Dermatophytosis Research Articles

Reliable and rapid identification of terbinafine resistance in dermatophytic nail and skin infections.

Fungal infections are the most frequent dermatoses. The gold standard treatment for dermatophytosis is the squalene epoxidase (SQLE) inhibitor terbinafine. Pathogenic dermatophytes resistant to terbinafine are an emerging global threat. Here, we determine the proportion of resistant fungal skin infections, analyse the molecular mechanisms of terbinafine resistance, and validate a method for its reliable rapid identification. Between 2013 and 2021, we screened 5634 consecutively isolated Trichophyton for antifungal resistance determined by hyphal growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine. All Trichophyton isolates with preserved growth capacity in the presence of terbinafine underwent SQLE sequencing. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method. Over an 8-year period, the proportion of fungal skin infections resistant to terbinafine increased from 0.63% in 2013 to 1.3% in 2021. Our routine phenotypic in vitro screening analysis identified 0.83% (n = 47/5634) of Trichophyton strains with in vitro terbinafine resistance. Molecular screening detected a mutation in the SQLE in all cases. Mutations L393F, L393S, F397L, F397I, F397V, Q408K, F415I, F415S, F415V, H440Y, or A398 A399 G400 deletion were detected in Trichophyton rubrum. Mutations L393F and F397L were the most frequent. In contrast, all mutations detected in T. mentagrophytes/T. interdigitale complex strains were F397L, except for one strain with L393S. All 47 strains featured significantly higher MICs than terbinafine-sensitive controls. The mutation-related range of MICs varied between 0.004 and 16.0 μg/mL, with MIC as low as 0.015 μg/mL conferring clinical resistance to standard terbinafine dosing. Based on our data, we propose MIC of 0.015 μg/mL as a minimum breakpoint for predicting clinically relevant terbinafine treatment failure to standard oral dosing for dermatophyte infections. We further propose growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine and SQLE sequencing as fungal sporulation-independent methods for rapid and reliable detection of terbinafine resistance.

Two Cases of Skin Mycosis Due to Hanseniaspora Opuntiae and Cutaneotrichosporon Mucoides at Basrah Southern of Iraq

Two Cases of Skin Mycosis Due to Hanseniaspora Opuntiae and Cutaneotrichosporon Mucoides at Basrah Southern of Iraq

Candidal Granuloma on the Lip Masquerading as Squamous Cell Carcinoma

Skin fungal infections are sometimes misdiagnosed as malignancies and vice versa. Herein, we present the case of a 78-year-old woman who visited our clinic because of a rapidly growing "hard-crusted nodule" on the lower lip persisting for 1 month. Keratoacanthoma or squamous cell carcinoma (SCC) was initially considered. However, the histopathological findings revealed suppurative granuloma and fungal elements without atypical cells. Candida albicans was grown in tissue culture. The lesions were treated with topical ketoconazole. After 2 years, the patient revisited because of a black-crusted nodule on the left corner of her mouth that had been persisting for 1 month. The nodule resembled SCC. Histopathological examination revealed suppurative granuloma and fungal elements. After confirming Candida glabrata in fungal culture, the lesion was diagnosed as candidal granuloma and disappeared spontaneously without any treatment. Herein, we report a case of candidal granuloma on lip mimicking recurrent malignancies.

Phytoconstituents and antidermatophytic activity of crude extracts of Senna occidentalis

