Tinea Manus Research Articles

An unusual presentation of cutaneous larva migrans mimicking Tinea manus treated with permethrin 5% topical: A case report

An unusual presentation of cutaneous larva migrans mimicking Tinea manus treated with permethrin 5% topical: A case report

Role of Sertaconazole in the Treatment of Dermatophytosis

Dermatophytosis is a major health burden worldwide and is now increasing day by day. Dermatophytosis is also becoming increasingly unresponsive to topical conventional antifungals now a day. Newer topical antifungals may be more effective in these patients. Sertaconazole is a new, broad spectrum, fungicidal and fungistatic imidazole with added antipruritic and anti-inflammatory activity that may be effective and beneficial in improving the quality of life for the patient with dermatophytoses. It is indicated in the European Union(EU) for the treatment of superficial skin mycoses such as dermatophytosis (including tinea corporis, tinea cruris, tinea manus, tinea barbae and tinea pedis), cutaneous candidiasis, pityriasis versicolor and seborrhoeic dermatitis of the scalp, and in the US for tinea pedis only. Sertaconazole has broad-spectrum antifungal activity against dermatophytes of the Trichophyton, Epidermophyton and Microsporum genera, and yeasts of the genera Candida and Cryptococcus; additionally, it is effective against opportunistic filamentous fungi and Gram-positive bacteria. Moreover, the antifungal activity of sertaconazole is maintained in clinical isolates of dermatophytes that show reduced susceptibility to other azoles. While the drug has good dermal penetration, this is not associated with systemic absorption. In clinical trials in patients with superficial mycoses, 2% sertaconazole cream applied twice daily was effective in the eradication of a range of dermatophytoses, and a significantly greater proportion of patients were cured compared with those receiving 2% miconazole cream twice-daily treatment. Both as a topical cream and suppository preparation, sertaconazole was generally well tolerated. Sertaconazole is a well-established antifungal agent, which is now available in a variety of formulations, and remains a useful treatment option particularly in patients with fungal infections resistant to other azoles. Medicine Today 2023 Vol.36 (1): 62-66

2021 Epidemiological Survey of Dermatomycoses in Japan

This is a report of the results of the epidemiological survey on dermatomycoses conducted in 2021. A total of 9,442 patients with dermatomycosis were reported for one year. They include 8,151 (86.3%) with dermatophytosis, 796 (8.4%) with candidiasis, 484 (5.1%) with Malassezia infection, and 11 (0.1%) with deep cutaneous mycosis. In order, the most common types of dermatophytoses were tinea pedis (4,195 cases, 2,341 males and 1,854 females), tinea unguium (2,711 cases, 1,509 males and 1,202 females), tinea corporis (674 cases, 445 males and 229 females), tinea cruris (399 cases, 305 males and 94 females), tinea manus (125 cases, 78 males and 47 females), and tinea capitis (47 cases, 25 males and 22 females). The number of cases of tinea pedis and tinea unguium increased during the summer. A higher percentage of patients were aged 80 or older than in previous surveys. These findings may reflect the increasing percentage of elderly patients seen and the superannuation of the population. As in previous surveys, Trichophyton rubrum and Trichophyton interdigitale were the two most frequently isolated species of fungi causing dermatophytoses. Microsporum canis and Trichophyton tonsurans were the two species most often causing tinea capitis.Regarding cutaneous candidiasis, while candidal intertrigo was the most common in previous surveys, diaper candidiasis in the elderly was the most common in this survey. A background check revealed that this was because a facility included a semi-prophylactic approach to address diaper candidiasis occurring within the ward.Malassezia infections by Malassezia folliculitis clearly increased with each survey. The tendency of certain facilities with many reports of Malassezia folliculitis suggests that it is greatly affected by the presence of physicians familiar with the disease.

