses and onychomycoses in Ireland (2001 to 2020): A single-institution review. Mycoses 2022; 65:770-779. [PMID: 35598177 PMCID: PMC9327510 DOI: 10.1111/myc.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
Background Fungal skin infections are recognised as one of the most common health disorders globally, and dermatophyte infections of the skin, hair and nails are the most common fungal infections. Dermatophytes can be classified as anthropophilic, zoophilic or geophilic species based on their primary habitat association, and this classification makes epidemiological analysis useful for the prevention and control of these infections. The Irish contribution to the epidemiology of these infections has been scant, with just two papers (both reporting paediatric tinea capitis only) published in the last 20 years, and none in the last seven. Objectives To perform a comprehensive retrospective epidemiological analysis of all dermatological mycology tests performed in University Hospital Limerick over a 20‐year period. Methods All mycology laboratory test results were extracted from the Laboratory Information Management System (LIMS, iLab, DXC Technologies) from 2001 to 2020 inclusive for analysis. Specimen types were categorised according to the site of sampling. The data were analysed using Microsoft Excel. Results About 12,951 specimens of skin, hair and nails were studied. Median patient age was 42 years (IQR 26–57) with a slight female preponderance (57.2%). Two thirds of samples (67%, n = 8633) were nail, 32% were skin scrapings (n = 4118) and 200 hair samples (1.5%) were received. Zoophilic dermatophytes were more commonly present in females (38% F, 23% M, proportion of dermatophytes) and in those under 10 years of age or from 45 to 70 years (36% and 34% zoophiles, respectively, proportion of dermatophytes), although anthropophiles predominated every age and gender category. Anthropophiles had their highest prevalence in the 10–20 years age category (80% anthropophiles, proportion of dermatophytes), and yeast infections were more prevalent in older patients (29% of >60 year olds vs. 17% of <60 year olds, proportion of all fungal positives). Trichophyton rubrum was the most prevalent pathogen detected, accounting for 53% of all dermatophytes detected, 61% of those detected from nail samples and 34% from skin and hair samples. Trichophyton tonsurans was the most prevalent dermatophyte in tinea capitis, accounting for 37% of dermatophytes detected. Both of these organisms are anthropophilic, and this group showed consistently increased prevalence in proportion to all fungal isolates. The proportion of this dermatophyte class (anthropophiles) increased among both nail samples and skin/hair samples during the study period, from 55% of samples in the first 5 years of the study (2001–2005) to 88% (proportion of dermatophytes) in the final 5 years. Conversely, yeast detection decreased. Conclusions This study provides a detailed overview of the epidemiology of the fungal cultures of skin, nail and hair samples in the Mid‐West of Ireland over a 20‐year period. Monitoring this changing landscape is important in identifying likely sources of infections, to identifying potential outbreaks, and may help guide empiric treatment. To the best of our knowledge, this study provides the first detailed analysis from Ireland of fungal detections from skin, hair and nail samples, and is the first epidemiological fungal report of any kind in over 7 years.
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Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Emma Porter
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Sinead Field
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Nuala O'Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Kieran Carty
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Colum P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
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25
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Abstract
Topical conveyance of antifungal agents like itraconazole ITZ has been giving good grounds for expecting felicitous antifungal medicines. The defiance of topical delivery of this poorly water soluble and high-molecular-weight drug, however, mightily entail an adequate vehiculation. ITZ aspasomes, newer antioxidant generation of liposomes, have been designed and enclosed in a cream to ameliorate skin deposition. The proposed creams containing non-formulated ITZ or encapsulated in aspasomes (0.1% or 0.5%) were topically applied in patients with diagnosed diaper dermatitis complicated by candidiasis, tinea corporis (TC), and tinea versicolor (TVC). Placebos (void aspasomal cream and cream base) were also utilized. The obtained results for diaper rash revealed that aspasomal cream (0.5% ITZ) was eminent with respect to complete cure and negative candida culture after 10-day therapy relative to counterparts containing 0.1% ITZ aspasomes or non-formulated ITZ (0.1% and 0.5%). For tinea, the same trend was manifested in terms of ‘cleared’ clinical response in 90% of patients and absence of fungal elements after 4-week treatment. Relative to non-formulated ITZ, ITZ aspasomal cream was endorsed to be auspicious especially when ITZ concentration was lowered to half commercially available cream concentration (1%), pushing further exploitation in other dermal fungal infections.
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Affiliation(s)
- Caroline Lamie
- Pharmaceutics and Pharmaceutical Technology, The British University in Egypt, Cairo, Egypt
| | - Enas Elmowafy
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maha H Ragaie
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
| | - Dalia A Attia
- Pharmaceutics and Pharmaceutical Technology, The British University in Egypt, Cairo, Egypt
| | - Nahed D Mortada
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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26
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Verma KK, Senthilnathan G, Bhatia S, Xess I, Gupta V, Dwivedi SN, Sahni K. Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis: An Open-Label Randomised Clinical Trial. Indian Dermatol Online J 2021; 12:820-825. [PMID: 34934716 PMCID: PMC8653726 DOI: 10.4103/idoj.idoj_167_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background Recurrent dermatophytosis is becoming arduous to treat. Recently, oral itraconazole with oral isotretinoin was successful in a patient suffering from recurrent dermatophytosis. Objectives To evaluate if oral isotretinoin confers any added benefit over oral terbinafine in the treatment of recurrent dermatophytosis. Materials and Methods This was an open-label randomized clinical trial including 100 adult patients with recurrent tinea cruris and/or tinea corporis randomized into two groups; Group A (oral isotretinoin 0.5 mg/kg/day and oral terbinafine 250 mg twice daily) and Group B (oral terbinafine 250 mg twice daily) for 4 weeks, and followed up for 3 months. Fungal culture and antifungal susceptibility testing against terbinafine, fluconazole, amphotericin B, itraconazole, and griseofulvin were performed. Results Out of the 100 patients, 91 patients (44 in Group A and 47 in Group B) completed the trial. Complete cure was seen in 19/44 (43.18%) patients in Group A and 20/47 (42.55%) patients in Group B (P = 0.951). Recurrence occurred in 12/19 (63.1%) patients in Group A and 13/20 (65%) patients in Group B (P = 0.904). Cheilitis and dryness of lips were the most common adverse effects seen in 32/44 (72.73%) patients in Group A. A total of 50 cultures were grown. The commonest species isolated was Trichophyton interdigitale in 36 (72%) patients, having a mean minimum inhibitory concentration of 3.13 μg/mL for terbinafine. However, for itraconazole, it was 0.13 μg/mL, and varied minimum inhibitory concentration (MIC) values were seen for fluconazole, griseofulvin, and amphotericin B. Conclusion The addition of isotretinoin to terbinafine has no added benefit in treating patients with recurrent dermatophytosis.
