Diagnosis and Management of Plantar Dermatoses.

Plantar dermatoses (PD) are common, occurring either spontaneously on healthy skin or developing secondarily from previously established foot disease. PD share similar symptoms and morphology, making them challenging to differentiate. A few of the most frequently encountered PD include tinea pedis, psoriasis, contact dermatitis, dyshidrotic dermatitis (or recurrent vesicular palmoplantar dermatitis), and juvenile plantar dermatosis. This review offers practical advice for diagnosing and treating the most common PD in the primary care office.

The attitudes, behaviors, and opinions about non-pharmacological agents in patients with tinea pedis.

Tinea pedis affects the life quality distinctly and patients those with a prolonged disease often resort to non-medical methods. We sought to evaluate patients' knowledge about tinea pedis and approaches to the non-pharmacological agents. A cross-sectional study was conducted on 152 patients with tinea pedis who answered the survey between July and November 2019. Demographic and clinical features, patients' attitudes, behaviors, and opinions about non-pharmacological treatments related to tinea pedis were evaluated. Of 152 patients, 65 (42.8%) were female and 87 (57.2%) were male. The frequency of at least one non-pharmacological agent use for tinea pedis was 55.9%. The most common non-pharmacological agent was cologne (27.0%), followed by saltwater, vinegar, and henna. The rate of non-pharmacological agent use was not significantly different between genders and patients with different education levels. Information sources for tinea pedis were dermatologists in only 42 patients (27.8%). The opinion that the disease will improve spontaneously was not significantly different between the groups according to the education level (P = .154). Tinea pedis needs awareness as a health problem particularly in Muslim populations. Patients should be prevented from applying wrong practices and informed about the risk factors, contagiousness, and treatment options by physicians.

Efficacy of combination of ozonated water with oil for treatment of tinea pedis.

OBJECTIVE: To evaluate efficacy of combined therapy with ozonated water and oil on patients with tinea pedis.
 Methods: A total of 60 patients with tinea pedis were divided into 2 groups in a randomized and blinded test. Patients in a control group were treated with naftinfine hydrochloride and ketoconazole cream once a day. Patients in an ozone group were treated with ozonated water bath and then ozonated oil topical application once a day. Patients in the 2 groups were treated for 4 weeks. Clinical and laboratory data were collected for both groups at the end of the 1st week, the 2nd week, and the 4th week. The Pearson chi-square was performed to compare scores of the clinical signs and symptoms (CSS) and the mycological result between the 2 groups. Independent samples T-test was performed to compare the curative effect between the 2 groups.
 Results: After 4 weeks' treatment, 6 patients were positive in the control group determined by mycological examination while 1 patient was positive in the ozone group, with no significant difference between the 2 groups (P>0.05). Changes in CSS at the end of the 1st week, 2nd week, and 4th week were obtained and showed no significant difference between the 2 groups at the 3 different time points (P>0.05). No side effects were observed.
 Conclusion: Combination of ozonated water with oil is effective on treatment of tinea pedis and it shows no side effects.

Common Child and Adolescent Cutaneous Infestations and Fungal Infections.

Cutaneous infections and infestations are common among children and adolescents. Ectoparasitic infestations affect individuals across the globe. Head lice, body lice, scabies, and infestations with bed bugs are seen in individuals who reside in both resource poor areas and in developed countries. Superficial cutaneous and mucosal candida infections occur throughout the life cycle. Dermatophyte infections of keratin-containing skin and skin structures result in tinea capitis (scalp), tinea corporis (body), tinea pedis (foot), and tinea unguium (nails). Less frequent endemic fungal infections such as blastomycosis, coccidiodomycosis, and histoplasmosis may present with skin findings. This article will describe the epidemiology and transmission of these conditions as well as their clinical manifestations. The approach to diagnosis will be addressed as well as primary prevention and current therapies.

Diagnosis and management of tinea infections.

Tinea infections are caused by dermatophytes and are classified by the involved site. The most common infections in prepubertal children are tinea corporis and tinea capitis, whereas adolescents and adults are more likely to develop tinea cruris, tinea pedis, and tinea unguium (onychomycosis). The clinical diagnosis can be unreliable because tinea infections have many mimics, which can manifest identical lesions. For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toenails from repeated low-level trauma. Physicians should confirm suspected onychomycosis and tinea capitis with a potassium hydroxide preparation or culture. Tinea corporis, tinea cruris, and tinea pedis generally respond to inexpensive topical agents such as terbinafine cream or butenafine cream, but oral antifungal agents may be indicated for extensive disease, failed topical treatment, immunocompromised patients, or severe moccasin-type tinea pedis. Oral terbinafine is first-line therapy for tinea capitis and onychomycosis because of its tolerability, high cure rate, and low cost. However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen. Failure to treat kerion promptly can lead to scarring and permanent hair loss.