S6.2d Dermatophytosis due to Trichophyton erinacei caused by contact with African hedgehogs as family pets

S6.2 Resurgence of dermatophytic infections, September 22, 2022, 4:45 PM - 6:15 PMObjectiveTo present a series of cases of various types of dermatophytosis caused by Trichophyton erinacei, caused by contact with African hedgehogs.MethodsPatients with clinical suspicion of ringworm caused by T. erinacei were included in the study. Each patient underwent a mycological study, with direct examinations (KOH), cultures in Sabouraud dextrose agar medium with and without antibiotics. With the cultures obtained, molecular identification was made using the PCR technique and Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) proteomics. Once confirmed, the patients were given treatment and follow-up. When the pets (hedgehogs) were accessible, they were cultured with a cytobrush and the quills removed.ResultsIn a period of 3.5 years, 16 verified cases were incorporated, 13 were females (72%) and 3 males (18%), the average age was 18.2 years, with the smallest case being 8 years old and the oldest 45 years old. The tineas manifested as follows: tinea manus 11 cases (68.7%); 2 respective cases of tinea corporis and tinea capitis (18.1 respectively) and one case of Majocchi's granuloma. The average evolution was 1.5 months with the case older than 3 months and the younger 15 days. All cases were given terbinafine at variable times and doses (according to weight and age) and clinical and mycological cure was obtained.DiscussionTineas can have epidemiological changes that are favored by a variety of factors, in general, pet ringworms are due to common domestic animals such as dogs and cats. Due to changing fashions, children and adolescents in recent years have changed pets such as hamsters, and recently hedgehogs, especially African variety (Atelerix albiventris) the latter may have T. erinacei as part of their skin microbiota, a similar dermatophyte or that was part of the T. mentagrophyes complex, in general of low virulence, however, its antigenic variants are little recognized by humans, which makes them present in a very inflammatory form, particularly in the hands, due to the handling of the animal, as well as the deeper inoculation (in the dermis) by the spikes left by the inoculum. So, they can generate deep tineas such as Majocchi's granuloma. In general, they respond well to systemic antifungals such as terbinafine and itraconazole, and sometimes the use of topical or systemic steroids is necessary.ConclusionsThis series of cases is a good example of how a change of habits when having pets can introduce new etiological agents that are poorly recognized antigenically, which give rise to more inflammatory and sometimes profound tineas.

The challenge of Diagnosing Common Dermatomycosis by Reflectance Confocal Microscopy

Background: Traditional detection of fungal infections of the skin relies on microscopy techniques or fungal culture. Currently, reflectance confocal microscopy (RCM) has been widely applied to assist the diagnosis of commondermatomycosis with advantages of non-invasiveness, celerity, real time, and repeatability. Materials and Methods: A total of 478 clinically suspected dermatomycosis patients were enrolled in this study including 148 cases of tinea manus and pedis, 188 cases of tinea corporis and cruris and 142 cases of pityriasis versicolor. RCM examination was performed to image the lesions. Aim: This study aimed to summarize the image characteristics of in vivo RCM examination on common dermatomycosis and retrospectively evaluate its accuracy as compared with microscopy results. Furthermore, we attempted to tackle the challenges of RCM diagnosis on common dermatomycosis. Results: Based on RCM images, 231 of 478 (48.3%) patients were detected with hyphae. Among all RCM confirmed cases, 58 out of 148 (39.2%) were tinea manus and pedis, 145 out of 188 (77.1%) were tinea corporis and cruris, and 28 out of 142 (19.7%) were pityriasis versicolor. The remaining patients (51.7%) could not be diagnosed by the dermatologist according to RCM. Hyphae structures were primarily identified during diagnoses of dermatomycosis by RCM. Conclusions: RCM is a novel optical imaging technique that confers high-resolution images of fungi. RCM has certain advantages in the diagnosis of tinea manus and pedis. RCM is not suitable for the diagnosis of pityriasis versicolor.

Research progress in pharmacology and toxicology of evodiamine

Evodiamine, a bioactive indole alkaloid from Evodia rutaecarpa, E. rutaecarpa var. officinalis, or E. rutaecarpa var. bodinieri, has been extensively investigated due to its pharmacological activities in recent years. At present, evodiamine is proved to significantly suppress the proliferation of a variety of cancer cells and mediate cell processes such as cell cycle arrest and cell migration. In addition, evodiamine displays significant pharmacological activities against cardiovascular diseases(hyperlipidemia, etc.), and tinea manus and pedis. Recently, evodiamine has been found to have potential toxic effects, such as hepatotoxicity, nephrotoxicity, and cardiotoxicity. However, the pharmacological and toxicological mechanism of evodiamine is not clear, and its toxicity in vitro and in vivo has been rarely reported. Therefore, this study reviewed the pharmacological and toxicological articles of evodiamine in recent years, aiming at providing new ideas and references for future research.