Dermatophytes are one of the major aetiologic agents of cutaneous mycoses Senna occidentalis is among the plants used in traditional herbal medicine in treating fungal skin infections and it is shown from literature to contain phytochemicals which are attributed to its antidermatophytic activity. This work is aimed at determining the Phytoconstituents and antidermatophytic activity of leaves and seeds crude extracts of the Senna occidentalis plant . The study is a qualitative study that determines the phytoconstituents and antidermatophytic activity of the plant extracts on some clinical dermatophyte isolates. The plant parts were sampled and were used to obtain aqueous and n-hexane extracts using distilled water and n-hexane as extracting solvents respectively. Phytochemical analysis was done on the extracts to determine the presence of secondary metabolites. The antidermatophytic activity of the extracts on clinical dermatophytes isolates was determined using poisoned food technique. Aqueous extraction gave higher percentage extraction yield than n-hexane extract . All extracts contain secondary metabolites and the extracts showed varying degree of percentage growth inhibition on the isolates. Phytochemical screening of the leaves and seeds extracts of Senna occidentalis revealed the presence of alkaloids, saponins, tannins and other phytoconstituents. The Senna occidentalis leaves and seeds extracts showed growth inhibition percentage (I) ranging between 9% to 39.8% for n-hexane leaf extract,1.3% to 52.6% for aqueous leaf extract,2.6% to 57.2% for n-hexane seed extract and 12.8% to 61.1% for aqueous seed extract. Senna occidentalis leaves and seeds extract have shown varying potential in inhibiting dermatophyte growth with no extract having 100% inhibition percentage on all the tested dermatophytes.

The Chemical Profile, and Antidermatophytic, Anti-Inflammatory, Antioxidant and Antitumor Activities of Withania chevalieri A.E. Gonç. Ethanolic Extract

Withania chevalieri, endogenous from Cape Verde, is a medicinal plant used in ethnomedicine with a large spectrum of applications, such as treating skin fungal infections caused by dermatophytes. The aim of this work was to chemically characterize the W. chevalieri crude ethanolic extract (WcCEE), and evaluate its bioactivities as antidermatophytic, antioxidant, anti-inflammatory and anticancer, as well as its cytotoxicity. WcCEE was chemically characterized via HPLC–MS. The minimal inhibitory concentration, minimal fungicidal concentration, time-kill and checkerboard assays were used to study the antidermatophytic activity of WcCEE. As an approach to the mechanism of action, the cell wall components, β-1,3-glucan and chitin, and cell membrane ergosterol were quantified. Transmission electron microscopy (TEM) allowed for the study of the fungal ultrastructure. WcCEE contained phenolic acids, flavonoids and terpenes. It had a concentration-dependent fungicidal activity, not inducing relevant resistance, and was endowed with synergistic effects, especially terbinafine. TEM showed severely damaged fungi; the cell membrane and cell wall components levels had slight modifications. The extract had antioxidant, anti-inflammatory and anti-cancer activities, with low toxicity to non-tumoral cell lines. The results demonstrated the potential of WcCEE as an antidermatophytic agent, with antioxidant, anti-inflammatory and anticancer activity, to be safely used in pharmaceutical and dermocosmetic applications.

Tinea pedis: an updated review.

Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis. A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years. Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients. Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.

Comparative Preclinical Evaluation of the Safety, Antifungal Activity, and Pharmacokinetics of Sertaconazole Products for External Use

SCIENTIFIC RELEVANCE. The high prevalence of fungal skin infections motivates expanding the range of sertaconazole products for external use.AIM. The study was a preclinical comparison of the safety, antifungal activity, and pharmacokinetics of Sertaverin® 2% medicated shampoo (VERTEX JSC, Russia) with those of Sertamicol® 2% solution for external use (Glenmark Pharmaceuticals Ltd, India) and Nizoral® 2% shampoo (Janssen Pharmaceuticals N.V., Belgium) approved in the Russian Federation.MATERIALS AND METHODS. In the toxicity study, the medicinal products were applied to the skin of male and female outbred rats at doses of 0.5 or 1.5 mL/animal for 28 days. The authors evaluated the pharmacokinetics of two sertaconazole formulations (shampoo and solution) following a single administration to adult male rats at the same dose. Nizoral® was not used in the pharmacokinetics study because it contains a different active substance, ketoconazole. The minimum inhibitory concentration (MIC) was determined using the serial microdilution method in a wide range of concentrations.RESULTS. The medicinal products did not exhibit any significant toxic effects in laboratory animals after 28 days of repeated dermal application. Plasma sertaconazole concentrations were negligible. Sertaconazole was intensively distributed in the liver, which is a highly vascularised organ, and in the target organ (skin at the site of application). The relative bioavailability of sertaconazole from the shampoo relative to that from the solution for external use was approximately 30% in liver tissues and approximately 363% in skin tissues at the application site. Sertaverin® was comparable to sertaconazole in the active substance form in terms of inhibiting the growth of Malassezia furfur strains. The MICs calculated on the active substance basis were ≤16–64 μg/mL.CONCLUSIONS. With its synergistic dual mechanism of action, broad-spectrum antifungal activity, lipophilic properties, and low systemic absorption, Sertaverin® may provide a more effective and safe alternative to marketed medicinal products for scalp diseases.