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Affiliation(s)
- Kaushal K Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Gridharan Senthilnathan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Fung MA, Vidal CI, Armbrecht EA, Andea AA, Cassarino DS, Comfere NI, Emanuel PO, Ferringer T, Hristov AC, Kim J, Lauer SR, Linos K, Missall TA, Motaparthi K, Novoa RA, Patel R, Shalin SC, Sundram U, Calame A, Bennett DD, Duncan LM, Elston DM, Hosler GA, Hurley YM, Lazar AJ, Lowe L, Messina J, Myles J, Plaza JA, Prieto VG, Reddy V, Schaffer A, Subtil A. Appropriate use criteria for ancillary diagnostic testing in dermatopathology: New recommendations for 11 tests and 220 clinical scenarios from the American Society of Dermatopathology Appropriate Use Criteria Committee. J Cutan Pathol 2021; 49:231-245. [PMID: 34536035 DOI: 10.1111/cup.14135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Appropriate use criteria (AUC) provide patient-centered physician guidance in test selection. An initial set of AUC was reported by the American Society of Dermatopathology (ASDP) in 2018. AUC reflect evidence collected at single timepoints and may be affected by evolving evidence and experience. The objective of this study was to update and expand AUC for selected tests. METHODS RAND/UCLA (RAND Corporation [Santa Monica, CA]/University of California Los Angeles) methodology used includes the following: (a) literature review; (b) review of previously rated tests and previously employed clinical scenarios; (c) selection of previously rated tests for new ratings; (d) development of new clinical scenarios; (e) selection of additional tests; (f) three rating rounds with feedback and group discussion after rounds 1 and 2. RESULTS For 220 clinical scenarios comprising lymphoproliferative (light chain clonality), melanocytic (comparative genomic hybridization, fluorescence in situ hybridization, reverse transcription polymerase chain reaction, telomerase reverse transcriptase promoter), vascular disorders (MYC), and inflammatory dermatoses (periodic acid-Schiff, Gömöri methenamine silver), consensus by panel raters was reached in 172 of 220 (78%) scenarios, with 103 of 148 (70%) rated "usually appropriate" or "rarely appropriate" and 45 of 148 (30%), "appropriateness uncertain." LIMITATIONS The study design only measures appropriateness. Cost, availability, test comparison, and additional clinical considerations are not measured. The possibility that the findings of this study may be influenced by the inherent biases of the dermatopathologists involved in the study cannot be excluded. CONCLUSIONS AUC are reported for selected diagnostic tests in clinical scenarios that occur in dermatopathology practice. Adhering to AUC may reduce inappropriate test utilization and improve healthcare delivery.
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Affiliation(s)
| | - Maxwell A Fung
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Claudia I Vidal
- Dermatology Center of Southern Indiana, Bloomington, Indiana, USA
| | - Eric A Armbrecht
- Center for Health Outcomes Research, Saint Louis University, Saint Louis, Missouri, USA
| | - Aleodor A Andea
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David S Cassarino
- Department of Pathology, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tammie Ferringer
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA.,Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Alexandra C Hristov
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jinah Kim
- Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Scott R Lauer
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Tricia A Missall
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Rajiv Patel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sara C Shalin
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Uma Sundram
- Department of Anatomic Pathology, Oakland University William Beaumont School of Medicine and Beaumont Health Systems, Royal Oak, Michigan, USA
| | | | | | - Daniel D Bennett
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Lyn M Duncan
- Pathology Service and Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory A Hosler
- ProPath, Department of Dermatology, Dallas, Texas, USA.,Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yadira M Hurley
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.,Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lori Lowe
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane Messina
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jonathan Myles
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jose A Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vijaya Reddy
- Department of Pathology, Rush Medical College, Chicago, Illinois, USA.,Department of Dermatology, Rush Medical College, Chicago, Illinois, USA
| | - András Schaffer
- Division of Dermatology, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Antonio Subtil
- Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
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Herzum A, Molle MF, Cozzani E, Burlando M, Tavilla PP, Micalizzi C, Trave I, Parodi A. Pruritic Erythematous Macules in a Patient with Systemic Sarcoidosis: A Quiz. Acta Derm Venereol 2021; 101:adv00531. [PMID: 34263332 PMCID: PMC9413782 DOI: 10.2340/00015555-3878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Astrid Herzum
- Department of Dermatology, Di.S.Sal., University of Genoa, San Martino Polyclinic Hospital IRCCS, Largo Rosanna Benzi 10, IT-16132 Genoa, Italy
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Mahmoudi S, Vahidi M, Malekabad ES, Izadi A, Khatami M, Dadashi A. In Vitro Antifungal Activity of Green Synthesized Silver Nanoparticles in Comparison to Conventional Antifungal Drugs Against Trichophyton Interdigitale, Trichophyton Rubrum and Epidermophyton Floccosum. Infect Disord Drug Targets 2021; 21:370-374. [PMID: 32669080 DOI: 10.2174/1871526520666200715095744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dermatophytosis is a globally distributed fungal infection. Treatment failure and relapse is common in this disease. Silver nanoparticles are known for their promising antimicrobial activity. The aim of this study was to determine the antifungal activity of these nanoparticles against common dermatophyte species. METHODS A set of 30 molecularly identified dermatophytes including Trichophyton interdigitale (n=10), Trichophyton rubrum (n=10), and Epidermophyton floccosum (n=10) were used in this study. Green synthesized silver nanoparticles using chicory (Cichorium intybus) were tested for their antifungal activity in comparison to fluconazole, itraconazole and terbinafine. Interspecies differences in minimum inhibitory concentrations of antifungal drugs and silver nanoparticles were tested using Kruskal-Wallis test in SPSS software version 21. RESULTS The highest minimum inhibitory concentrations (MICs) among antifungal drugs were observed for fluconazole [range: 4-64 μg/mL, geometric mean (GM) =17.959 μg/mL], followed by itraconazole (range: 0.008-0.5, GM= 0.066) and terbinafine (range: 0.004-0.25 μg/mL, GM=0.027 μg/mL). Silver nanoparticles showed potent antifungal activity against all dermatophyte isolates with MICs (range: 0.25-32 μg/mL, GM=4.812 μg/mL) higher than those of itraconazole and terbinafine, but lower than fluconazole. MIC values of silver nanoparticles demonstrated significant differences between species (P=0.044), with E. floccosum having the highest MICs (GM=9.849 μg/mL) compared to T. interdigitale (GM=3.732 μg/mL) and T. rubrum (GM=3.031 μg/mL). CONCLUSION Silver nanoparticles demonstrated promising anti-dermatophyte activity against the studied dermatophytes. Due to their wide-spectrum activity against other fungal and bacterial pathogens, they could be a potential choice, at least in the case of cutaneous and superficial infections.