Dermatophyte infections in children compared to adults in Germany: a retrospective multicenter study in Germany.

Dermatophyte infections of the skin and nails are common worldwide and vary between geographical areas and over time. The aim of this study was to determine the epidemiological profile of dermatophytes in Germany with a focus on comparing children with adults. In this retrospective multicenter study, mycological dermatophyte culture results in the period 01/2014 to 12/2016 were analyzed according to identified pathogen, age and gender of patients, and type of disease. Of 1,136 infections (children: n=88, adults: n=1,048), 50.8% were clinically classified as onychomycosis, followed by tinea pedis (34.6%), tinea corporis (16.2%), tinea manus (16.2%), tinea capitis (2.5%), and tinea faciei (1.2%). The most frequent pathogen was Trichophyton (T.) rubrum (78.6%), followed by T.interdigitale (14.3%), T.benhamiae (3.2%), T.mentagrophytes (2.1%), and Microsporum canis (1.7%). The fungal spectrum differed particularly in tinea corporis and tinea capitis between children and adults with a more diverse pathogen spectrum in children. Trichophyton tonsurans was rarely identified as cause for tinea corporis (2.7%) or tinea capitis (3.3%). Differences in pathogens and frequency of fungal infections between age groups should be considered for optimal selection of the appropriate therapeutic regimen.

The Role of PCR in the Diagnosis of Dermatophytes in Onychomycosis

Background: Onychomycosis is a critical medical problem. This fungal infection of the nails leads to disfigurement, pain and impaired quality of life. Given that it requires long-term expensive therapy; a proper diagnosis of this infection is greatly demanded. Hence, study aimed at investigating the different laboratory methods used in the identification of dermatophytes implicated in onychomycosis including conventional laboratory methods (KOH preparation), Culture and PCR (multiplex). Subjects and Methods: This cross-section study included sixty-one (61) patients [ 82% females and 18% males]. All collected samples were investigated using microscopic examination and cultivation of samples. In addition, DNA extraction and PCR amplification were evaluated. Results: Distal and lateral subungual onychomycosis(DLSO) was the most common clinical types of onychomycosis represented 70 % of total cases. Pain was the most common presenting symptoms. Among the studied group, the most common fungal infections encountered were chronic paronychia, tinea pads and tinea manum (37.7%, 16.4%, and 8.2%) respectively. The 67.2% of the studied group by PCR were +ve, by culture 60.7% were +ve and finally, 73.8% were +ve by direct smear. The sensitivity of PCR in the diagnosis of lesions was 100% specificity was 83.3% and accuracy was 93.4%. Conclusion: The dermatophyte responsible for a majority of cases of onychomycosis. However, the role of NDMs should not be ignored and this may be now a consideration in evaluating and treating onychomycosis. PCR is highly sensitive methods for diagnosis of fungal infection. The application of PCR technology directly to the clinical specimens will allow early and accurate diagnosis of onychomycosis. This will permit prompt and targeted initiation of antifungal therapy. So, it is recommended to be used in the rapid diagnosis of onychomycosis.

Whole-genome resequencing of Trichophyton rubrum provides insights into population differentiation and drug resistance.

Trichophyton rubrum (T. rubrum) is anthropophilic fungus and thus a very common cause of dermatophyte infections around the world. Infection of T. rubrum could result in conditions such as tinea capitis, tinea corporis, tinea inguinalis, tinea manus, tinea unguium, or tinea pedis. Because of this, the resistance of T. rubrum to antifungal therapies has drawn extensive research interest. However, the pathogenic characteristics of T. rubrum, such as site of infections, geographic location and host groups, have yet to be explored. In this study, the whole genome of 48 strains from different regions is resequenced and the population structure and association of single nucleotide polymorphism with resistance to six widely used antifungal drugs are analyzed. A total of 23,394 genomic variations are detected, which cover 2165 genes with only 15.14% of the variations located in exons. The population structure of T. rubrum is monomorphic, and genetic diversity is very low. Population structure analysis shows that the 48 sampled strains can be divided into two sub-populations. The gene TERG_08771 harboring the highest SNPs density is found to be associated with resistance to voriconazole. Although many proteins have yet to be identified and explored, association studies could still be useful to identify drug resistance or drug-susceptible loci, which would warrant further insightful investigations.

