Tinea Pedis Research Articles

Sports et spores

AbstractSports practice, in general, promotes the occurrence of mycosis which usually remains superficial. Swimming, gymnastics, marathon, judo and wrestling are the most affected sports. Many epidemiological studies carried out on sports sites reveal that visitors who attend them have a higher risk of fungal infections, mainly Tinea pedis or athlete’s feet, than the rest of the general population. The species encountered are practically all dermatophytes of anthropophilic origin, Trichophyton rubrum and T. interdigitale and more rarely Epidermophyton floccosum. These same species are found on the floor and tiles of these sport establishments as well as on the judoka dojos. Among wrestlers and judokas who are involved in contact sports, there are small epidemics of “Tinea gladiatorum” due to Trichophyton tonsurans causing damage to the skin (Tinea corporis) and sometimes to the scalp (Tinea capitis). For other sports requiring the prolonged wearing of closed shoes (sneakers) and or close-fitting skin clothing that promotes perspiration, dermatophyte or yeast intertrigos predominate. More rarely, the practice of horse riding, through contact with an infected animal, can be exposed to the risk of zoophilic dermatophytosis.

Tinea Gladiatorum Detection With a Dermatophyte Test Strip.

Determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and concordance of diafactory hs-TP (DTS) to detect tinea gladiatorum using direct potassium hydroxide (KOH) microscopy as the reference standard. Prospective, comparative study. Seventeen Minnesota high schools during the winter wrestling season. Seventy-one consecutive high school wrestlers identified with a suspicious rash during skin inspection. Samples were obtained from each rash for both DTS and direct KOH microscopy. Readings were recorded as positive or negative. Direct KOH microscopy identified tinea gladiatorum in 35 of the 71 samples (46%). DTS sensitivity was 80% (95% confidence interval 63%-92%), and specificity was 82% (66%-92%). PPV was 85% (68%-95%), and NPV was 86% (72 %-91%). The DTS result was 83% concordant (72%-91%) with direct KOH microscopy. Similar to rapid Covid antigen tests, DTS required brief, basic training to perform and gave onsite results in 5 to 30 minutes. Although DTS is not approved for use in the United States by the FDA, concordance compared with direct KOH microscopy in diagnosing tinea gladiatorum was similar to results reported for DTS-TU in tinea unguium and tinea pedis. Further study comparing DTS to a reference standard using PCR plus direct microscopy is warranted.

RECURRENT FUNGAL INFECTIONS FROM BIRTH TO ADULTHOOD: UNKNOWN DIAGNOSIS UNTIL GENETIC TESTING FOR STAT-1 VARIANTS

<h3>Introduction</h3> Signal transducer and activator of transcription 1 (STAT-1) is a transcription factor that plays key roles in cell viability and pathogen responses. Mutations in STAT-1 result in differing degrees of susceptibility to viral, fungal and bacterial infections, vascular alterations, failure to thrive, and autoimmunity. We report a case of STAT-1 variant presenting with a life-long history of recurrent fungal infections where the diagnosis required genetic testing. <h3>Case Description</h3> A 33-year-old man presented for an evaluation of recurrent fungal infections. He experienced oral thrush, tinea pedis, tinea corporis, and onychomycosis since infancy. He was hospitalized twice for Candida esophagitis requiring IV antifungals. He required treatments with oral antifungals every few months, as he was refractory to topical treatments. He had no bacterial or viral infections, and otherwise unremarkable past medical history. He had thorough workups through multiple specialists with no diagnosis made as his immunologic laboratory studies were normal. However, his 4-year-old son was diagnosed with chronic mucocutaneous candidiasis (CMCC) and had genetic testing showing a STAT-1 variant (c.1159A>G (p.Thr387Ala)). The patient then underwent genetic testing which revealed the same pathogenic STAT-1 variant. Further evaluation showed normal T-cell mitogen studies, total IgG/A/M/E, IgG subclass levels, and vaccine responses. Flow cytometry showed mild B-cell lymphopenia and normal T/NK cells. <h3>Discussion</h3> Patients with pathogenic STAT-1 variants can present with variable infection histories and normal immunologic testing. This case highlights the importance of genetic testing for patients presenting with CMCC regardless of normal immunologic testing to identify a specific diagnosis and defects associated with CMCC.