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Affiliation(s)
- Shahram Mahmoudi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Aja University of Medical Sciences, Tehran, Iran
| | - Mahmoud Vahidi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Aja University of Medical Sciences, Tehran, Iran
| | | | - Alireza Izadi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Khatami
- Nano Bio Electrochemistry Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Alireza Dadashi
- Department of Infectious Diseases, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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30
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Tahiliani S, Saraswat A, Lahiri AK, Shah A, Hawelia D, Shah GK, Girdhar M, Rao PN, Raghav PA, Agarwal P, Kharkar RD, Gupta RP, Udare S, Hegde S, Haldar S. Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study. Indian J Dermatol Venereol Leprol 2021; 87:800-806. [PMID: 34160163 DOI: 10.25259/ijdvl_1025_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. AIMS The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. METHODS Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. RESULTS Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL. LIMITATIONS Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. CONCLUSION T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.
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Affiliation(s)
- Sushil Tahiliani
- Dr. Tahiliani's Clinic, A 201/202, Gasper Enclave Ambedkar Road, Pali Market, Next to Gold's Gym, Bandra West, Mumbai, Maharashtra, India
| | - Abir Saraswat
- Indushree Skin Clinic, Near Hotel Bandhan, Faizabad Road, Indiranagar Colony, Lucknow, Uttar Pradesh, India
| | - A K Lahiri
- Skin and Laser Clinic, 204, Amsri Plaza, Sarojini Devi Road, Near to Domino's Pizza, Secunderabad, Telangana, India
| | - Avani Shah
- Dr. Miskeen's Central Clinical Microbiology Laboratory, Nirmal, 1st Floor, Behind Amrapali Hotel, Near Gadkari Rangayatan, Old Mumbai-Pune Road, Thane (West), Thane, Maharashtra, India
| | - Dinesh Hawelia
- Dr.Hawelia's Skin Clinic, 1st Floor, 245A, Chittaranjan Avenue, Kolkata, West Bengal, India
| | - G K Shah
- Skin Zone, No. 404, Vini Elegance, Above Tanishq Jewellers, L. T. Road, Borivali (West), Mumbai, Maharashtra, India
| | - Mukesh Girdhar
- Dr Mukesh Girdhar's Skin Clinic, 101, 1st Floor, Rishab Tower, Community Centre, Karkardooma, Anand Vihar, Delhi, India
| | - P Narasimha Rao
- Comprehensive Dermatology Clinic, Plot No 4, Satya Apartment, Masab Tank, Opposite Polytechnic College, Beside Golconda Hotel, Hyderabad, Telangana, India
| | - Potharaju Arun Raghav
- Comprehensive Dermatology Clinic, Plot No 4, Satya Apartment, Masab Tank, Opposite Polytechnic College, Beside Golconda Hotel, Hyderabad, Telangana, India
| | - Pramod Agarwal
- Yuva Skin and Laser Center, A-1031, A-Block, Indira Nagar, Lucknow, Uttar Pradesh, India
| | - R D Kharkar
- Dr. Kharkar's Skin Clinic, Room No 55 , 5th Floor, Dattani Chambers, S V Road, Opposite Shantinath Shopping Centre, Malad West, Mumbai, Maharashtra, India
| | - R P Gupta
- GNH Excel Medical Centre, BN-56, Jhulelal Mandir Marg, Shalimar Bagh, Block BN, Poorbi Shalimar Bag, Shalimar Bagh, Delhi, India
| | - Satish Udare
- Sparkle Skin and Aesthetic Centre, Shanti Center Building, Sector 17, Vashi, Navi Mumbai, India
| | - Sudha Hegde
- Dr. Sudha Hegade Clinic, 101, 1st Floor, Eknath Apartment, Near Paanch Rasta, Above Real Pharmacy, M G Road, Mulund (West), Mumbai, Maharashtra, India
| | - Susmit Haldar
- Calcutta Skin Institute, 169, Scheme 6 M, C I T Road, Kankurgachi, Kolkata, West Bengal, India
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Sonthalia S, Agrawal M, Bhatia J, Zeeshan M, Elsamanoudy S, Tiwary P, Bhat YJ, Jha A, Bosseila M. Entodermoscopy Update: A Contemporary Review on Dermoscopy of Cutaneous Infections and Infestations. Indian Dermatol Online J 2021; 12:220-236. [PMID: 33959518 PMCID: PMC8088165 DOI: 10.4103/idoj.idoj_559_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/16/2020] [Accepted: 12/20/2020] [Indexed: 01/11/2023] Open
Abstract
Infectious cutaneous diseases are very common, especially in certain geographic and tropical regions. Sometimes they may simulate other dermatoses, ordering verification of diagnosis with particular investigations. Dermoscopy is among one of the most important tools readily available in the outpatient setting for the dermatologist to confirm the diagnosis. In this up-to date review, literature concerning the various dermoscopic features of parasitic, viral, dermatophytic and bacterial cutaneous infections is composed. In addition artefacts as well as practical issues in dermoscopy usage are discussed; with the aim to empower dermatologists to promptly and non-invasively diagnose and manage cutaneous infections and infestations.