A Case of Bilateral Tinea Manus and the Frequency of the Superficial Fungal Hand Infection (1997-2016)

A Case of Bilateral Tinea Manus and the Frequency of the Superficial Fungal Hand Infection (1997-2016)

Human Infections with Microsporum gypseum Complex (Nannizzia gypsea) in Slovenia.

Microsporum gypseum complex is a group of geophillic dermatophytes with a worldwide distribution and is a rare cause of dermatomycoses in humans. The infection most commonly presents as tinea corporis, with some geographical and occupational variations. We studied M. gypseum complex infections in patients examined in the Mycological Laboratory of the Department of Dermatovenereology, University Medical Centre Ljubljana, during the period 2000-2015. Diagnosis was confirmed by mycological examination. Skin scales were examined by direct microscopy and cultivated on Sabouraud glucose agar. A total of 226 patients were identified, representing 1.5% of all dermatophyte infections during the study period. Tinea corporis was diagnosed in majority of patients, followed by tinea manus, tinea faciei, tinea inguinalis and tinea pedis. Tinea capitis was observed in three and onychomycosis in two patients only. Infection was disseminated on different parts of the body in nine patients. In 39% of patients, infection was diagnosed in children younger than 9years. Face and scalp infection was more often observed in children. The incidence was the highest during July and October. Contacts with soil and domestic animals were often reported. Data on the prevalence and clinical characteristics of M. gypseum complex infection in other countries are reviewed.

Significant Therapeutic Effect of Acupuncture on Intractable Dermatophytosis

Objective: To observe the clinical efficacy of acupuncture on intractable dermatophytosis so as to provide the new approach to the treatment of dermatophytosis. Method: The fire needling and body acupuncture were used in combination. The main points were selected from the local lesions and the fire needling technique with multiple stimulation and shallow puncture was used on the skin lesions. Supplementary points: (1) Selection along the meridians: The He-sea points of the related meridians with the skin lesion involved were added. (2) Selection according to the syndrome differentiation. The therapeutic efficacy was evaluated according to the scores of symptoms and physical signs as well as infrared thermogram and laser speckle blood flow imaging techniques. Results: After 24-time treatments, the curative rate was 45.16% and the remarkably effective rate was 48.39% in intractable tinea corporis and cruris (TCC); the curative rate of tinea manus and pedis (TMP) was 38.89% and the remarkably effective rate was 50%. It deserves noticing that acupuncture achieved the apparent effect on dermatophytosis, which is irreplaceable by the other therapies. Conclusion: Acupuncture is the considerably effective method in treatment of dermatophytosis

Microsporum canis: Current data on the prevalence of the zoophilic dermatophyte in central Germany