Investigation of Nagashima-type palmoplantar keratoderma in China: A cross-sectional study of 234 patients.

Nagashima-type palmoplantar keratoderma (NPPK) is the most prevalent hereditary palmoplantar keratoderma (PPK) in China, but there is a paucity of epidemiological data on the Chinese population. To explore the clinical and genetic characteristics, evaluate the demographic distribution, and estimate the burden of disease of NPPK. A total of 234 Chinese patients with NPPK were enrolled from two medical centers and an online PPK support group. Next-generation sequencing and Sanger sequencing were performed to screen out and confirm pathogenic mutations in SERPINB7. Clinical features and quality of life (QOL) were evaluated using self-completed questionnaires. In total, 14 pathogenic mutations were identified in SERPINB7 from the cohort. The top four recurrent mutations were c.796C>T (355, 75.9%), c.522dupT (66, 14.1%), c.650_653delCTGT (24, 5.1%), and c.455G>T (12, 2.6%), accounting for 97.6% of Chinese NPPK patients. Other mutations (11, 2.4%) include c.455-1G>T, c.336+2T>G, c.635delG and seven novel mutations c.2T>C, c.434delG, c.455-16A>G, c.656T>C, c.745-553T>G, c.832C>T, c.1036G>T. The estimated prevalence of NPPK in China was found to be 0.975/10 000 based on Chinese databases. Clinically, there were no apparent genotype-phenotype correlations in NPPK patients. Pediatric patients mainly presented with palmoplantar peeling, while adults presented with scale (p< 0.001). The most common comorbidities in NPPK patients were onychomycosis (40.0%), eczema (36.8%), and tinea pedis (30.3%). As for burden of disease, NPPK patients' QOL was decreased by a moderate degree. In this study, pathogenic mutations' allele frequencies in SERPINB7 were updated, and prevalence of NPPK in China was estimated. This large-scale cohort study provides evidence-based recommendations for patient management. Identification of new mutations are important for timely diagnosis of NPPK. Palmoplantar peeling in children can be used as a hallmark for early recognition of NPPK.

Cutaneous Fungal Infections in Patients Experiencing Homelessness and Treatment in Low-Resource Settings: A Scoping Review.

Patients experiencing homelessness (PEH) suffer from a high burden of cutaneous fungal infections. Preventative treatment is important as such infections can lead to harmful complications such as cellulitis and even osteomyelitis. There are sparse data regarding cutaneous fungal infections of homeless populations and management in low-resource settings. A MEDLINE search was conducted using the key terms "cutaneous," "fungal," "infections," "dermatophytes," and "homeless." The search included case-control, cohort, and randomized controlled trials published in the English language. This scoping review of studies yielded information with regard to practical treatment advice for providers in low-resource settings, including medical, hygiene, prevention, and treatment options for PEH with cutaneous fungal infections, the most common of which were tinea pedis (3-38%) and onychomycosis (1.6-15.5%). Few studies have been conducted on the differences between sheltered and unsheltered homeless patients, which can have treatment implications. Systemic antifungal therapy should be carefully considered for diffuse, refractory, or nail-based cutaneous fungal infections if there is a history of alcohol use disorder or liver disease. While PEH have a high risk of alcohol use disorder, this can make definitive treatment challenging.

Onychomycosis in underrepresented groups: an all of us database analysis.