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Affiliation(s)
| | - Mahima Agrawal
- Department of Dermatology and STD, Lady Hardinge Medical College and ASS Hospitals, New Delhi, India
| | | | - Md Zeeshan
- Department of Skin and V.D., Patna Medical College and Hospital, Patna, Bihar, India
| | - Solwan Elsamanoudy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Pankaj Tiwary
- Department of Skin and V.D., Patna Medical College and Hospital, Patna, Bihar, India
| | - Yasmeen Jabeen Bhat
- Department of Dermatology, Venereology & Leprosy, Government Medical College, Srinagar, J&K, India
| | - Abhijeet Jha
- Department of Skin and V.D., Patna Medical College and Hospital, Patna, Bihar, India
| | - Manal Bosseila
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Araya S, Abuye M, Negesso AE. Epidemiological Characterization of Dermatomycosis in Ethiopia. Clin Cosmet Investig Dermatol 2021; 14:83-89. [PMID: 33519223 PMCID: PMC7837531 DOI: 10.2147/ccid.s292286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
Background Superficial mycosis is common worldwide and their epidemiological characteristics are different in different geographical areas and have shown variations in the last decades. The aim of this study was to analyze and characterize the epidemiology of dermatomycosis and their causative fungi species in Ethiopia between 2015 and 2019. Methods A laboratory-based cross-sectional study was conducted using the data of mycological examination and culture findings from all patients who visited the Dermatology Department of Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia. The direct wet mount microscopy and culture data of the isolates were collected from the database of the dermatology unit from 2015 to 2019 after permission was obtained from the laboratory head. The data were double-entered into Microsoft Excel, exported and analyzed using SPSS version 20. Results The total prevalence of fungi causing dermatomycosis was 67.7% (760/1122 cases) using direct wet mount microscopy and from these 489/1122 (43.5%) were culture positive. Dermatomycosis was found to be higher among females 694/1122 (61.9%) than male participants. Age group 25–44 years was the most affected 442/1122 (39.4%) followed by 1–14 years old 291/1122 (25.94%). Tinea unguium (50.8%) is the most common type of dermatomycosis followed by tinea capitis (24.1%) and tinea corporis (13.9%). Trichophyton spp. (32%) was the most highly distributed causative agent, followed by Epidermophyton spp. (20.2%) and Aspergillus fumigatus (8.3%). Conclusion The retrospective analysis of epidemiological data collected at Arsho Advanced Medical Laboratory since 2015 showed a gradual increase in the frequency of tinea unguium and tinea pedis. However, during the past years, there was a gradual decline in the frequency of tinea corporis. In parallel with this variable pattern, the rate of isolation of non-dermatophytes especially Aspergillus fumigates and Candida species has shown a gradual increment during the past five years.
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Affiliation(s)
- Shambel Araya
- Addis Ababa University College of Health Sciences, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
| | - Million Abuye
- Addis Ababa University College of Health Sciences, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
| | - Abebe Edao Negesso
- Addis Ababa University College of Health Sciences, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
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Abstract
BACKGROUND Treatment of dermatophytosis is becoming costlier and challenging. AIMS AND OBJECTIVES To study the efficacy of salicylic acid peel in dermatophytosis. METHODS Twenty-five patients (20 males and 5 females) having dermatophytosis with positive potassium hydroxide (KOH) mounts were enrolled in the study. Salicylic acid 30% was applied over the lesions weekly for 4 weeks, thereafter patients were followed up weekly for 4 weeks. RESULTS Of the 25 patients, 22 (88%) patients showed clinical and microbiological cure 1 week after the last application, while the remaining 3 patients were nonresponders. Nine (41%) patients of the 22 responders showed recurrences indicating that 4 weeks' treatment is not sufficient in some patients to eradicate fungus and may require longer treatment. LIMITATIONS A relatively small sample size and lack of long-term follow-up are the shortcomings of our study. CONCLUSION Salicylic acid peel is a cheap and useful option in the treatment of dermatophytic infection.
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Affiliation(s)
- Vikrant Saoji
- Consultant Dermatologist, Midas Heights, Ramdaspeth, Nagpur, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
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de Oliveira Pereira F, Gomes SM, Lima da Silva S, Paula de Castro Teixeira A, Lima IO. The prevalence of dermatophytoses in Brazil: a systematic review. J Med Microbiol 2021; 70. [PMID: 33533707 DOI: 10.1099/jmm.0.001321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Dermatophytosis is a common cutaneous mycosis worldwide whose prevalence in Brazil is still unknown. This systematic review has estimated the burden of dermatophytoses from updated literature data reported in the general Brazilian population. We used the following databases: Web of Science, Medline/PubMed, Embase, The Cochrane Library and Scopus for studies published between 2011 and 2020. Original articles with an emphasis on prevalence data for dermatophytosis in the Brazilian population, and diagnosed by culture exam or molecular biology were eligible. We also assessed the methodological quality of the studies. A total of 24 articles met the inclusion criteria and were reviewed. The occurrence of dermatophytoses found in the studies ranged from 4-88.50 %. The pooled prevalence of dermatophytosis for the population studies was 25 % (95 % CI: 24.7-25.3 %). The size of the samples used in the studies ranged from 45 to 36 446 participants, and ages ranged up to 98 years old. The populations studied involved mostly women. The presence of tinea unguium (toenail and fingernail) and tinea pedis were the most frequent dermatophytosis, and we observed a predominance of Trichophyton rubrum, T. interdigitale and T. mentagrophytes. The studies were primarily conducted in patient groups with suspected mycoses and were not entirely representative of the general population. Yet we believe that in the future, more collaborative strategies would improve both diagnostic capacity and epidemiological methodologies, associating the prevalence of dermatophytosis with social and environmental risk factors. This review helps to better understand future epidemiological trends in Brazil and the world.
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Affiliation(s)
| | - Sávio Marcelino Gomes
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Shellygton Lima da Silva
- Postgraduate Program in Natural and Bioactive Synthetic Products, Federal University of Paraiba, João Pessoa, Brazil
| | - Anna Paula de Castro Teixeira
- Postgraduate Program in Development and Technological Innovation in Medicines, Federal University of Paraiba, João Pessoa, Brazil
| | - Igara Oliveira Lima
- Postgraduate Program in Natural Sciences and Biotechnology, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
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Alghaith AF, Alshehri S, Alhakamy NA, Hosny KM. Development, optimization and characterization of nanoemulsion loaded with clove oil-naftifine antifungal for the management of tinea. Drug Deliv 2021; 28:343-356. [PMID: 33517791 PMCID: PMC8725874 DOI: 10.1080/10717544.2021.1879314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Tinea is a common superficial infection caused by keratinophylic fungi called dermatophytes. The objective of the current investigation was to develop and optimize a self-nanoemulsion drug delivery system (SENDDs) using clove oil loaded with naftifine (NF). Clove oil possesses good anti-inflammatory and antifungal properties that can support naftifine action. Box–Behnken designs were used to prepare plain and naftifine loaded SENDDs. The plain SENDDs were evaluated for their globule size. The medicated formulations (NF-CO-SENDDs) were characterized by measuring their globular size, ex vivo % NF permeated, level of interleukin-31 in rats, and antifungal activity. The optimum clove oil level was found to be 10–17%, while NF-CO-SENDDs formulations displayed globular sizes ranging from 119 to 310 nm. The statistical design confirmed the synergistic effect of clove oil and NF in the treatment of fungal infections, confirming that the anti-inflammatory effect of clove oil can counteract the side effects of NF. The optimized formulation composed of 14% clove oil, 12.5 mg Naftifine, and prepared with an Smix ratio equaling 3:1, exhibited good antifungal and anti-inflammatory activity, achieving up to 2-, 3-, 5.75-, and 2.74-fold increases in the amount of permeated NF, steady-state flux, permeability, and diffusion coefficients, respectively, compared with a commercial product. Moreover, the optimum formulation revealed an adequate zeta potential value of 28.31 ± 1.37 mV and showed reasonable stability with no or mild signs of skin sensitivity. Therefore, the designed nanoemulsions containing a combination of clove oil and naftifine could be considered promising delivery systems for the treatment of tinea.
