Superficial Fungal Infections Research Articles

Isolation and Identification of Dermatophytes from Animals in the Malwa Region of Punjab: A Preliminary Study

Aim and Scope: In recent decades, there has been an increase in the incidence of dermatophytosis among humans, especially those who are in close contact with animals. It is caused by one of the dermatophyte groups causing superficial mycoses in both humans and animals. Trichophyton and Microsporum spp are the most common genera responsible for skin infection in animals. Despite reports of dermatophytes from various regions, there is increasing evidence of geographical variation in fungal species, their spread to new areas, and growing resistance to antifungal treatments. The ability of these infections to transmit from animals to humans underscores the need for vigilance and proactive management. Addressing this issue can help protect animal and human health, making early detection and treatment vital in preventing outbreaks and ensuring overall well-being. Hence, we conducted a preliminary study on the incidence of dermatophytosis in animals of the Malwa region with a hot-humid climatic condition and a large animal population. Study Design: Purposive sampling was done and samples were subjected to isolation and identification of dermatophytes. Place and Duration of Study: The study was conducted in the Malwa region of Punjab state, India from July 2021 to June 2023. Methodology: Samples (n=51) from various animal species were examined for fungal infection by direct microscopy (10% KOH). Fungal isolates were cultured on Sabouraud’s dextrose agar (SDA) and Dermatophyte test medium. Microscopic and macroscopic identification of dermatophytes was performed. Results: Of the 51 clinically suspected dermatophytosis cases, 27 (52%) were found positive by KOH preparations. Trichophyton spp were isolated from 11(40%) samples demonstrating their significant presence among animals. The results of the present study highlight the incidence of dermatophyte infections in animals within the Malwa region, offering valuable insights into the prevention and control of dermatophytosis in both animals and humans. This information is a critical reference for public health strategies and underscores the importance of effective monitoring and managing dermatophytosis in animals and humans.

SNAKEBITE POISONING: Advances in treatment, Vaccination, and Management Strategies

So, roughly 15% of the 3000 snake species discovered globally are thought to be harmful to humans. The eastern and western diamondback rattlesnakes cause the most fatalities. Snake poisoning deaths are more common in youngsters, the elderly, and those to whom antivenom is not supplied or is administered late or in insufficient quantities. Snake poisoning kills mostly young individuals between the ages of 17 and 27. Snakebites envenoming is mostly an occupational condition that can result in death or severe disability. The treatment is based on both the patient's history and a syndromic approach. The treatment should be provided rapidly and affordably to all citizens of the particular country. Snakes have both dry and moist bites. Dry bites do not produce envenoming symptoms. In such a situation, many people noticed it as a miraculous solution that suggested the bite from the offending snake species was quite innocuous. The diagnosis for such bites is also not noted in the literature, which may cause difficulty while treating the sufferer with antivenom. Because humans are too huge to be considered food for even the largest dangerous snakes, snakes may not always deliver venom when they bite, instead saving this metabolically costly weapon for predation. These dry bites appear as bites from non-venomous snakes, which exhibit comparable symptoms. To aid with this, a greater awareness of both the snake-related and human-related aspects involved in both wet and dry snakebites is essential. Snake venom poisoning is a complex medical emergency that not only involves the site of bite but also multiple organ failure; hence, contacting a physician who is qualified in the diagnosis and treatment of venomous snake bites is vital.

Candida albicans cells exhibit media specific proteomic profiles during induction of filamentation