Microsporum (M.) canis, whose source of infection is mostly cats, is still considered as the most frequently occurring zoophilic dermatophyte in Germany and Europe. In distinct areas of Germany, the zoophilic dermatophyte Trichophyton (T.) anamorph of Arthroderma (A.) benhamiae also presents a frequent and emerging causative agent of dermatophytoses. Over a period of 3 years, from March 2010 to March 2013, skin samples from scalp, face, trunk, and limbs were investigated using mycological cultivation and by polymerase chain reaction (PCR) for dermatophytes. Materials originated in particular from the German Free States Saxony and Thuringia, and from the Federal State Saxony-Anhalt, but also included samples submitted from around Germany. The cultural detection of dermatophytes was performed on Sabouraud's 4% glucose agar with and without cycloheximide. For dermatophyte DNA detection, a uniplex PCR-ELISA was used. In all, 8464 samples from a total of 7680 patients were investigated. In 114 (1.5%) of 7680 patients, M. canis could be detected both by culture and/or PCR. M. canis was detected culturally in 100 samples, in 107 samples by PCR, in 91 samples both culturally and by PCR. For 12 patients, only cultural detection was done (without PCR). Also detected was tinea corporis due to M. canis in 59 patients, tinea capitis 8, tinea faciei 5, and tinea manus 2 patients. Of the patients, 45% were younger than 20 years, 42% were 20-49 years old, and 13% were 50 years or older. In comparison, T. anamorph of A. benhamiae was detectable by culture and/or PCR in 231 of 7680 patients (2.9%). M. canis was the second most common zoophilic dermatophyte. M. canis is still a frequent zoophilic dermatophyte in Germany. Since a few years ago, a rise of infections due to T. anamorph of A. benhamiae has been observed in Germany and other European countries. At least in distinct regions of Germany, this zoophilic dermatophyte, which is transferred from guinea pigs to human beings, currently seems to be more frequent when compared to M. canis.

Two Feet-One Hand Syndrome: A Case Report / Sindrom dva stopala i jedne šake – prikaz slučaja

Abstract Two feet-one hand syndrome is a superficial fungal infections of the skin which involves both feet and one hand. Trichophyton rubrum and occasionally Trichophyton mentagrophytes are the usual causative organisms. We present a 32-year-old healthy man with sharply demarcated papular erythematous and squamous lesions on dorsal aspect of the feet and diffuse dry scaling lesions of the right palm. In this syndrome, the development of tinea pedis generally precedes the development of tinea manus, which usually occurs on the hand that excoriated the pruritic feet or picked the toenails with onychomycosis. Our patient often used his dominant right hand to scratch the feet. On mycological examination, fungal spores and mycelia were present and Trichophyton mentagrophytes was isolated. The patient was treated with itraconazole 200 mg daily for two weeks and topical terbinafine cream for four weeks. After the treatment all lesions resolved and fungal culture was negative. Early diagnoses and treatment of tinea pedis and education about prophylaxis, constant care and regular medical assistance would minimize this problem in predisposed individuals.

Isolation and identification of some dermatophytes causing Tinea

The study was included collection of 200 samples (100 samples of skin scales , 79 samples of hairs and 21 samplesof nails) , from patient suffering Tinea . The number of positive samples for culture were 102 sample at ratio 51% ,male form at ratio 53.9% and 46.1% for female. Five dermatophytes species were identified: Microsporum canis(41.75%) , Trichophyton verrucosum (36.89%) , T. violaceum (16.50%) , M. persicolor (3.88%) and M. gypseum (0.97%). Tinea capitis was the most dermatophytosis infection with ratio 39.5% , followed by Tinea corporis (26%) ,then Tinea faciei (12.5%) , Tinea unguium (10.5%) , Tinea cruris (5%) , Tinea pedis (4.5%) , Tinea manum (1.5%),finally Tinea barbae (0.5%) . The high percentage of infection of Tinea capitis , Tinea corporis , Tinea faciei andTinea cruris were within males , while females had a high percentage of infection with Tinea unguium , Tinea pedisand Tinea manum. The stage of age( ≤10) occupied high percentage of Tinea capitis , Tinea corporis and Tinea faciei.

Profile of Dermatophyte and Non Dermatophyte Fungi in Patients Suspected of Dermatophytosis