Infective skin conditions in an adult sea-going population.

Infective skin conditions represent a significant element of the caseload for sea-going and shore-side clinicians. They are common within the wider military setting due to the frequent requirement to live in close proximity to others in conditions which favour the spread of skin and soft tissue infections (SSTI). Within the UK civilian population, 24% of individuals see their family doctor for skin conditions each year, accounting for 13 million primary care consultations annually. Of these, almost 900,000 were referred to dermatologists in England in 2009-2010 and resulted in 2.74 million secondary care consultations. Several recent articles have highlighted the problem of Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) infection and carriage in sailors on submarines, and soldiers deployed to Afghanistan. However, the majority of published articles relate to land-based military personnel. This article aims to provide an overview of the most common infective skin conditions presenting among Naval personnel (based on the authors' experience), illustrated by several case studies, together with an approach to their diagnosis and management.

Nail and skin disorders of the foot.

Disorders of the dermis and the nails on the feet are common. Despite the simplicity of the skin and nail disorders of the foot, they can be debilitating and impact the patient's ability to ambulate and perform activities of daily living. Diagnosis in most cases is confirmed on physical examination alone. Diligent care of skin and nail disorders can prevent further pathology involving the deeper structures of the foot and allow the patient to fully participate in their usual activities.

The prevalence of tinea pedis and tinea manuum in adults in rural areas in Turkey.

The aim of this study was to determine the frequency of tinea pedis and manuum (dermatophyte infections of the hands and feet) in adults in rural areas of Turkey, the risk factors and self-administered treatment options. A total of 2,574 people living in a rural area were enrolled in the study. Participants were asked demographic data, hygienic habits in a questionnaire. KOH preparations and culture were performed from suspicious lesions. Medical and alternative therapy methods and former dermatophytosis diagnosis history were taken from the respondents with suspicious lesions. Microbiological samples were taken from 285 (11.1%) participants. Culture was positive in 109 (4.2%) of those. The most common agent was Trichophyton rubrum. The predisposing factors were found as age older than 40, male gender and obesity. Forty-nine (44.9%) of patients had taken a medical therapy, 56 (51.4%) had performed non-medical methods (cologne, Lawsonia inermis-Henna and softener creams). Patient's education about the treatment compliance is important.

[Observation on therapeutic effect of medicinal moxa stick moxibustion for treatment of tinea pedis].

OBJECTIVE: To observe therapeutic effect of using medicinal moxa stick moxibustion for treatment of tinea pedis. METHODS: One hundred and forty-four cases were randomly divided into a medicinal moxa stick group (MMS), a moxa stick group (MS) and a Nitramisole cream group (NC) (n = 48 in each group). The moxibustion method was applied in both MMS group and MS group. The Nitramisole cream was applied in NC group. The treatment course was lasted for 21 days. The symptoms of patients with tinea pedis were recorded and scored before and after the treatment course, the effectiveness was assessed. RESULTS: The total effective rates were 89.59% and 81.25% in the MMS group and the MS group, respectively, with no significant difference between the two groups (P > 0.05). However, the total effective rate in these two groups were better than that of NC group (70.84%, P < 0.05). CONCLUSION: The therapeutic effect of medicinal moxa stick moxibustion is better than that of moxa stick moxibustion or Nitramisole cream.

[The control of dermatophytoses based on ecological aspect of causative fungi].

Dermatophytes are fungi capable of digesting keratin and able to infect the skin surface of animal. Among them, the anthropophilic species Trichophyton rubrum is the most important human pathogen in Japan as the causative species of tinea lesions. The lesions caused by this fungus are known to be mild in their inflammatory reaction. More than 20% of the Japanese population is believed to be suffering from tinea pedis and the situation has not changed despite the introduction of new potent antifungal drugs. Several attempts made to cultivate the fungus on the skin surface has revealed the presence of pathogenic dermatophytes in healthy looking skin around a lesion or on the skin of surrounding individuals. Also, more than half of tinea pedis patients are left untreated or are treated intermittently only when the patient has noticed uncomfortable symptoms due to a lesion. The low QOL impairment due to tinea pedis lesions by anthropophilic dermatophytes is one reason preventing complete cure and has resulted in a growing number of tinea pedis patients, especially among the aged. To achieve control of the infections by anthropophilic dermatophytes, the ecological background of the causative fungi should be taken under consideration rather than their eradication.

Treatment of tinea pedis with socks containing copper-oxide impregnated fibers.