Candida albicans is an opportunist pathogen responsible for a broad spectrum of infections, from superficial mycosis to the systemic disease candidiasis. C. albicans has various morphological forms, including unicellular budding yeasts, filamentous pseudohyphae and true hyphae, and the ability to switch from yeast to hyphal forms is a key survival mechanism underlying the adaptation of the pathogen to the microenvironments encountered within the host. Filamentation is regulated by multiple signalling pathways and its induction in different growth media in vitro has often led to conflicting results. In this study, we performed quantitative proteomic analyses to compare the response of C. albicans yeast cells grown in YNB minimal medium to those of cells grown in four media widely used in the literature to induce the yeast-to-hyphae transition: YNB-Serum, YNB-N-acetylglucosamine (YNB-NAG), Lee medium and rich Spider medium. We show that each growth medium induces a unique pattern of response in C. albicans cells, and that some conditions trigger an original and specific adaptive metabolic response, showing significant differences in the intracellular content of the various filamentous forms. Moreover, this comparison of proteomic profiles indicates that the medium used can modify the thiol-dependent redox status of the cells, particularly in YNB-Serum and Lee medium and, to a lesser extent, in Spider medium, confirming the role of oxidative stress in the filamentation process. Overall, our data indicate that some of the media routinely used to induce hyphae cause significant changes in proteomic signature that should be taken account more carefully when exploring the hyphal transition in this pathogen.

Reproductive effects of wartime stress and possibilities of their correction (Literature review)

The article presents modern literary data and data of own clinical observations regarding the effects of long-term chronic stress on reproductive processes with an emphasis on the effects of wartime. All stages of the reproductive cycle, from the regulation of the menstrual cycle, conception and implantation to the birth of a child, are energy-consuming and unprofitable for the body. All these processes require a lot of energy, but their purpose is to reproduce the species, not to maintain homeostasis. Therefore, the body temporarily slows down these processes, withdraws energy aimed at their support, and uses it to resist stress.The biological meaning of inhibition of reproductive function in stressful conditions is that if a woman becomes pregnant under unfavorable conditions, it is bad for her body, and for the offspring, and for the future prospects of the biological species as a whole. Therefore, from an evolutionary point of view, it is very beneficial to reduce the production of hormones, exclude ovulation and prevent implantation, and reduce libido during periods of high stress.Stress causes activation of the neuroendocrine and sympatho-adrenal systems, which leads to the release of such hormones as cortisol, adrenaline, norepinephrine into the blood. This helps to mobilize the body’s resources to overcome a threatening situation. However, prolonged stress depletes these systems and leads to maladjustment and increased risk of disease. Stress hormones affect all body systems, including the reproductive system. According to the literature, stress disorders occur three times more often in women than in men.In conditions of chronic stress, in particular during war, pregnancy complications can be caused by stress of various origins: metabolic, associated with micronutrient deficiency, psychological, physical, a combination of factors.Prenatal stress during wartime is a part of our existence, which reduces the quality of life of a pregnant woman and affects the intrauterine development of the fetus and the subsequent health of the child. Long-term chronic stress also leads to deterioration of the general state of health of the expectant mother: it reduces work capacity and appetite, causes lethargy, apathy, sleep disturbances, and increases the risk of obstetric complications.Stress negatively affects the state of immunity of the female population both before conception and during pregnancy, which can lead to the activation of latent infections, and makes the body of pregnant women more vulnerable to acute seasonal infections. This is also facilitated by the lack of necessary vitamins and trace elements with antioxidant properties in conditions of occupation, disruptions in the supply of medicines to certain problematic regions of the country, frequent changes of residence, etc.During pregnancy, all the negative effects of wartime can be realized in the form of major obstetric syndromes. In conditions of pronounced energy deficit caused by long-term stress, the body has to provide for itself to the detriment of the future child, which leads to ZRP, and in the most tragic cases – to intrauterine death. Violation of the psycho-emotional state of pregnant women today leads to the birth of “children of war” – insecure, low self-esteem, deeply ill babies with mental disorders.For the onset of pregnancy and its successful bearing, vitamins and micro/macroelements with antioxidant properties are needed in order to resist oxidant stress inherent in stressful conditions (vitamins of group B, vitamin D, iron, magnesium, omega-3 polyunsaturated fatty acids, L-arginine, L- carnitine). Rational management of pregnancy in today’s complex conditions should be complex and multi-vector. One of the promising directions in ensuring an uncomplicated course of pregnancy and successful perinatal outcomes is work with perinatal psychologists. At the same time, the use of additional psychosomatic effects of basic therapy should not be underestimated.