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Affiliation(s)
- Adel F Alghaith
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Department of Pharmaceutical Sciences, College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia
| | - Nabil A Alhakamy
- Faculty of Pharmacy, Department of Pharmaceutics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled M Hosny
- Faculty of Pharmacy, Department of Pharmaceutics, King Abdulaziz University, Jeddah, Saudi Arabia.,Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Yotsu RR, Kouadio K, Yao A, Vagamon B, Takenaka M, Murota H, Makimura K, Nishimoto K. Tinea Capitis Caused by Microsporum audouninii: A Report of Two Cases from Côte D'Ivoire, West Africa. Trop Med Infect Dis 2021; 6:9. [PMID: 33445615 DOI: 10.3390/tropicalmed6010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
We report here two cases of tinea capitis caused by Microsporum (M.) audouinii in Côte d’Ivoire, West Africa. The patients were a three-year-old boy and a six-year-old girl who presented with scaly patches on the scalp. The causative fungus was isolated using an adhesive tape-sampling method and cultured on Sabouraud dextrose agar plates. It was identified as M. audouinii both by its macroscopic and microscopic features, confirmed by DNA sequencing. These are the first documented cases of M. audouinii infections confirmed with DNA sequencing to be reported from Côte d’Ivoire. The practicality of the tape-sampling method makes it possible to carry out epidemiological surveys evaluating the distribution of these dermatophytic infections in remote, resource-limited settings.
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Kumar S, Kaur A, Kaur S. Autoimplantation Therapy in Extensive and Recalcitrant Dermatophytosis: A Case Series. J Clin Aesthet Dermatol 2021; 14:34-37. [PMID: 33584966 PMCID: PMC7869813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dermatophytosis is one of the most common diseases worldwide and is difficult to treat due to its recalcitrant nature. Conventional treatment modalities are associated with frequent relapses due to the absence of a host immune interaction. Here, we present a case series of three patients with difficult-to-treat and recalcitrant dermatophytosis who were treated with homologous autoimplantation. Complete clearance of dermatophytosis was observed after three months in two of the patients and after two and a half months in one patient without the use of any antifungals. No relapses were observed within six months of follow-up. The outcomes of the three patients presented in this case series support homologous autoimplantation as a safe and effective procedure for the treatment of recalcitrant dermatophytosis. The procedure requires only a single visit that can be performed either alone or in combination with other modalities.
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Affiliation(s)
- Sumir Kumar
- Drs. Kumar and A. Kaur are with the Department of Dermatology, Leprology and Venereology at Guru Gobind Singh Medical College in Faridkot, Punjab, India
- Dr. S. Kaur is with Fortis Clinic, in Chandigarh, India
| | - Amandeep Kaur
- Drs. Kumar and A. Kaur are with the Department of Dermatology, Leprology and Venereology at Guru Gobind Singh Medical College in Faridkot, Punjab, India
- Dr. S. Kaur is with Fortis Clinic, in Chandigarh, India
| | - Sukhmani Kaur
- Drs. Kumar and A. Kaur are with the Department of Dermatology, Leprology and Venereology at Guru Gobind Singh Medical College in Faridkot, Punjab, India
- Dr. S. Kaur is with Fortis Clinic, in Chandigarh, India
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Zareshahrabadi Z, Totonchi A, Rezaei-Matehkolaei A, Ilkit M, Ghahartars M, Arastehfar A, Motamedi M, Nouraei H, Sharifi Lari M, Mohammadi T, Zomorodian K. Molecular identification and antifungal susceptibility among clinical isolates of dermatophytes in Shiraz, Iran (2017-2019). Mycoses 2020; 64:385-393. [PMID: 33295089 DOI: 10.1111/myc.13226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
Dermatophytosis is a common superficial mycotic infection affecting individual's quality of life worldwide. The present study aimed to perform species-level identification and evaluate the antifungal susceptibility patterns of dermatophytes isolated in Shiraz, Iran. This cross-sectional study was conducted on clinical samples collected during 2017-2019 from 307 patients suspected of having dermatophytosis. The isolates were identified by direct microscopy, culture and internal transcribed spacer ribosomal DNA sequencing, and their antifungal susceptibility patterns were determined by the microdilution method. Among 307 patients, dermatophytosis was diagnosed by microscopy in 190 (61.8%) subjects and confirmed in 130 (42.3%) cases by both microscopy and culture. It was found out tinea pedis was the most common clinical manifestation, and Trichophyton mentagrophytes was the most prevalent species (28.4%), followed by T tonsurans (23.8%), Microsporum canis (11.5%), T interdigitale (10%), T verrucosum (6.9%), T rubrum (6.9%), T benhamiae (4.6%), T violaceum (3%), T simii (3%), Epidermophyton floccosum (0.7%) and M ferrugineum (0.7%). Moreover, it was revealed that luliconazole with a geometric mean (GM) minimum inhibitory concentration (MIC) of 0.03 μg ml-1 was the most effective agent against all tested isolates. Regardless of species, 30% of isolates responded to high MICs of griseofulvin (MIC90 > 2 μg ml-1 ). The increasing prevalence of nonindigenous species of T simii, T benhamiae and M ferrugineum in Shiraz, Iran, was a notable finding. In addition, infections due to zoophilic species showed an increasing trend. These epidemiological data, along with antifungal susceptibility patterns, may have implications for clinical decision-making and successful treatment.