Few research studies evaluating the impact of dermatologic diseases in the United States (US) have adequately included underrepresented groups. All of Us (AoU) is an ongoing precision medicine-based research initiative by the National Institutes of Health (NIH) that facilitates research in populations traditionally underrepresented in biomedical research by prioritizing them for data collection. Our objective was to evaluate the burden of onychomycosis in underrepresented groups defined by the framework provided by AoU. The AoU Registered Tier dataset version 5 was used which includes data collected between May 30, 2017 and April 1, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of onychomycosis in underrepresented groups defined by race, ethnicity, age (≥ 75years), disability, sexual orientation/gender identity (LGBTQIA +), income (annual household income ≤ $35 000) and education (less than a high school degree). The latest All of Us data release includes 329,038 participants. Of these, 251,597 (76%) had EHR data and 13,874 had onychomycosis (overall prevalence, 5.5%; 95% CI, 5.4-5.6). Multivariate analyses adjusted by tinea pedis, diabetes mellitus, immune compromise, nail psoriasis, and insurance status, in addition to the aforementioned variables, revealed that, compared with White participants, Black and Hispanic participants had a higher adjusted odds of onychomycosis (OR, 1.29; 95% CI, 1.23-1.36 and OR, 1.24; 95% CI, 1.17-1.31, respectively). Higher adjusted odds of onychomycosis were also observed in underrepresented groups. Our findings suggest a disproportionately high burden of onychomycosis in underrepresented groups, although further studies are needed to replicate our findings and address this disparity.

Prevalence of fungal infections that cause tinea pedis in farmers in Tegalharjo Banyuwangi

Tinea pedis is a type of superficial mycosis. Tinea pedis is a dermatophyse that is most often found in humans and is usually called water fleas. Lack of maintaining cleanliness and wearing closed shoes is one of the factors that causes Tinea pedis. Tinea pedis usually affects adults who work in wet or humid places, such as car and motorcycle washers, garbage collectors and farmers. When doing activities, the average farmer uses boots for too long. However, some farmers who do not wear boots while working experience itching on the soles of their feet. This research aims to determine the prevalence of fungal contamination that causes water fleas (Tinea pedis) in farmers in Tegalharjo village, Banyuwangi Regency. The population of this research are 30 farmers in Tegalharjo village, while the research sample Is skin scrapings between the toes of the farmers. Then the sample obtained is directly examined by using a microscope and 10% KOH reagent. The results shows that the farmers who are contaminated with the fungus that caused Tinea pedis are 6 people with a percentage (20%) and 24 people who are not contaminated with a percentage (80%). The incidence of infection Tinea Pedis among farmers in Tegalharjo Village, Banyuwangi Regency is also influenced by the duration of working in a day and the habit of wearing boots.

Pattern of skin diseases in children attending the dermatology clinic in Alert referral hospital, Addis Ababa, Ethiopia: a retrospective study

Background: A Skin disease, which is estimated to affect between 21 and 87% of children, are the reason for up to a third of outpatient visits to pediatricians and dermatologists. It can possibly re-sult in considerable anxiety, parental worry, and embarrassment to the child and lead to loss of confidence, disruption of social relations, and feeling of stigmatization. This study aimed to assess the pattern of skin diseases in children attending at ALERT referral hospital.Methods: The study setting is ALERT referral hospital, Addis Ababa, Ethiopia. A hospital-based, retrospective, cross-sectional descriptive study was carried out between July and August 2020. All children younger than 12 years, who were diagnosed for skin diseases from May 2018 to May 2020, were included. Four hundred twenty-three children were sampled using a random sampling method. SPSS Version 20 software was used for data analysis.Results: The results showed that 385(91%) of patients had one skin disease and the remaining 38(9%) had two or more skin diseases. Fungal infections were present in30.1% of the cases fol-lowed by eczema, which accounted for 27.4%. Among fungal infections, Tinea Capitis (106/116), 91.4% followed by Tinea Corporis and Tinea Pedis were the most common in ALERT dermatology clinic. Among eczema cases, family atopic dermatitis (82/106), 77% was the most common. The result showed seasonal variation in some diseases.Conclusion: Skin fungal infections were the most common followed by eczema, pigmentary dis-order, infestation, viral infection, urticaria, bacterial infection, and others. There was some sea-sonal variation in some diseases.