Forms of Design Resistance in the Temporarily Occupied Territories of Ukraine

The purpose of the study is to investigate design forms of creative resistance to Russian aggression in the temporarily occupied territories. Research methods involve combining art analysis with documentary recording of resistance efforts under occupation conditions. Scientific novelty. It consists in the introduction into scientific circulation of previously undescribed and unanalyzed volume of works of graphic design or related to it, which were created either in the occupied territories, or for use in such territories. For the first time, the types of graphic design used for underground work are defined, the stylistics, means and methods of execution are analyzed. Conclusions. Graphic design uses creative techniques and technologies that can be effectively used in resistance actions in the occupied territories. The effectiveness of graphic design is determined by the ability to express itself in many areas of application in various forms, including: stickers, money, postcards, illustrations, posters, newspapers, growth figures, street graffiti, etc. As a result of the conducted art analysis of the body of works, the ideological motivation, specifics of performance, and stylistics of the visual aids, which use widespread forms of functioning of graphic design in the modern world, were established. Despite the partial isolation from Ukraine, the information coming from the controlled territory of the state was enough for Ukrainian artists to invent creative technologies and create appropriate samples in the conditions of a total ban on Ukrainian content by the occupying administrations and sufficiently severe punishment for violating the rules established by the aggressors. The presence of the Russian language and paraphernalia in the mentioned works is a requirement for the effective performance of the task and targeting the target audience.

Targeted 308-nm Excimer Laser A Safe and Effective Solution for Inflammatory Skin Disorders

Background: The 308-nanometer excimer laser is a targeted ultraviolet B (UVB) light therapy that delivers high-intensity UVB rays directly to affected skin. It has shown considerable efficacy in managing various inflammatory skin conditions, including Psoriasis, Vitiligo, Atopic dermatitis (Eczema), Leukoderma, Alopecia Areata, Chronic recalcitrant dermatitis, Lichen planus, Cutaneous T-cell Lymphoma (e.g. Mycosis fungoides/ Sezary Syndrome), Parapsoriasis, Pityriasis lichenoides chronica, Pruritus, Urticaria pigmentosa, Superficial mycoses (e.g., dermatophytosis [ringworm]. The patient demographic of some of these conditions (e.g. Vitiligo) tends to skew towards patients with darker skin tones. Results: The excimer laser is particularly effective for treating resistant areas, such as the scalp, palmoplantar psoriasis, and hand and foot dermatitis, which often do not respond well to conventional therapies. It has also demonstrated notable success in promoting repigmentation in facial vitiligo, especially in patients with Fitzpatrick skin types IV–VI. Treatment results are typically observed quickly after 5-10 sessions, with sustained improvement and psoriasis clearance evident even at 1-year follow-up. Over the years, access to the Excimer laser procedures has expanded with the availability of these procedures in many private clinics as well as academic facilities. That has increased the availability of the treatment modality and patient choice of therapy. Conclusions: The excimer laser provides a safe, non-invasive treatment option with a strong record of efficacy for multiple inflammatory skin conditions. It is a viable alternative to systemic therapies and can be used either alone or in conjunction with other treatments for optimal patient outcomes.

Deep learning models for vision-based occupancy detection in high occupancy buildings