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Affiliation(s)
- Zahra Zareshahrabadi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Totonchi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University Çukurova, Adana, Turkey
| | - Mehdi Ghahartars
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Marjan Motamedi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hasti Nouraei
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Sharifi Lari
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tooba Mohammadi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Mercer DK, Robertson JC, Miller L, Stewart CS, O'Neil DA. NP213 (Novexatin®): A unique therapy candidate for onychomycosis with a differentiated safety and efficacy profile. Med Mycol 2020; 58:1064-1072. [PMID: 32232410 PMCID: PMC7657096 DOI: 10.1093/mmy/myaa015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/17/2022] Open
Abstract
NP213 (Novexatin®) is a novel antifungal peptide specifically designed for the topical treatment of onychomycosis. NP213 was designed using host defense peptides (HDP), essential components of the innate immune response to infection, as a template. NP213 is a water-soluble cyclic fungicidal peptide that effectively penetrates human nail. NP213 demonstrated a promising preclinical and clinical safety profile, with no evidence of systemic exposure following topical application to the skin and nails. NP213 was efficacious in two phase IIa human trials with 43.3% of patients having no fungi detectable by culture of fragments from NP213-treated nails after 180 days in the first study and likewise 56.5% of patients were culture negative for dermatophytes after 360 days in the second phase IIa study. In both trials, NP213 was applied daily for only 28 days in marked contrast to other topical onychomycosis treatments that require application for up to 52 weeks. Patient reported outcomes from the phase IIa studies were positive with participants recording an improved appearance of their nails after only 14 days of application. All fungi identified in these studies were Trichophyton spp. NP213 (Novexatin®) is a promising, highly differentiated peptide-based candidate for the topical treatment of onychomycosis, addressing the infectious cause and cosmetic issues of this very common condition.
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Affiliation(s)
- Derry K Mercer
- NovaBiotics Ltd, Bridge of Don, Aberdeen, United Kingdom
| | | | - Lorna Miller
- NovaBiotics Ltd, Bridge of Don, Aberdeen, United Kingdom
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Khurana A, Gupta A, Sardana K, Sethia K, Panesar S, Aggarwal A, Ghadlinge M. A prospective study on patterns of topical steroids self-use in dermatophytoses and determinants predictive of cutaneous side effects. Dermatol Ther 2020; 33:e13633. [PMID: 32449316 DOI: 10.1111/dth.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
Nonprescription use of topical corticosteroids (TCS) is a significant concern. This can lead to cutaneous adverse effects, altered morphology of skin disorders and chronicity of cutaneous infections. To record and analyze the patterns of TCS use in patients with tinea corporis/cruris and analyze factors determining the development of cutaneous side effects. Hundred patients with a clinical diagnosis of tinea corporis/cruris who could recall the TCS preparation/s used were included. The TCS usage patterns were recorded and analyzed. Most patients had used very potent TCS (n = 66). Most reported using TCS intermittently for duration ranging from 1 to 4 weeks (n = 78). Relapse of symptoms occurred within 1 to 2 weeks of stopping TCS, triggering reuse. Cutaneous adverse effects were present in 44 patients (striae [n = 29], hypo/depigmentation [n = 11], skin thinning [n = 8], hypertrichosis [n = 1], tinea pseudoimbricata [n = 1]). There was a significant correlation between presence of cutaneous adverse effects and the total duration of TCS use (P = .0016), duration of disease (P = .016), and total amount of TCS used (P = .012). Use for >60 days and of >32 g were associated with 89% and 96.3% (respectively) probability of developing cutaneous adverse effects. Self-use of TCS is a worrisome trend. Intermittent use is a plausible reason for development of cutaneous side effects in only 44% patients.
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Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Aastha Gupta
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Khushboo Sethia
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Sanjeet Panesar
- Department of Community Medicine, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Aastha Aggarwal
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Manik Ghadlinge
- Department of Pharmacology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
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Diep D, Calame A, Cohen PR. Tinea Corporis Masquerading as a Diffuse Gyrate Erythema: Case Report and a Review of Annular Lesions Mimicking a Dermatophyte Skin Infection. Cureus 2020; 12:e8935. [PMID: 32760635 PMCID: PMC7392473 DOI: 10.7759/cureus.8935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tinea is a superficial fungal infection of the skin. Gyrate erythemas are reactive conditions that present as annular red lesions. A 61-year-old woman was diagnosed with tinea corporis whose skin lesions morphologically mimicked a gyrate erythema. She presented with diffuse annular plaques affecting the left side of her chest and abdomen that did not respond to a combination antifungal-corticosteroid cream for six-month duration. The appearance and clinical differential diagnosis included a gyrate erythema. Initial evaluation of the skin biopsy from the lesion's edge demonstrated a spongiotic dermatitis, and staining for fungal organisms was negative. However, deeper sections and a different fungal stain revealed hyphae in the stratum corneum and established a diagnosis of tinea corporis. The PubMed database was used to review the following terms: tinea corporis, gyrate erythema, and tinea incognito. Relevant papers and references cited in those papers that were generated by the search were used. Tinea corporis, especially if previously treated with topical corticosteroids, can masquerade as other dermatoses including a gyrate erythema. Correlation of clinical presentation and pathology findings is essential, especially if the biopsy results do not confirm the suspected clinical diagnosis. Consideration to perform deeper sections or additional special stains or both should also be entertained when the initial pathology observations do not support the presumptive diagnosis based on clinical morphology and history.
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Affiliation(s)
- Darlene Diep
- Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, San Diego, USA.,Dermatology, Scripps Memorial Hospital, La Jolla, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Abstract
Tinea incognito is a variant of dermatophyte infection of the skin modified by an erroneously applied topical or systemic steroid. Aim of the study: to describe the various clinic-epidemiological aspects of tinea incognito found among our patients. A prospective study was carried out in the Department of Dermatology, Basra Teaching Hospital, Basra, Iraq. The clinical diagnosis was confirmed by mycological tests. Clinical data were described in more detail and the lesions were classified according to the site, shape, and extent. Ninety cases of tinea incognito were seen, median age was 34years. The initial inaccurate diagnoses were eczema in 60 patients (67%), intertrigo in 16(18 %) and psoriasis in 14 (15%) patients. The type of topical drugs applied was topical corticosteroid (potent and fluorinated) in most cases (54.4%), fixed drug combination creams in 36.6% and a topical calcineurin inhibitor in 5.5%. Commonly presented as acute eczema-like, on hands and trunk, discoid lupus erythematosus-like lesions on the face and psoriasiform lesions on the scalp. Due to the wide range of clinical manifestations, tinea incognito imitates many skin diseases and should, therefore, be considered in any chronic, erythematous, scaly skin lesions not responding to topical treatment.