A Novel Interleukin 17 Receptor A Mutation in a Child with Chronic Mucocutaneous Candidiasis and Staphylococcal Skin Infections.

Chronic mucocutaneous candidiasis leads to persistent or recurrent fungal infections of the nail, skin, oral, and genital mucosa. Impaired interleukin 17-mediated immunity is a cause of chronic mucocutaneous candidiasis. We aimed to show the pathogenicity of a novel interleukin 17 receptor A mutation through functional studies. After next-generation sequencing analysis showed the interleukin 17 receptor A variant, we confirmed the variant by Sanger sequencing and functional validation of the variant by flow cytometry. We present the case of a 6-year-old male patient who presented with recurrent oral and genital Candida infections and eczema. He had staphylococcal skin lesions, fungal susceptibility, and eczema. The patient carried a novel homozygous nonsense [(c.787C> T) (p.Arg263Ter)] mutation in the interleukin 17 receptor A gene. Sanger sequencing confirmed the variant and revealed the segregation of the variant in the family. We used flow cytometry to detect interleukin 17 receptor A protein expression in peripheral blood mononuclear cells from patients and measured Th17 cell percentage. We observed low interleukin 17 receptor A protein expression in patient peripheral blood mononuclear cells, decreased CD4+ interleukin 17+ cell percentage, and decreased interleukin 17F expression in CD4+ cells compared to healthy controls. Innate immune defects may lead to chronic recurrent fungal and bacterial infections of the skin, mucosa, and nails. Generally, genetic and functional analysis is needed in addition to basic immunological tests.

Clotrimazole for Treatment of Fungal Skin Infections Disease

The research includes the preparation of a pharmaceutical composition of Clotrimazole at a concentration of 2.5%, which is used to treat bacterial and fungal infections of the skin of field animals, which mainly work on ring worms, eczema (atopic dermatitis) and candidiasis.The initial biological laboratory tests were conducted for the preparation and it was 100% in conformity with the pharmaceutical specification and within the constitutional limits (110-90) % according to the British Pharmacopoeia .The stability was studied at temperatures (40, 30) °C and relative humidity (70, 75) %, respectively, for a period of six months. The prepared composition proved its ability to heal the wound by acting as an anti-oxidant to preserve the tissue from external influences that hinder the healing process and activate the formation of fibroblasts and collagen in the damaged layer and thus the formation of granulation tissue that accelerates healing .The results of the research were enhanced by sending samples to the veterinary department/ veterinary hospital, where it was tested on a cases of skin fungi in the face and legs in poultry, about 24, and the response to treatment was good through the improvement of the condition, and an acceptance certificate was obtained from the veterinary hospital.