Accurate occupancy information is crucial for enhancing energy efficiency and reducing carbon emissions in buildings. However, the inherent unpredictability of occupants introduces uncertainties in energy analysis and control strategy development. To address these challenges, this study proposes a vision-based method employing state-of-the-art deep learning models to capture real-time occupancy profiles in crowded indoor spaces. Utilising a self-collected image dataset, various deep learning models, including Single Shot MultiBox Detector (SSD), Faster Region-based Convolutional Neural Networks (Faster R-CNN), and different versions of You Only Look Once (YOLO) were trained and evaluated. An experiment was conducted in a lecture room equipped with cameras and environmental sensors to evaluate the performance of each model in terms of precision, computational efficiency, and adaptability to varying occupancy levels during a lecture session. The session included varying occupancy conditions: entering (barely occupied), during the lecture (typical occupancy), and leaving the room (again barely occupied). Among the models tested, YOLOv8x exhibited the best performance in terms of accuracy, while SSD lagged notably. The impact on the detection performance of various locations of camera setups was also explored. Energy simulations revealed that deep learning-based model generated occupancy profiles significantly deviated from conventional “fixed” occupancy profiles, resulting in a 13.45 % variation in predicted heating energy demand. However, compared to the ground truth, these profiles showed minimal variation (up to 6.72 %) for the Faster R-CNN and YOLO models, highlighting their accuracy and robustness. Additionally, although the deep learning-based occupancy profiles generally overpredicted the recorded data, the CO2 concentration trends they predicted aligned closely with the recorded data, unlike the “fixed” occupancy profiles. The findings underscore the importance of realistic occupancy profiles for reliable energy predictions in buildings and demonstrate the potential of the proposed vision-based method for advancing occupancy detection and building energy management.

Dermatological manifestations in diabetes mellitus and its relation with HbA1c levels – An observational study

Diabetes Mellitus is a chronic, metabolic disease characterised by elevated levels of blood glucose, which over time leads to serious damage. The most common is type 2 diabetes which occurs when body becomes resistant to insulin or doesn’t make enough insulin. Skin manifestations are seen generally in pre-diabetes, undiagnosed, long-term and uncontrolled diabetes mellitus. Skin symptoms may help in diagnosing a denovo case and may give an insight into the patient's diabetic status. This is a cross-sectional, observational study conducted in patients attending the outpatient departments of Dermatology, General Medicine and those admitted under these departments over a period of four months. Clearance from Institutional Ethics Committee was taken before the start of the study. A sample population of 100 was selected randomly based on inclusion and exclusion criteria. Glycaemic profiles including HbA1c were done. Infections (35%) were the most common cutaneous symptoms, followed by papulosquamous illnesses (19%), autoimmune diseases (7%), obesity-related (6%), diabetic vasculopathy-related (5%) and miscellaneous conditions (28%), which included generalised pruritus and xerosis etc. The majority of infections were superficial fungal infections, followed by bacterial and viral infections. Dermatophytosis accounted for a majority of superficial fungal infections. Significant correlation was found between higher HbA1c levels and infections, papulo-squamous diseases, auto-immune diseases, obesity-related manifestations.Higher HbA1c levels were found to be significantly associated with a variety of cutaneous symptoms such as infections, papulosquamous illnesses, autoimmune disorders, and obesity-related manifestations.

Appreciation for the Publication of A real-world observational study to evaluate the safety & effectiveness of Naftifine 2% cream in patients with superficial fungal skin infection in Indian patients and request for subgroup analysis

Appreciation for the Publication of A real-world observational study to evaluate the safety & effectiveness of Naftifine 2% cream in patients with superficial fungal skin infection in Indian patients and request for subgroup analysis

The weight of office? A scoping review of mental health issues and risk factors in elected politicians across democratic societies.

The mental health and capacity to govern of democratically-elected politicians have become burgeoning topics of interest. Notably, in fulfilling demanding and high-stress roles, political officeholders could encounter distinctive risk factors, yet existing research literature about these subpopulations remains underexplored. This scoping review aimed to systematically examine the breadth of available evidence on mental health issues and risk factors affecting democratically-elected politicians internationally and to identify future research needs. Using pre-defined eligibility criteria based on JBI guidelines, a systematic keyword search was conducted in May 2024 of MEDLINE, Scopus, and APA PsycNet, supplemented by snowballing techniques. Only those studies reporting primary, empirical evidence on mental ill-health or risk factors with psychological correlates from serving politicians in "Full" or "Flawed" democracies (per Democracy Index) were included from 1999 to 2024. Titles and abstracts were screened and the full-texts of potentially eligible literature were assessed before extraction and synthesis. Eighteen sources met the eligibility criteria, cumulatively encompassing ~3,500 national, state, and municipal politicians across seven democracies (Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States). Cross-sectional surveys were predominantly utilized, with lesser use of mixed-methods approaches, qualitative interviews, and longitudinal cohorts. Violence emerged as a key concept, with twelve sources (66.7%) underlining its psychological toll and certain data indicating a disproportionate impact on female officeholders. Furthermore, four sources (22.2%) explored general psychopathology trends, revealing varying but sizeable mental ill-health and high-risk alcohol consumption rates, and two studies (11.1%) demonstrated adverse effects from specific occupational conditions. Current literature suggests that democratically-elected politicians can face complex mental health challenges. However, significant research gaps remain, including a paucity of prevalence estimates, longitudinal data, and intervention studies. Equally, the underrepresentation of most democratic countries accentuates the need for a more diverse evidence-base to better support the mental wellbeing of politicians worldwide.