Treatment of Taenia carporis with individualized Homoeopahic medicine: A case report

Tinea corporis is a superficial fungal skin infection of the body caused by dermatophytes. Tinea corporis is present worldwide. It is defined explicitly by the location of the lesions that may involve the trunk, neck, arms, and legs. Alternative names exist for dermatophyte infections that affect the other areas of the body. These include the scalp (tinea capitis), the face (tinea faciei), hands (tinea manuum), the groin (tinea cruris), and feet (tinea pedis). A case of 22 years old male suffering from tinea carporis since 2-3 years here treated successfully within 2 months by an individualized homoeopathic medicine phosphorus with minimum repetitions. There was remarkable improvement in a very short period of time. The case was observed for 1 years without recurrence which suggests that permanent cure is achievable through single and simple individualized homoeopathic treatment.

Foot Care Applications of Patients with Tinea Pedis Diagnosis and Affecting Factors

Foot Care Applications of Patients with Tinea Pedis Diagnosis and Affecting Factors

Tinea pedis in underrepresented groups: All of Us database analysis.

Tinea pedis is the most common form of dermatophytosis resulting in interdigital infections. All of Us (AoU) is a National Institute of Health initiative with an emphasis on patient populations traditionally underrepresented in biomedical research. Our objective was to evaluate the burden of tinea pedis in underrepresented groups in the United States, utilising the novel AoU research program. We analysed AoU Registered Tier dataset version 5, which includes data collected between 30 May, 2017, and 1 April, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of tinea pedis in underrepresented groups. All of Us data release includes 329,038 participants. Of these, 251,597 (76.5%) had electronic health record data and 6932 had tinea pedis (overall prevalence, 2.76%; 95% CI, 2.69-2.82). Multivariate analyses revealed that compared with White participants, Black and Hispanic participants had a higher adjusted odds of tinea pedis (OR, 1.29; 95% CI, 1.20-1.38 and OR, 1.38; 95% CI, 1.28-1.48, respectively). Higher adjusted odds of tinea pedis were observed in underrepresented groups defined by: age > =75 years (OR, 1.45; 95% CI, 1.33-1.57), LGBTQ status (OR, 1.17; 95% CI, 1.09-1.27), less than a high school education (OR, 1.22; 95% CI, 1.11-1.34), income <$35,000 (OR, 1.09; 95% CI, 1.02-1.16) and physical disability (OR, 1.56; 95% CI, 1.08-1.24). Our findings are consistent with overall age, and gender-specific prevalence estimates from prior epidemiologic studies, validating the scientific consistency of the new AoU database. Additionally, there may be an increased burden of tinea pedis among Black and Hispanic individuals.

Systematic review of the prevalence of onychomycosis in children.

Onychomycosis is one of the most common nail diseases in adults but is described as infrequent in children. Data are, however, scattered and diverse. Studies have nevertheless suggested that the prevalence of onychomycosis is increasing in children lately and the aim of this review was therefore to examine this problem. Two authors individually searched PubMed, Embase, and Cochrane Library for articles on epidemiology and prevalence of onychomycosis in children. The literature search was conducted in accordance per PRISMA guidelines. In total 1042 articles were identified of which 23 were eligible for inclusion. One of the articles presented two studies and a total of 24 studies were therefore included. Seventeen studies presented data of the prevalence of onychomycosis in children in the general population and seven studies among children visiting a dermatological and pediatric department or clinic. The prevalence ranged from 0% to 7.66% with an overall discrete increase of 0.66% during the period 1972 to 2014 in population studies (not statistically significant). This review supports a trend towards an increased prevalence of onychomycosis in children, albeit based on a paucity of studies. The data suggests an increasing prevalence of onychomycosis with age, and co-infection with tinea pedis (reported in 25% of the studies). The most common pathogen reported was Trichophyton rubrum and onychomycosis was more prevalent in toenails compared to fingernails. The general characteristics of onychomycosis in children are thus similar to those described in adults.