Formulation of Nystatin 2.4%, Neomycin Sulfate 0.35%, Dexamethasone 0.05% (w/w) Ointment

The aim of study is production of new local drug consisting of Nystatin, Neomycin sulfate, Dexamethasone ointment are veterinary medicinal preparations used in the treatment of exogenous fungi and infections in small and large animals that cause by (candida albicans) and affected by gram positive and gram negative bacteria like (Staphylococcus aureus, Escherichia coli, Haemophilus influenza, Klebsiella-Enterobacter species, Neisseria species, and Pseudomonas aeruginosa). Nystatin is considered one of the safe drugs when treating external fungal infections in field animals. Neomycin works by inhibiting protein synthesis in the bacterial cell and thus leads to the killing of bacteria either dexamethasone works to stop infections in the affected area of ​​animals. In order for this product to be both research and applied, many of the initial pharmaceutical compositions were prepared until the final and stable composition was reached in this form. (90-110% permissible limit of activity). This process included several stages of collecting information on the substances included in the formula, active substances and additives, and then preparing the formula according to the specifications. International pharmacology using pharmacopoeia, followed by a study of stability and resistance of the preparation at room temperatures, then sending samples for field examination to the veterinary department and for the lack of cases for other animals where it was used on cases of fungal infections and skin infections in small animals (Cats). The treatment period was 5-10 days, and it brought very good results, according to the field evaluation form attached to the research. Outcomes of study its good and new research and very important to treatment skin infection in small animals.

Cutaneous Fungal Infections Caused by Dermatophytes and Non-Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing.

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.

A scientific review on Dadrukushta with special reference to Dermatophytosis and its management through Ayurveda

Skin is the largest organ of the body and skin diseases has a high prevalence throughout the world and fungal infection of skin is one of them. In the high populated countries like India and China the incidence of skin diseases is considerably increased in recent years due to predisposing factors like warm, humid climate, crowded living conditions, hygiene and poor nutrition. In Ayurveda all the skin related diseases are explained under main heading of Kushta and skin fungal infections termed as Dadrukushta (Dermatophytosis). Ayurveda has a versatile approach towards skin disorders depending on the requirement of the patient. The present article is aimed at understanding the disease Dadrukushta with special reference to Dermatophytosis and its management through Ayurveda.

In vivo Guinea Pig Model Study for Evaluating Antifungal Effect of a Dual-Diode Laser with Wavelengths of 405 Nm and 635 Nm on Dermatophytosis.

Various laser- and light-based devices have been introduced as complementary or alternative treatment modalities for dermatophytosis, particularly for finger or toenail onychomycosis. This study aimed to comparatively evaluate the antifungal effects of 405-nm and 635-nm dual-band diode lasers using an in vivo guinea pig model of dermatophytosis. A guinea pig model was developed by the repetitive application of fungal spore preparations to the back skin of guinea pigs. Dual-diode laser treatment was delivered to the guinea pig skin at a power of 24 mW at a wavelength of 405 nm and 18 mW at 635 nm for 12 min. The treatments were administered three times weekly for 2 weeks, and a mycological study was performed. Mycological studies using scraped samples obtained from treatment groups A (N = 8) and B (N = 8) after dual-diode laser treatment revealed that seven of eight (87.5%) samples in each group had negative results for direct potassium hydroxide microscopy and fungal culture studies. Skin specimens from each infected laser-untreated guinea pig exhibited spongiotic psoriasiform epidermis with parakeratosis. Meanwhile, skin specimens from infected laser-treated guinea pigs in groups A and B demonstrated thinner epidermal thickness than those from infected untreated controls but thicker than those from uninfected treated controls without noticeable inflammatory cell infiltration in the dermis. The guinea pig dermatophytosis model can be used to comparatively evaluate the efficacy and safety of various treatment modalities, including dual-diode lasers, for superficial fungal skin infection.