Repurposing of Statins Against Superficial Fungal Infections

In a few decades fungal infections will become a major worldwide health concern. Research reveal that the fungal strain becomes resistant to current medications in cases of HIV infections, corona infections and environmental factors particularly in people with impaired immune systems. The amount of organ transplants and medication used for therapy all have contributed to an increase in the immunocompromised population. The fungal infections are becoming a more significant cause of mortality and morbidity. An estimated 1.5 million fatal consequences are caused by fungal pathogens annually. In a few decades, fungal infections will become a major worldwide health concern, so that unprecedented rates of fungal resistance to currently available antifungal medicines has been observed.The drug repurposing approaches lowers costs and time by investigating previously approved medicines with known safety and pharmacokinetics toxicity profile for novel therapeutic effects.The HMG – CoA reductase inhibitors drugs statins shows antifungal properties against tinea spp. group of common fungus that causes superficial infections. We have evaluated statins for their antifungal potential by insilico studies & Invitro studies & validate results with standard drugs itraconazole & ketoconazole.The docking studies shows highest binding energy shown by atorvastatin among all statin were used for docking studies pravastatin , atorvastatin, simavastatin ,fluvastatin & rosuvastatin . against fungal protein (PDB ID:5V5Z) & human protein (PDB ID: 3LD6) was found to be -13.52 &13.4 kcal/mole .The invitro studies shows MIC values for atorvastatin against Trichophyton rubrum , Microsporum canis & Epidermatophyton flocossum fungal strains found between 125 μg/ml to 150 125 μg/ml where as for standard drugs was found between 12.5 μg/ml to 25 μg/ml. Following insilico & invitro research atorvastatin determined and may be used for the treatment of fungal infections.

Photoprotection and its implications for drug safety

Appropriate photoprotection plays a key role in the safety of using medicinal preparations whose active substances may induce photosensitivity reactions. This aspect applies not only to drugs applied topically to the skin, but also systemically. Drug-induced photosensitivity reactions to light depend on the active substance contained in the medicinal product and its dose, which translates into the concentration in the skin, the type of ultraviolet radiation, its intensity and exposure time. The chemical structure of phototoxic drugs contains unsaturated chemical bonds and aromatic groups, which are responsible for the absorption of radiation, the formation of degradation products and/or free radicals and hypersensitivity reactions. Therefore, in order to prevent hypersensitivity reactions, it is necessary to use appropriate sun protection and/or avoid exposure to solar radiation during pharmacotherapy with selected groups of drugs. The paper presents the latest research results on the impact of drug-induced photohypersensitivity on the increased likelihood of skin cancer. Drugs with the potential to induce photohypersensitivity reactions are discussed, including information on the relationship between their long-term use and the incidence of skin cancer. Based on the data contained in the Product Characteristics, exemplary indications regarding the appropriate photoprotection method to ensure the safe use of the medicinal product are presented. Med Pr Work Health Saf. 2024;75(5).