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Affiliation(s)
- Samer Dhaher
- Head of Department of Dermatology, College of Medicine, University of Basra, Basra, Iraq
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Thomas M, Wong CC, Anderson P, Grills N. Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients. BMJ Open 2020; 10:e032829. [PMID: 32430446 PMCID: PMC7239529 DOI: 10.1136/bmjopen-2019-032829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients' perception of skin disease. METHODS A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome. RESULTS Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days' wages of a labourer). CONCLUSION Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek 'quick fixes' from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations.
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Affiliation(s)
- Molly Thomas
- Department of Dermatology, Herbertpur Christian Hospital, Dehradun, Uttarakahnd, India
| | - Celestine C Wong
- Department of Dermatology, Monash Medical Centre, Melbourne, Victoria, Australia
- Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Pam Anderson
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Grills
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- The Australia India Institute, University of Melbourne, Melbourne, Victoria, Australia
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Ebert A, Monod M, Salamin K, Burmester A, Uhrlaß S, Wiegand C, Hipler UC, Krüger C, Koch D, Wittig F, Verma SB, Singal A, Gupta S, Vasani R, Saraswat A, Madhu R, Panda S, Das A, Kura MM, Kumar A, Poojary S, Schirm S, Gräser Y, Paasch U, Nenoff P. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: A multicentre study. Mycoses 2020; 63:717-728. [PMID: 32301159 DOI: 10.1111/myc.13091] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. OBJECTIVES The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. PATIENTS/METHODS We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. RESULTS Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine-sensitive and terbinafine-resistant isolates but was associated with increased MICs of itraconazole and voriconazole. CONCLUSIONS The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future.
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Affiliation(s)
- Andreas Ebert
- Medizinische Fakultät, Universität Leipzig, Leipzig, Germany.,Labor für medizinische Mikrobiologie, Rötha, Germany
| | - Michel Monod
- Service de Dermatologie et Vénéréologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Karine Salamin
- Service de Dermatologie et Vénéréologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anke Burmester
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | - Silke Uhrlaß
- Labor für medizinische Mikrobiologie, Rötha, Germany
| | - Cornelia Wiegand
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | | | | | - Daniela Koch
- Labor für medizinische Mikrobiologie, Rötha, Germany
| | | | | | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sanjeev Gupta
- M M Institute of Medical Sciences and Research, MM Deemed to be University, Ambala, India
| | - Resham Vasani
- Department of Dermatology, Bhojani Clinic, Mumbai, India
| | - Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, India
| | - Rengarajan Madhu
- Department of Dermatology (Mycology), Madras Medical College, Chennai, India
| | - Saumya Panda
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Mahendra M Kura
- Department of Dermatology, Grant Medical College & Sir J J Group of Hospitals, Mumbai, India
| | - Akshy Kumar
- Department of Dermatology, Government Medical College, Kota, India
| | - Shital Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, India
| | - Sibylle Schirm
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig, Germany
| | - Yvonne Gräser
- Institut für Mikrobiologie und Hygiene, Nationales Konsiliarlabor für Dermatophyten, Universitätsmedizin Berlin Charité, Berlin, Germany
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Pietro Nenoff
- Labor für medizinische Mikrobiologie, Rötha, Germany
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Yousefian F, Crowley C, Skupsky H, Calame A, Cohen PR. Tinea Corporis-associated Erythroderma: Case Report and Review of Erythrodermic Patients with Chronic Dermatophyte Infection. Cureus 2020; 12:e7578. [PMID: 32391227 PMCID: PMC7205383 DOI: 10.7759/cureus.7578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Erythroderma presents as generalized skin redness. The features of a 39-year-old man who presented with erythroderma are described. His skin biopsy revealed hyphae in the stratum corneum, which established the diagnosis of tinea corporis. His erythroderma resolved following treatment with an oral antifungal agent. Several conditions can be associated with erythroderma. Common etiologies for erythroderma include medications, neoplasms, and papulosquamous disorders. Superficial dermatophyte-associated erythroderma is rare. However, although erythroderma caused by generalized superficial mycosis is infrequently encountered, tinea corporis should be included in the new-onset or chronic erythroderma. The detection of fungal hyphae in the stratum corneum of a biopsy of the erythrodermic skin can not only establish dermatophyte infection as the underlying cause of the individual’s erythroderma but also an alternative cause of erythroderma.
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Affiliation(s)
- Faraz Yousefian
- Osteopathic Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | | | - Hadas Skupsky
- Dermatopathology, Compass Dermatopathology, San Diego, USA
| | | | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Carrascal-Correa DF, Zuluaga A, González A. Species distribution of the main aetiologic agents causing skin dermatophytosis in Colombian patients: A 23-year experience at a Mycological Reference Center. Mycoses 2020; 63:494-499. [PMID: 32163641 DOI: 10.1111/myc.13073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dermatophytosis is one of the most frequent superficial mycoses in the world. MAIN AIM To describe the cases of skin dermatophytosis and its main aetiologic agents in patients referred to a Mycological Reference Laboratory in Medellín, Colombia. METHODS A retrospective study was carried out with records of patients referred between 1994 and 2016 to the Corporación para Investigaciones Biológicas (CIB), Medellín-Colombia, because of clinical suspicion of skin dermatophytosis. RESULTS Of a total of 5628 clinical records of patients with suspicion of skin dermatophytosis analysed, 2780 (49.4%) had a proven or probable dermatophytosis diagnosis, 2774 cultures were performed, and aetiologic agents were isolated in 2576 samples (92.9%). The most frequently isolated aetiologic agents were Trichophyton rubrum (44.3%), followed by Trichophyton mentagrophytes complex (33.3%), Epidermophyton floccosum (12.4%), Nannizzia gypseum complex (5.7%, formerly Microsporum gypseum), Microsporum canis (3.5%) and Trichophyton tonsurans (0.8%). The most frequent clinical forms were tinea pedis (72.7%) and tinea corporis (12.7%). In addition, a group of patients (0.9%) developed mixed infections by two dermatophyte agents and another (4.1%) developed infections in more than one anatomical site. CONCLUSIONS The results of the present study are coherent with previous reports where T rubrum and T mentagrophytes complex were the main causative agents of dermatophytosis. However, the increased incidence of N gypsea complex over M canis is worth highlighting.