Prevelance of Fungal Infections to the Human Population of District Buner

Aims: The current study is conducted to determine the prevalence of fungal skin infection to the human population of district Buner, Khyber Pakhtunkhwa, Pakistan. Methods: In the current study we investigate 470 patients containing the fungal skin infection in the seven tehsil of District Buner. Results: During the study there are three major infections we investigate which is present in District Buner among the fungal skin infections and it’s are the following, Tinea infection, Candidiasis infection and Pityriasis versicolor infection. . The Tinea consists of tinea capitis, tinea faciei, and tinea corporis, tinea cruris, tinea pedis and tinea Unguium. Practical Implication: The fungal skin infection is more common in this tehsil because of their humidity. We also reported the mode of the transmissions and as will is the cause of fungal skin infections in human in district Buner. We reported the proper lab procedure and the treatment of fungal skin infection in human in district Buner. Conclusion: There are three fungal infections are present one is Ringworm infection about 55% are present and Candidiasis infection and it is about 27% and the Pityriasis versicolor is 18%. We also determined the sub Tinea infection, Tinea Capitis are 35 %, Tinea Faciei is 22%, Tinea Corporis 15%, Tinea Cruris 13%, Tinea Pedis 10%, and Tinea Unguium is 05%.We determine the distributions of fungal skin infection in human with age below the ten years 25%, above the ten years is 25%, above the twenty years is 15%, above the thirty years is 17% and above the fourty years is 18%. We also investigate the ratio and tehsil wise. Tehsil Daggar consist 7%, Tehsil Gagra 8%, Tehsil Gadezai 10%, Tehsil Mandan 25%, Tehsil Chagharzi 20%, Tehsil Amazi 13% and Tehsil Khodokhel 17% is present in District Buner Khyber Pakhtunkhwa, Pakistan. Keywords: Fungal skin infection, in Human, Prevalence, Buner, Khyber Pakhtunkhwa, Pakistan.

Formulation Perspectives in Topical Antifungal Drug Therapy: A Review

Topical medication delivery is the process of directly treating a cutaneous ailment or the cutaneous manifestation of a general disease by applying a pharmaceutical dosage form to the skin with the goal of reducing the drug's pharmacological or other effects to the surface of skin. A wide range of pharmacological dosage forms, such as semisolids, liquid preparations, sprays, solid powders, gels, creams, and ointments, are used in topical drug delivery systems. A gel is a cross-linked polymer network swollen in a liquid medium. Its properties depend strongly on the interaction between solid state polymer and the liquid component. Gels don't have a flow that is steady. An interlacing three-dimensional network of dispersed phase particles is created by the interaction of the polymer and the liquid dispersion medium. Because topical gel formulations are less oily and readily removed from the skin, they provide an effective medication delivery mechanism. Compared to cream and ointments, gel composition offers greater application properties and stability. One of the most frequent issues with dermatological problems is fungal infection of the skin. The most effective option for treating cutaneous infections is topical treatment. The most popular antifungals in the treatment of both local and systemic fungal infections are azoles. The benefits of topical treatment for fungal infections include less risk of systemic adverse effects and medications that are targeted to the infection site. Important actions for boosting treatment effectiveness include formulation design and optimization. The most helpful aspects of a topical medication delivery system are the medication's physiochemical characteristics and formulation type. As a result, some recent developments in formulation have been researched for the delivery of antifungal medications via the target region of the skin. This review focuses on the research that has been done so far on antifungal gel and a thorough analysis of it.
 Keywords: Topical gel, Antifungal, Drug delivery, dispersion medium, fungal infection, adverse effects

Topical glucocorticosteroids: from high clinical efficacy to the problem of uncontrolled use (case report)

Due to their pronounced biological activity, glucocorticosteroids are widely used in various fields of medical practice. The variety of effects of these hormones makes them an important part of the treatment of dermatological patients. This group of drugs has a pronounced positive effect on various links in the pathogenesis of many chronic dermatoses due to anti-inflammatory, vasoconstrictive, immunosuppressive and antiproliferative effects. The creation of combined external preparations containing a glucocorticosteroid in combination with an antibacterial and/or antifungal component has become a significant achievement in dermatological practice. Due to the rapid relief of signs of inflammation, as well as additional antibacterial and antifungal effects, these external agents have become especially attractive to patients. Widespread advertising and over-the-counter sale of drugs containing glucocorticosteroids leads to the fact that a significant part of patients seek advice from a dermatologist only after their ineffective use. At the same time, their uncontrolled use can lead to a number of side effects, including both pathological changes in the skin and pronounced negative systemic reactions. This fact significantly changes the clinical picture of the disease, limits the possibilities of early laboratory diagnosis of infection, which often prolongs the time for verification of the diagnosis and complicates therapy. The article presents our own clinical observations of patients with skin mycoses who have been using combined topical preparations containing glucocorticosteroids for a long time. This led to an atypical clinical course of the infection and required additional diagnostics using histological examination. The analysis of clinical observations is intended to focus the attention of primary care physicians on this problem, which can increase patient awareness of the risks of using topical drugs containing glucocorticosteroids.