Dynamics of AKAP/Calmodulin complex is largely driven by ionic occupancy state

AKAP79/150 is a scaffold protein found in dendritic spines and other neuronal compartments. It localizes and regulates phosphorylation by protein kinase A and C and is, in turn regulated by Ca2+, mediated by Calmodulin (CaM). Thus, the interaction of AKAP79/150 with CaM is of biological interest. A 2017 study used a peptide cross linking coupled to mass spectrometry (XLMS) to identify the CaM binding site on AKAP79/150 and subsequently solved an X-ray crystallography structure of CaM in complex with a short helical AKAP79/150 peptide. The XRD structure revealed an unusual mixed ionic occupancy state of CaM as bound to the AKAP79/150 peptide. In this molecular dynamics-based study, we have explored the motional modes of the CaM-AKAP helix complex under three ionic occupancy conditions. Our results indicate that the dynamics of this CaM backbone is largely dominated by the ionic occupancy state. We find that binding of the AKAP79/150 peptide to CaM is not preferentially stabilized in energetic terms in the Ca2+ state as compared to apo. However, the Mg2+ state is destabilized energetically as compared to the apo state. In addition, in the Ca2+ state, the AKAP79/150 peptide appears to be preferentially stabilized by additional hydrogen bonds. Our simulations suggest that further structural biology studies should be carried out, with a focus on driving the system equilibrium to full Ca2+ occupancy. NMR studies may be able to capture conformational states which are not seen in crystals.

Hand infections : when to consult a hand surgeon ?

The hand is an anatomical site frequently affected by infection due to its central role in all daily activities. It is therefore regularly the site of wounds (contused, penetrating, insect stings, bites, etc.), all of which are potential entry points for infections. Recognition by the general practitioner of the red flags requiring an urgent specialist consultation is therefore essential in order to improve the patient's functional prognosis, determined by the initial management. In this article, we focus on the most frequent situations encountered in primary care.

Prevalence of Superficial Dermatophyte Fungal Infections in a Tertiary Care Hospital in Fez, Morocco: An 8-Year Retrospective Study

Prevalence of Superficial Dermatophyte Fungal Infections in a Tertiary Care Hospital in Fez, Morocco: An 8-Year Retrospective Study

Nanoformulations Insights: A Novel Paradigm for Antifungal Therapies and Future Perspectives.

Currently, fungal infections are becoming more prevalent worldwide. Subsequently, many antifungal agents are available to cure diseases like pemphigus, athlete's foot, acne, psoriasis, hyperpigmentation, albinism, and skin cancer. Still, they fall short due to pitfalls in physiochemical properties. Conventional medications like lotion, creams, ointments, poultices, and gels are available for antifungal therapy but present many shortcomings. They are associated with drug retention and poor penetration problems, resulting in drug resistance, hypersensitivity, and diminished efficacy. On the contrary, nanoformulations have gained tremendous potential in overcoming the drawbacks of conventional delivery. Furthermore, the potential breakthroughs of nanoformulations are site-specific targeting. It has improved bioavailability, patient-tailored approach, reduced drug retention and hypersensitivity, and improved skin penetration. Nowadays, nanoformulations are gaining popularity for antifungal therapy against superficial skin infections. Nanoformulations-based liposomes, niosomes, nanosponges, solid lipid nanoparticles, and potential applications have been explored for antifungal therapy due to enhanced activity and reduced toxicity. Researchers are now more focused on developing patient-oriented target-based nano delivery to cover the lacunas of conventional treatment with higher immune stimulatory effects. Future direction involves the construction of novel nanotherapeutic devices, nanorobotics, and robust methods. In addition, for the preparations of nanoformulations for clinical studies, animal modeling solves the problems of antifungal therapy. This review describes insights into various superficial fungal skin infections and their potential applications, nanocarrier-based drug delivery, and mechanism of action. In addition, it focuses on regulatory considerations, pharmacokinetic and pharmacodynamic studies, clinical trials, patents, challenges, and future inputs for researchers to improve antifungal therapy.