Fungal infections of hair, nail and skin are common worldwide and continue to increase. The present study was undertaken to determine the prevalence of dermatophytosis, isolation rates and the profile of fungi associated with dermatophytosis. Samples were collected from 305 patients and a portion of each sample was examined microscopically and the remaining portion was cultured on to plates of Sabouraud’s Dextrose Agar containing chloramphinical with and without cychloheximide. Fungal cultures were identified by studying macroscopic and microscopic characteristics of their colonies. Of 305 clinical samples, fungi were detected in 265 (86.9%) samples by KOH and 224 (73.4%) clinical samples were culture positive. Dermatophytes were the most common isolates accounting 130 (58.0%) of the total isolates and this was followed by non- dermatophyte molds and yeasts that accounted 49 (21.9 %.) and 45 (20.0%) respectively. T. violaceum was the dominant species accounting for 49 (37.7%) dermatophyte isolates. Candida albicans was the dominant species accounting 30 (66.7%) of the total yeast isolates. The genus Aspergillus was the most common non-dermatophyte molds consisting of 13 (26.5%) species. Tinea unguium was the predominant clinical manifestation accounting 51.1% of the cases of which 119 (76.3%) were from females and 37 (23.7%) from males. T. violaceum was the most common pathogen in tinea unguium and tinea capitis, whereas T. mentagrophytes was the most common pathogen in tinea pedis and tinea manum. Seventy five percent of yeasts and 77.6% non dermatophyte molds were isolated from nails. Along with dermatophytes, non-dermatophyte fungi are also emerging as important causes of dermatophytosis. Both direct microscopy and culture are important tools for diagnosis of the fungal infections.

Virulence factors of dermatophytes: an update

Dermatophytoses are the most common fungal infection in human.Dermatophytes exclusively infect the stratum corneum,nails and hairs,and induce a series of skin diseases such as tinea corporis,tinea manus,tinea pedis and tinea capitis.Adhesion and invasion are two important processes in dermatophyte infection.In vitro studies using experimental models have shown that adhesin and multiple proteases are essential virulence factors of dermatophytes,but their precise pathogenic mechanisms remain unclear.The authors review advances in virulence factors of dermatophytes,which may bring new clues to the pathogenesis and treatment of dermatophytoses. Key words: Dermatomycoses; Dermatophyte; Adhesion; Proteases

Trichophyton species of Arthroderma benhamiae - a new infectious agent in dermatology.

In Germany, infections due to the zoophilic dermatophyte Trichophyton (T.) species of Arthroderma benhamiae are being more frequently diagnosed. The source of infection of this emerging pathogen overlaps with that of the zoophilic species T. interdigitale. The most common source are guinea pigs. T. species of Arthroderma benhamiae causes inflammatory dermatophytosis in children and adolescents. In addition to tinea capitis, it may cause both tinea corporis, tinea manus and frequently tinea faciei. In Germany, T. species of Arthroderma benhamiae is a frequent zoophilic dermatophyte, which in regions is probably more frequent than Microsporum canis. The mycological identification of the isolates with their yellow stained colonies is based on their macroscopic and microscopic features. However, some exhibit colony features consistent with those of T. interdigitale. These strains only can be identified unambiguously by means of molecular techniques. Using detection methods such as PCR-ELISA or real-time PCR, the dermatophyte can be identified directly from clinical material. Sequencing of the internal transcribed spacer region (ITS) of the ribosomal DNA has been approved as culture confirmation test for T. species of Arthroderma benhamiae. In addition, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) is useful. Widespread dermatophytosis due to T. species of Arthroderma benhamiae, in particular of tinea capitis, requires oral antifungal agents. Terbinafine is most effective, alternatives are fluconazole and itraconazole.

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis

English

Onychomycosis is defined as the fungal infection of the nail by any fungus including non-dermatophytes and yeasts. Tinea unguium is clinically defined as a dermatophytic infection of the nail plate. OBJECTIVES: To assess the prevalence of fungal infections in nail disorders and to find out incidence of dermatophytes, candida and other non-dermatophytic moulds. METHODOLOGY: History of patient was noted. The material was collected from lesions which were inoculated to the media. Slants were incubated and examined. If there was growth of dermatophytes, they were subjected to lactophenol cotton blue staining. RESULTS: Incidence was 100 (out of 260 nail cases). Male: female ratio was 1.3:1.69% presented with subungual hyperkeratosis. Distal subungual onychomycosis was most common (51%), proximal (46%) and superficial white (3%). Predisposing factor- occupation associated with wet work (48%). Commonly isolated species were dermatophytes (31%) in which more common was trichophyton rubrum (27%), Non dermatophytes (48%), Aspergillus species (41%), and candida albicans (4%). INTERPRETATION AND CONCLUSION: Finger nails were commonly affected. Associated diseases were Tinea pedis, Tinea manum, diabetes mellitus and anemia. It is a significant and important disease which can generate physical, psychological and occupational problems.