KETOCONAZOLE LADEN MICROEMULSION BASED GEL FORMULATION AGAINST SKIN FUNGAL INFECTION

Objective: The present research was aimed to develop ketoconazole (KT) loaded microemulsion-based gel formulation for effective topical delivery through enhanced drug solubility, improved skin permeation and reduced side effects overcoming drawbacks of conventional dosage forms. Methods: For the selection of oil, surfactant and co-surfactant mixture (Smix) ratio, the phase titration method was used and pseudo-ternary phase diagrams were prepared. D-optimal mixture design was employed to optimize the microemulsion system taking oil, Smix and water as independent variables and particle size, polydispersity index, zeta potential, % transmittance and cumulative % drug release as response variables. Finally, topical gel formulation of KT-loaded microemulsion was developed and evaluated for physico-chemical properties, rheological properties, in vitro drug release kinetics and ex-vivo drug permeation. Results: The optimized microemulsion was found to be a transparent formulation with 19.7 nm particle size, 0.268 polydispersity index,-0.2 mV zeta potential, 97.83% transmittance and 85.85% cumulative drug release at 24 h. The developed gel of optimized microemulsion possessed pH 6.20, viscosity 2178 cps, spreadability 18.634 g.cm2/sec, adhesiveness 45.989 N/mm2, and cohesiveness-85.583. The in vitro drug release was found to be 69.08 % (at 24 h), showing sustained release and Higuchi kinetic profile. The developed gel exhibited 1.84-fold higher drug permeation flux as compared to the marketed product. Conclusion: The developed gel formulation possessed all desired quality attributes and physico-chemical properties. The in vitro and ex-vivo study data proved it’s suitability as a better alternative to conventional products in the effective treatment of fungal skin infections.

Father and son are carriers of two different types of human inborn errors of immunity: a case report

IntroductionChronic granulomatous disease (CGD) is an inborn error of immunity (IEI) characterized by recurrent bacterial and fungal infections of skin, airways, liver, brain and bones with the estimated prevalence of 1 in 250,000 live births. CGD can inherited either in an X-linked (allelic variants in the CYBB gene) or autosomal recessive mode (allelic variants in the CYBA, NCF1, NCF2, NCF4, and CYBC1 genes). Wiskott-Aldrich syndrome is an X-linked disorder with an estimated incidence of 1 in 100 000 live male births caused by variants in the WAS gene, characterized by microthrombocytopenia, eczema, recurrent infections, increased risk for autoimmune disease and malignancy. Materials and MethodsIn this case report, we present our experience about two cases of blood relatives diagnosed with different types of human inborn errors of immunity. Genetic analysis of CYBB gene in 2007 was performed by Sanger sequencing and of WAS gene in 2022 by next generation amplicon sequencing. All subjects consented to the study. ResultsThe first case was a 15-year-old male (1992 y.o.b., proband) who was diagnosed as X-linked CGD patient in 2007 due to his clinical history and hemizygote allelic variant in the CYBB gene (NM_000397.4: c.484–1G>T, COSV101059810). The second case was a 2-month-old boy (biological son of proband) who was hospitalized in 2022 due to microthrombocytopenia, low platelet volume, cytomegalovirus infection, mild anemia. Genetic analysis revealed in the DNA sample of the second case the hemizygote allelic variant in the WAS gene (NM_000377.3: c.777 +3_777+6del GAGT). Genetic testing didn’t reveal such variant in the DNA sample of the proband's wife, that's why this variant was classified as “de novo”. ConclusionInborn errors of immunity (IEI) present clinically as increased susceptibility to infections, autoimmunity, autoinflammatory diseases, allergy, bone marrow failure, and/or malignancy. There are now a total of 485 IEI, which are segregating to 10 groups of disorders into overlapping phenotypes. Despite the fact that IEI are rare diseases, we have shown that even in one family two different types of disorders can occur. In our case the second IEI was occur due to spontaneously alterations during the process of DNA replication during cell division.