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Affiliation(s)
| | - Alejandra Zuluaga
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Angel González
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
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Brasch J, Beck-Jendroschek V, Walther G, Rubbel D. Clinical isolates of Trichophyton rubrum are completely inhibited by photochemical treatment with a γ-cyclodextrin formulation of curcuminoids. Mycoses 2020; 63:369-375. [PMID: 31975440 DOI: 10.1111/myc.13051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION It was shown previously that dermatophytes can markedly be inhibited by a photochemical treatment with curcumin. This kind of photo-inactivation needs to be improved, however, because curcumin is poorly water-soluble. Therefore, a new water-soluble γ-cyclodextrin formulation of curcuminoids was tested for its photochemical inactivation of Trichophyton (T.) rubrum. MATERIALS AND METHODS Conidia were harvested from 6 typical strains of T rubrum and used to inoculate wells of microtiter plates. These wells were also filled with a γ-cyclodextrin curcuminoid formulation with 0.1% DMSO and Sabouraud broth. The assays were then irradiated with visible light (wavelength 420 nm, 45 J/cm2 ). After 24 hours, curcuminoid was added once more, and irradiation was repeated. Fungal growth was monitored photometrically for 8 days and compared with controls. RESULTS Growth of all 6 T rubrum strains was completely inhibited by the photochemical treatment with the γ-cyclodextrin formulation of curcuminoids. The same curcuminoid formulation applied without irradiation had only a minor inhibitory effect. DISCUSSION Photo-inactivation of dermatophytes with a γ-cyclodextrin formulation of curcuminoids plus visible light is a very promising procedure with potential for a new treatment of patients with superficial tinea.
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Affiliation(s)
- Jochen Brasch
- Department of Dermatology, Venerology and Allergology, University Hospitals of Schleswig-Holstein, Kiel, Germany
| | - Vera Beck-Jendroschek
- Department of Dermatology, Venerology and Allergology, University Hospitals of Schleswig-Holstein, Kiel, Germany
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Darian Rubbel
- Department of Dermatology, Venerology and Allergology, University Hospitals of Schleswig-Holstein, Kiel, Germany
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Cohen PR, Erickson C, Calame A. Malassezia (Pityrosporum) Folliculitis Incognito: Malessezia-associated Folliculitis Masked by Topical Corticosteroid Therapy. Cureus 2020; 12:e6531. [PMID: 32038889 PMCID: PMC6993079 DOI: 10.7759/cureus.6531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Malassezia (Pityrosporum) folliculitis usually appears as pruritic monomorphous papules and pustules on the upper back, chest, extensor arms and face. Acne vulgaris, bacterial folliculitis, eosinophilic folliculitis and systemic corticosteroid-induced acne can clinically mimic the fungal-caused acneiform condition. The designation incognito is used to describe tinea or scabies when the characteristic presentation is masqueraded by the application of topical corticosteroid treatment. Application of corticosteroid cream altered the morphology of the skin lesions in a man with Malassezia folliculitis. His cutaneous findings-localized areas of post-inflammatory hyperpigmentation with flattened or completely resolved follicular papules-raised the possibility of partially treated follicular eczema or follicular contact dermatitis. Pathognomonic findings from biopsies of the skin lesions established the diagnosis of Malassezia folliculitis; the condition completely resolved after treatment with topical antifungal shampoo and cream. Similar to tinea incognito and scabies incognito, folliculitis caused by Malassezia yeast in which the cutaneous morphology has been concealed by management with topical corticosteroids should be referred to as Malassezia (Pityrosporum) folliculitis incognito.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, San Diego, USA
| | | | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, Inc., San Diego, USA
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Mushtaq S, Faizi N, Amin SS, Adil M, Mohtashim M. Impact on quality of life in patients with dermatophytosis. Australas J Dermatol 2019; 61:e184-e188. [PMID: 31691274 DOI: 10.1111/ajd.13191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Dermatophytosis can have a significant effect on patient's psychosocial and economic life. Despite this, knowledge on the quality of life (QoL) in patients with dermatophytosis is limited. The objective of the present study was to assess the quality of life in patients with dermatophytosis. METHODS This was a cross-sectional study conducted in the Department of Dermatology at a tertiary care hospital from August 2018 to December 2018. All the patients with dermatophytosis aged ≥16 years were included and evaluated for impact on quality of life. The association of Dermatology Life Quality Index (DLQI) scores with disease characteristics was assessed using t-test, ANOVA and Pearson's correlation test, as applicable. RESULTS A total of 348 patients were analysed. The mean ± SD DLQI score in our study was 13.4 ± 7.3. Dermatophytosis was found to have a very large effect on the QoL in majority (44.8%) of our patients. DLQI questions pertaining to symptoms and feelings and daily activity had the highest impact on patients. The DLQI score was significantly affected by the number of sites involved (P < 0.001), body surface area (P < 0.001) and the severity of symptoms (P = 0.007). CONCLUSION Dermatophytosis was found to have a significant impact on the QoL of affected patients. The DLQI score was influenced by the severity of the disease. This study also underscores the feasibility of DLQI score based QoL assessment in dermatophytosis.
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Affiliation(s)
- Sabha Mushtaq
- Department of Dermatology, Venereology & Leprology, Jawahar Lal Nehru Medical College, AMU, Aligarh, UP, India
| | - Nafis Faizi
- Department of Community Medicine, Jawahar Lal Nehru Medical College, AMU, Aligarh, UP, India
| | - Syed S Amin
- Department of Dermatology, Venereology & Leprology, Jawahar Lal Nehru Medical College, AMU, Aligarh, UP, India
| | - Mohammad Adil
- Department of Dermatology, Venereology & Leprology, Jawahar Lal Nehru Medical College, AMU, Aligarh, UP, India
| | - Mohammad Mohtashim
- Department of Dermatology, Venereology & Leprology, Jawahar Lal Nehru Medical College, AMU, Aligarh, UP, India
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Duldulao PM, Ortega AE, Delgadillo X. Mycotic and Bacterial Infections. Clin Colon Rectal Surg 2019; 32:333-339. [PMID: 31507342 DOI: 10.1055/s-0039-1687828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews the salient clinical features, evaluation, and treatment of mycotic and bacterial infections of the perianal and contiguous zones of the human body.
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Affiliation(s)
- Phillip M Duldulao
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adrián E Ortega
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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