P320 Ten cases of tinea incognito due to Trichophyton rubrum, and literature review on the pathogenic characteristics

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveWe present ten tinea incognito (TI) patients caused by Trichophyton rubrum combined with a review of the characteristics of tinea incognito infections reported worldwide over the past 20 years, leading to clinical requirements for diagnosis and treatment.Patients and MethodsPatients were scraped for direct KOH microscopy of the skin lesions at the initial visit, isolates were cultured in SDA medium for 14 days and species were identified by morphology and molecular analysis using ITS regions. Literature review by searching articles on ‘PubMed’ and ‘Web of Science’, using the keywords ‘Tinea incognito or Incognito’, Set the year as ‘2002-2022’, and screened the literature for cases with clear types of TI infecting pathogens. Clinical, mycological, and treatment data of all cases were collected and analyzed.ResultsWe report 10 cases of tinea incognito caused by T. rubrum, ranging in age from 5 to 70 years, with clinical manifestations of eczema-like (Figs. 1a, b, and f), SLE-like (Fig. 1d) and pustular psoriasis-like (Figure 1c, e, g, h, i and j), seen in multiple sites. All of our patients had either tinea pedis or onychomycosis themselves or in their family members.A total of 660 cases reported in the last 20 years, T. rubrum (279/660) was the main anthropophilic dermatophytes causing TI, T. mentagrophytes (162/660) and Microsporum canis (135/660) were the common zoophilic pathgens. There were median age differences in patients infected with T. rubrum, T. mentagrophytes, M. canis, and Nannizzia gypsea, at 56, 22.5, 23, and 5.5 years old, respectively (Fig. 2a). The TI patients infected by T. rubrum often had cutaneous or non-cutaneous underlying diseases (27/41), TI patients with zoophilic or geophilic dermatophyte infections had a definite animal or soil contact history (114/136). The face and trunk are the most frequently affected areas, followed by the extremities and the whole body (Fig. 2b). TI appears on the face and is often thought of as eczema, rosacea, DLE, photosensitive rash, and when it occurs on the trunk is misdiagnosed as eczema, pyoderma, psoriasis (Fig. 2c). In Asia and the Americas, anthropophilic dermatophytes are by far the most reported pathogens, especially T. rubrum. In Europe, zoonotic pathogens have been reported in excess of the anthropophilic (Fig. 2d). For patients in whom the nature of the lesions cannot be determined and with negative direct microscopic examination, dermoscopy can be used to aid in the diagnosis. Our review of all cases found that topical or systemic antifungal treatment always gave good efficacy.ConclusionTI has a broad spectrum of mimics, and an unrestricted range of target audiences, zoonotic pathogens are adapting to the human host, so the history of illness and contact is essential at the time of the initial visit. A definitive diagnosis must be obtained in a mycological laboratory, multiple modalities can be used to diagnose TI, and systemic antifungal treatment is often necessary.

P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time.

P505 Genotyping of Trichophyton mentagrophytes infections in animals in Italy through sequencing of the ITS region

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectives Trichophyton mentagrophytes is a zoophilic dermatophyte that recognizes lagomorphs and rodents as primary hosts. The fungus can also infect other animals, such as dogs and cats. While T. mentagrophytes is a polymorphic sexual species, T. interdigitale is recognized as its clonal offshoot. This delineation is meaningful from a clinical point of view in human patients. Trichophyton interdigitale is exclusively anthropophilic and mainly causes non-inflammatory chronic tinea pedis or onychomycosis. Trichophyton mentagrophytes is predominantly of animal origin and often leads to the development of inflammatory lesions. These two dermatophytes form a species complex and have several ribosomal internal transcribed spacer (ITS) region genotypes. Identifying the ITS type allows species attribution and simultaneously strain typing. Many studies have been dedicated to this argument concerning human infections, while scarce information is available regarding animals. This study aimed to gain insights into the current epidemiology of T. mentagrophytes genotypes in animals.MethodsThe fungal isolates included in the study regarded cases involving various animal species seen at multiple veterinary clinics in Italy (n = 39) and France (n = 1) between 2005 and 2021. DNA was extracted from isolates cultured on Sabouraud dextrose agar using a commercially available kit (NucleoSpin® Tissue, Macherey-Nagel, Düren, Germany). PCR was performed with the primer pair V9G and LR3. PCR products were sequenced using ITS5 and ITS4 primers through a commercial service (Macrogen Europe). Using MEGA11 software (https://www.megasoftware.net/), ITS sequences were aligned with the currently recognized genotypes (6 and 22 for T. interdigitale and T. mentagrophytes, respectively).ResultsFigure 1 shows the ITS Type attribution for our isolates within a phylogenetic tree that includes the currently recognized genotypes. A new genotype (that, following the nomenclature, we called XXVII) was found in two isolates coming from a dog and a cat living in the same city. Figure 2 shows the distribution of the genotypes according to the animal host.A total of 23 samples out of 40 (57.5%) belonged to the ITS Type III*. It was the lone found in rabbits and the most prevalent in cats. This finding agrees with past literature, which reported a wide distribution of this ITS type in European animals. Of note is the high number of isolates with ITS Type II* found in dogs. ITS Type II* differs only by one nucleotide substitution from T. interdigitale and is considered an ‘intermediate’ entity between it and T. mentagrophytes. Clinical pictures, as well as molecular data, would suggest attributing this genotype to T. interdigitale. On the other hand, it has been detected from animal sources (chinchilla, guinea pig, and brown rat) which would justify its interpretation as T. mentagrophytes. Our data support the latter possibility.Though we could not have a detailed description of all the dogs harboring ITS Type II*, it is noteworthy that many showed the same clinical presentation, i.e., exfoliative chronic disseminated alopecia. Moreover, in most cases, despite the extensive lesions, the infection was not transmitted to the owners.ConclusionsThis study adds information on the molecular epidemiology of T. mentagrophytes infections in animals.