The Comparison of Ketokonazol and Hypochlorous Acid (Hocl) Applications for the Treatment of The Fungal Infections (Dermatophytosis)

Dermatophytosis is a mycotic disease of the skin that is resistant to treatment. The aim of this study was to investigate the treatment efficacy of a novel antimicrobial agent, Hypochlorous Acid (HOCL), on dermatophytosis of cats and dogs, in comparison with Ketaconazole.
 In this study, a total of 76 animals (26 cats and 50 dogs) without any disease other than skin fungal infection after clinical, hematological, biochemical, microscopic and Wood's lamp examinations were used. Subjects were randomly assigned to two equal treatment groups within their own species as HOCL: HP and Ketaconazole: KT. Naked eye inspection results were collected on the 8th, 11th and 15th days of all patients. The study was terminated on the 15th day by collecting the Wood's lamp and microscopic examination data together with the last inspection finding. Findings were analyzed statistically with chi-square and CART (Classification and Regression Tree) algorithm test.
 Inspection results of the treatment groups exhibited significant recovery over time (day 8, 11 and 15) for both species (p0.05). According to the microscopic examination results, a significant statistical difference was observed between the HP and KT groups (p0.05).
 As a result, it was concluded that HOCl has an effect on dermatophytosis of cat and dogs, although not as much as Ketaconazole, but further studies are needed to reveal the results more clearly.

Topical Steroids: Awareness and Misuse Among General Medical Practitioners

Introduction: Topical steroids (TS) contributed in the management of several inflammatory, tumoral or allergic dermatoses. However, their misuse may lead to serious or even irreversible adverse effects. This study aimed to evaluate the knowledge and attitudes of general medical practitioners in Morocco regarding topical steroids use and misuse. Materials and Methods: Cross-sectional national survey over a 4-month period from 01/09/2022 to 30/12/2022. The data was collected by a Google Forms questionnaire which was shared on different professional groups on the social networks. The target population was Moroccan general practitioners. Data analysis was performed by Excel software. Results: A total of 200 general medical practitioners answered the questionnaire, of which 133(66.5%) practiced in the public sector and 67(33.5%) in the private sector. 11% had rated their frequency of prescription as high, 56% as medium and 33% as minimal or rare; the indications were dominated by eczema, atopic dermatitis and psoriasis. The prescription of topical corticosteroids started from the age of 1 year in 32.5% of general practitioners while the majority prescribed them at any age. Sixty (30%) were aware of the pharmacological effects of topical corticosteroids. The most frequently prescribed galenic form was cream in 95% of cases followed by gels, lotions and finally preparations. One hundred and thirty-three (66%) had answered correctly to the indications of topical corticosteroids and 106(53%) prescribed them in short cures. Few doctors (1%) had been able to identify all side effects. One hundred and fifty (75%) of the general medical practitioners had already seen patients presenting adverse effects dominated by skin atrophy, delayed healing, depigmentation, fungal or bacterial infection; their response consisted of degression in 75% of cases or switching to a lower class, while 11.5% had wrongly suggested an abrupt discontinuation. Conclusion: The high frequency of topical steroids side effects is an increasing problem encountered by dermatologists. Lack of some general practitioners and patient awareness are also important underlying factors. To our knowledge, this is the first Moroccan study that aimed to evaluate the knowledge, attitudes, and behavior regarding topical corticosteroids by general medical practitioners.