BACKGROUND: Tinea pedis, known as Athlete's foot, is a common fungal infection of the feet, the majority of cases caused by dermatophytes. Copper oxide has potent antimicrobial and antifungal properties. OBJECTIVE: A pilot study designed to examine the efficacy of treating tinea pedis utilizing copper-oxide impregnated fibers woven into socks worn on a daily basis. METHODS: Fifty-six patients, ranging in age from 21 to 85 years were clinically diagnosed, photographed, and treated with the copper soled socks. Eight variables were studied, including scaling, erythema, fissuring, burning or itching, vesicular eruptions, edema, odor, and drainage. RESULTS: In a 9-day average follow up, all patients showed improvement or resolution of erythema (with a 95% Confidence interval (CI) of 1.0), fissuring (CI=1.0), vesicular eruptions (CI=1.0), scaling (CI=0.9-1.0) and for burning and itching (CI=0.61-0.95). In a 40-day average follow up, the 95% CI for improvement or resolution of scaling was 0.68-0.97, for erythema, 0.65-0.97, and for fissuring, burning and itching and vesicular eruptions it was 1.0. None of the study subjects worsened or showed adverse reactions while wearing copper-oxide impregnated socks. CONCLUSION: This study strongly supports the effectiveness in using copper-oxide impregnated polyester fibers in treating the common manifestations of tinea pedis.

Low-voltage direct current as a fungicidal agent for treating onychomycosis.

Onychomycosis, most commonly caused by two species of dermatophyte fungi--Trichophyton rubrum and Trichophyton mentagrophytes--is primarily treated with regimens of topical and systemic antifungal medications. This study was undertaken to evaluate in vitro the efficacy of low-voltage direct current as an antifungal agent for treating onychomycosis. Agar plate cultures of T rubrum and T mentagrophytes were subjected to low-voltage direct current electrostimulation, and antifungal effects were observed as zones in the agar around the electrodes lacking fungal growth. Zones devoid of fungal growth were observed for T rubrum and T mentagrophytes around anodes and cathodes in a dose-dependent manner in the current range of 500 microA to 3 mA. Low-voltage direct current electrostimulation has great clinical potential for the treatment of onychomycosis and perhaps other superficial maladies of fungal etiology.

Skin diseases of the lower extremities in the elderly.

Routine care of the legs and feet in the elderly is important in helping to prevent infections, malignancies, and further deterioration. The lower extremities are of particular interest because of the increasing amount of diseases and disorders involving the legs and feet. Foot disorders in the elderly are associated with poor choices in footwear, structural changes, brought on by aging, and inadequate knowledge about prevention and treatment. Conservative treatments along with gait modification provide positive long-term results, although sometimes surgery is necessary for severe foot disorders. Onychomycosis and other nail disorders commonly infect the elderly despite the wide variety of treatment options. The increase in malignancy formation in the elderly is caused by the increase in the elderly population and inadequate treatment of leg ulcers and other chronic lesions. Aging is associated with many dermatologic changes; many of the disorders and diseases of the lower extremities can be managed if detected and treated early. Proper awareness of the signs, symptoms, and care is important.

[Tinea pedis and Onychomycosis in Children of the Mazahua Indian Community in Mexico]. / Tinea pedis y onicomicosis en niños de una comunidad indígena Mazahua.

BACKGROUND: Tinea pedis and onychomycosis in childhood are unusual, The previous reported prevalence range from 4.2 to 8.2%. In a mestizo population, in the South of Mexico a 3.4% has been found. OBJECTIVE: To determine the frequency of dermatophytosis of feet and toenails in scholars in an Indian Mazahua community. METHODOLOGY: A total of 456 children were studied. The age range from 5 to 15 years of age (average 11.4). Only 71 children with suggestive lesions of dermatophytosis were studied (15.57%). Mycological samples (66/71) and a KOH and Chlorazol black, and cultures on Mycocel agar were performed. RESULTS: 71 children (15.57%) presented suggestive lesions of dermatophytosis of the feet and toenails. A fungal infection was demonstrated in 13 cases (18%), 8 males and 5 females (mean age 12.3 years), but pathogenic fungi were isolated only in 7 (10%). All of them with tinea pedis and three also had toenail involvement (4.2%) and also Trichosporon sp was isolated in two cases and Candida albicans in one. CONCLUSIONS: We found a low frequency of tinea pedis and onychomycosis in children from this Mazahua community. The environmental factors such as humidity, and the frequently use of rubber and leather shoes instead of the traditional "huarache" (sandals), make them prone to maceration and can be cofactors in the development of mycotic infections and in the high incidence of pitted keratolysis (29.5%).

Micoses superficiais / Superficial Mycosis

As micoses superficiais säo infecçöes cultâneas causadas por fungos. Säo limitadas às porçöes superficiais da pele, aos pelos e às unhas. Esses tipos de fungos näo afetam a derme e as camadas mais profundas. Atualmente säo classificadas em ceratofitoses,dermatofitoses e candidiases. O diagnóstico e as recomendaçöes sobre seu tratamento säo revisados neste trabalho.(au)