A retrospective study on the prevalence of tinea (ringworm) infections in patients who attended halibet national referral hospital, dermatologic clinic from 2014 to 2018 Asmara, Eritrea.

Introduction: Skin fungal diseases pose a significant burden on the health care system of a country. Superficial fungal skins infections are caused by dermatophytes. Dermatophytes are classified as one of the groups of Fungi. The three genera of dermatophytes grow in keratinized environments such as hair, skin, and nails. Anthropophilic dermatophytes are restricted to human hosts; zoophilic dermatophytes to pets, livestock, and horses; and geophilic dermatophytes, from soil, only occasionally infect humans and animals. Objective: The aim of the study was to determine the prevalence of Tinea (Ringworm) infections in patients who attended Halibet National Referral Hospital, Dermatologic Clinic from 2014 to 2018 Asmara, Eritrea. Methods: A five year retrospective study on the prevalence of superficial fungal skin infections was conducted in the outpatient department in patients who attended dermatologic Clinic at Halibet National Referral Hospital, Asmara, Eritrea from 2014 to 2018. A review of clinical cards / medical records was conducted and the data was analyzed using SPSS version 22. Results: During the five years period (2014- 2018) the Dermatology clinic of Halibet Hospital had a total visit of 32,153 patients who were treated as outpatients. Out of these patients who came from the whole country as referral and self-referral, 5524 (17.18%) were diagnosed clinically as cases with different types of Tinea infections. The number of females (2791, 50.5%) and males (2732, 49.5%) was almost the same. The highly infected body site was the head (77.5%) followed by the body (11%), face (6%) and hand (3%). And the most common type of Tinea that clinically identified was Tinea capitis 58% (n=4426) as it is compared to other types of Tinea. The other types of Tinea species that were found as comorbid with others were Tinea faciei, Tinea corporis, Tinea pedis, Tineamanuum, Tinea cruris and Tineaunguium as prevalent as 26.8%, 6.6%, 3.5%, 3.4%, 1.2% and 0.3%, respectively Conclusion: The study concludes the overall prevalence of superficial Tinea skin fungal infections was found to affect mostly the head (77.0%), body (11%), face (6%) and hand (3%), foot (2%) and groin (1%), respectively. And the most common type of Tinea that clinically identified was Tinea capitis 58%. The other types of Tinea species ere found as comorbid with others Tinea faciei, Tinea corporis, Tinea pedis, Tineamanuum, Tinea cruris and Tineaunguium as prevalent as 26.8%, 6.6%, 3.5%, 3.4%, 1.2% and 0.3%, respectively.