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Clinically Cure with Oral Fluconazole of a Wide Spread Tinea Corporis in Immunocompromised Patient

Tinea Corporis is a commonly superficial fungal infection that mainly affects the skin either immunocompetent or immunocompromised host. Widespread Tinea corporis has been rarely reported. We report an extensive superficial fungal infection with a successful clinical cure with oral Fluconazole. A 38-year- old male presented generalized acuate and annular elevated erythematous scaly border with central clearing distribute on the trunk, both hand and leg. The blood test was confirmed positive for human immunodeficiency virus. KOH preparation was requested which was shown a positive result. The diagnosis was widespread tinea corporis. He was misdiagnosed and received inappropriate treatment with various topical steroid and systemic antihistamine and steroid for several months without any improvement. We emphasized the necessary mycological intervention that enables fast and provides the correct diagnosis and thus medical care. Furthermore, in extensive skin lesions immunocompromised comorbidity should be requested. Mycology detection such as fungal culture and PCR were important tools diagnoses to detect agent-causal, however, it was costly and required a period of time. KOH preparation is one of the in-office methods effective and fast in assisting in an appropriate diagnosis.

Retrospective Investigation of the Utility of Potassium Hydroxide Smear in the Diagnosis and Management of Cutaneous Fungal Infections by Dermatologists

Abstract Background: Superficial cutaneous fungal infections are common dermatologic conditions. A significant proportion do not present with typical clinical findings. However, the 10% potassium hydroxide (KOH) smear, a simple bedside test, is often underused when diagnosing cutaneous fungal infections. Aims: We aimed to evaluate whether KOH smear results altered dermatologists’ diagnosis and management, and the factors that influenced its ability to detect cutaneous fungal infections. Methods: A total of 373 patients with suspected cutaneous fungal infection were identified retrospectively from the dermatology database of inpatient referrals in a Singapore tertiary hospital between 1 January 2017 and 30 June 2020. The dermatologists’ eventual diagnoses, based on their assessment until 2 months post-discharge to allow consideration of KOH smear results and response to treatment, were taken as a gold standard. Statistical analyses evaluated for changes between initial and eventual diagnoses and management relative to the KOH smear. Use of topical steroids, topical and/or systemic antifungals before skin sampling, and whether sampling was done by dermatologically-trained personnel, were assessed for association with KOH smear positivity in eventually diagnosed cases. Results: The percentage of uncertain diagnoses was reduced, and the use of topical antifungal as the sole treatment significantly changed after the KOH smear result was available. The adjusted odds ratio of a positive KOH smear in eventually diagnosed cases was 0.19 when systemic antifungals were used before skin sampling, and 3.03 if sampling was performed by a dermatologically-trained person. Limitations: Limitations of our study include dependence on retrospective medical records which may result in misclassification bias and the limited generalisability of our results to patients managed by non-dermatologists. Conclusions: KOH smear is a useful adjunct in diagnosing and managing cutaneous fungal infections. Clinicians should consider the presence of confounders affecting KOH smears when making an overall clinical diagnosis. Focused training of personnel on skin sample collection may improve the detection rate of KOH smear.

Utilization of Injectable and Device-Based Treatments in Medical Dermatology: A Survey on Demographics, Conditions, and Resident Involvement.

Injectable and device-based treatments are used for medical dermatologic conditions, but understanding dermatologists' practices remains limited. This study examines injectable and device-based treatments for medical dermatologic conditions to identify patterns and potential improvements. A survey was distributed to Association of Academic Cosmetic Dermatology members, covering practice settings, conditions treated, pricing, and resident involvement. Thirty-four of 40 (85%) respondents practiced in academic teaching hospitals, primarily in urban settings. Conditions treated included acne vulgaris, alopecia, skin cancers, disorders of pigmentation, follicular disorders, gender-affirming care, birthmarks, oncodermatology, rosacea, scars, tattoos, and vascular lesions. Treatments were offered at various prices, with clinical trials and insurance used in some cases. Resident involvement ranged from 72% to 94% of cases. Respondents also reported laser usage, with 100% using lasers for treating scars, 98% for treating vascular lesions, 98% for treating rosacea, and 88% for treating disorders of pigmentation. For acne vulgaris and associated scarring, the top treatments were chemical peels (86%), lasers (83%), and mechanical modalities (48%). With gender-affirming care, respondents used lasers (100%), filler (55%), and neurotoxins (48%). Academic dermatologists treat medical dermatologic conditions and involve residents.