The Comparison Level of Parent’s Knowledge Towards Interdigital Tinea Pedis (Athlete’s foot) in Parents with and without Interdigital Tinea Pedis in Namu Trasi

Background: Tinea pedis occurs in 30-70% of the world's population. In Indonesia, some data are known, such as statistical data on the prevalence of tinea pedis in several teaching hospitals, such as RS. Dr. Soetomo, RSCM, RS. Dr. Hasan Sadikin, RS. Dr. Sardjito obtained a relative yield of 16%. Therefore, public knowledge about tinea pedis is something that is very relatively owned by the community to respond to, control, and prevents the occurrence of tinea pedis. Objective: The purpose of this study was to compare the level of parental knowledge of Interdigital Tinea Pedis (Athlete’s foot) in parents with and without Interdigital Tinea pedis in Namu Trasi. Method: This research was conducted using an analytical method of cross-sectional design with a collection technique using a questionnaire to be filled out by the respondent and then analyzed using a statistical program application. Results: The level of knowledge of parents with and without Interdigital Tinea pedis in Namu Trasi Village was 45.8% with good knowledge, 34.7% with sufficient knowledge, and 19.4% with poor knowledge. Conclusion: There is a significant difference between the level of parental knowledge of Interdigital Tinea pedis (Athlete’s foot) in patients and non-patients with Interdigital Tinea pedis in Namu Trasi

34071 Combination of photodynamic therapy and oral antifungals for the treatment of onichomycosis

Background: Onychomycosis (OM) represents 50% of nail pathology, making it one of the most prevalent fungal diseases and a therapeutic challenge. Photodynamic therapy (PDT) could be a therapeutic alternative due to its good adherence, low probability of resistance, no interaction with drugs, and acceptable risk-benefit. Patients and methods: Retrospective observational study that included all patients with a microbiological diagnosis of OM treated with PDT in our service (2013-2021). The protocol used was 16% methyl-aminolevulinate (MAL) as a photosensitizer and red light (37 J/cm2), every 1 or 2 weeks. Antifungal intake was recorded and whether a previous treatment with 40% urea was performed. Results: Twenty patients were included, 55% men, with a mean age of 59 ± 17 years. The most frequent microorganism was T rubrum (55%) and the most frequent location was the feet (90%), half associated with tinea pedis. The mean number of sessions was 6.3. Fifty percent required treatment with terbinafine 250 mg/day, although the majority (8) only for 1 month, and 3 patients with topical terbinafine achieving a resolution of 60%. Discussion: Studies support the efficacy of PDT alone or in combination with urea or different photosensitizers (methylene-blue, ALA and MAL), associated or not with keratolytics. However, there is only 1 study of PDT as adjuvant therapy demonstrating its ability to accelerate its resolution. We conclude that PDT is an alternative to the treatment of OM either in monotherapy or adjuvant, reducing the dose of antifungal agents, thus avoiding the comorbidity that it entails and achieving even higher cure rates.

34293 Epidemiologic study of tinea cruris and decremental trend of Epidermophyton floccosum infection: A 12-year retrospective review

Background: Tinea cruris is a common fungal infection worldwide. Most common pathogens include Epidermophyton floccosum, Trichophyton rubrum, and T mentagrophytes complex. E floccosum is an anthropophilic fungi which primarily causes tinea cruris and tinea pedis. This study aimed to determine causative pathogens of tinea cruris particularly E floccosum.

Adult kerion caused by Trichophyton rubrum in a vegetarian woman with onychomycosis

A 75-year-old vegetarian woman presented with a 1.5-year history of an enlarging, inflammatory scalp mass. Physical examination revealed a wide scarring area of alopecia on the scalp with perifollicular pustules and crusts (Fig. 1a) with tinea pedis and onychomycosis (Fig. 1b). The patient weighed 38 kg. Fluorescence staining revealed numerous septate hyphae in the pus, piles of ectothrix spores and septate hyphae located in the outer part of the hair cortex (Fig. 2a and b). Histopathologic examination revealed suppurative and granulomatous perifolliculitis, whereas periodic acid–Schiff staining revealed follicular hyphae (Fig. 1c).