Fungal Skin Disease Classification Using the Convolutional Neural Network.

Skin is the outer cover of our body, which protects vital organs from harm. This important body part is often affected by a series of infections caused by fungus, bacteria, viruses, allergies, and dust. Millions of people suffer from skin diseases. It is one of the common causes of infection in sub-Saharan Africa. Skin disease can also be the cause of stigma and discrimination. Early and accurate diagnosis of skin disease can be vital for effective treatment. Laser and photonics-based technologies are used for the diagnosis of skin disease. These technologies are expensive and not affordable, especially for resource-limited countries like Ethiopia. Hence, image-based methods can be effective in reducing cost and time. There are previous studies on image-based diagnosis for skin disease. However, there are few scientific studies on tinea pedis and tinea corporis. In this study, the convolution neural network (CNN) has been used to classify fungal skin disease. The classification was carried out on the four most common fungal skin diseases: tinea pedis, tinea capitis, tinea corporis, and tinea unguium. The dataset consisted of a total of 407 fungal skin lesions collected from Dr. Gerbi Medium Clinic, Jimma, Ethiopia. Normalization of image size, conversion of RGB to grayscale, and balancing the intensity of the image have been carried out. Images were normalized to three sizes: 120 × 120, 150 × 150, and 224 × 224. Then, augmentation was applied. The developed model classified the four common fungal skin diseases with 93.3% accuracy. Comparisons were made with similar CNN architectures: MobileNetV2 and ResNet 50, and the proposed model was superior to both. This study may be an important addition to the very limited work on the detection of fungal skin disease. It can be used to build an automated image-based screening system for dermatology at an initial stage.

FT-IR investigation of Terbinafine interaction with stratum corneum constituents.

Terbinafine (Tbf) is a well-established anti-fungal agent used for management of a variety of dermal conditions including ringworm and athlete's foot. Both the biochemical mechanism of Tbf fungicidal action (based on squalene epoxidase inhibition) and the target region for Tbf in vivo (the stratum corneum (SC)) are well determined. However, the biochemical and pharmacokinetic approaches used to evaluate Tbf biochemistry provide no biophysical information about molecular level physical changes in the SC upon Tbf binding. Such information is necessary for improved drug and formulation design. IR spectroscopic methods were used to evaluate the effects of Tbf on keratin structure in environments commonly used in pharmaceutics to mimic those in vivo. The Amide I and II spectral regions (1500-1700 cm-1) provided an effective means to monitor keratin secondary structure changes, while a Tbf spectral feature near 775 cm-1 provides a measure of relative Tbf levels in skin. Interaction of Tbf with the SC induced substantial ß-sheet formation in the keratin, an effect which was partially reversed both by ethanol washing and by exposure to high relative humidity. The irreversibility suggests the presence of a Tbf reservoir (consistent with kinetic studies), permitting the drug to be released in a controlled manner into the surrounding tissue.

Anti-inflammatory effect of lanoconazole on 12-O-tetradecanoylphorbol-13-acetate- and 2,4,6-trinitrophenyl chloride-induced skin inflammation in mice.

BACKGROUND: Lanoconazole (LCZ) is a topical antifungal agent clinically used to treat fungal infections such as tinea pedis. LCZ has not only antifungal effects but also anti-inflammatory effects, which have the potential to provide additional clinical benefits. However, the characteristic features of the inhibitory effects of LCZ on skin inflammation remain unclear. OBJECTIVE: We evaluated the inhibitory effects of topical application of LCZ, and compared the effects of LCZ with those of other antifungal agents including liranaftate, terbinafine and amorolfine. METHODS: Each antifungal agent was topically applied on 12-O-tetradecanoylphorbol-13-acetate-induced irritant dermatitis and 2,4,6-trinitrophenyl chloride-induced contact dermatitis in mice (BALB/c). The ear thickness, myeloperoxidase activity and inflammatory mediator contents were evaluated. RESULTS: LCZ dose-dependently suppressed 12-O-tetradecanoylphorbol-13-acetate-induced irritant dermatitis, suppressed the production of neutrophil chemotactic factors such as keratinocyte-derived chemokine and macrophage inflammatory protein-2, and inhibited neutrophil infiltration to the inflammation site. Moreover, 1% LCZ reduced the ear swelling in mice with 2,4,6-trinitrophenyl chloride-induced contact dermatitis in accordance with the inhibition of interferon-γ production. The inhibitory potency of LCZ on these types of dermatitis in mice was stronger than that of other types of antifungal agents. CONCLUSION: The anti-inflammatory effects of LCZ were exerted through the inhibition of inflammatory mediator production. These effects may contribute to the relief of dermatitis symptoms in patients with tinea pedis.

One Foot After Another-Fungal Foot Issues in Expedition Adventure Racing.

Skin infections are an important issue among participants in expedition-length adventure races. Prolonged stress, scant sleep, and water exposure mean that competitors are at risk of uncommon manifestations of infections. Ulcerative tinea pedis is an example of this. We present a case with characteristic clinical manifestations, including the "sandpaper symptom." There is limited literature exploring infectious foot complaints in expedition adventure racers. Beyond this case report, more research is needed to better understand incidence rates, risk factors, diagnostic measures, treatment, and prevention options.

Successive potassium hydroxide testing for improved diagnosis of tinea pedis.

In this study, we investigated the role of successive potassium hydroxide (KOH) tests for the diagnosis of tinea pedis with different clinical presentations. The study included 135 patients with 200 lesions that were clinically suspicious for tinea pedis. Three samples of skin scrapings were taken from each lesion in the same session and were examined using a KOH test. This study offers an inexpensive, rapid, and useful technique for the daily practice of clinicians and mycologists managing patients with clinically suspected tinea pedis.

Treatment of Tinea Pedis in Elderly Patients Using External Preparations.

Infection rate of tinea pedis is high in the elderly, wherein treatment by a dermatologist should be considered to prevent infecting their family members. About 90 percent of cases with tinea pedis is treated only using external preparations. In treating the elderly with tinea pedis using external preparation, we should take into consideration that the elderly have thinner and weaker skin compared to younger people. There are many kinds of dosage form (cream, ointments, lotion, spray, and so on) for external preparations to treat tinea pedis. Generally, liquid forms such as lotions and sprays cause stronger irritation compared to ointments and creams, thus, caution should be taken for side effects when applying them to the elderly. Contact dermatitis is the most frequent side effect of external preparations. Caution should also be taken for the type of additives used. The composition of the preparation should be checked when changing dosage forms, or when switching brand-name drugs to generic drugs. Since the adherence rate of external preparations is low, it is preferable to use those with strong antibacterial activity and only have to be applied once a day.

Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities.

OBJECTIVE: The aim of this study was to examine the accuracy of visual diagnosis of tinea pedis (Athlete's foot) and tinea unguium (fungal nail infection), as well as to provide information on skin abnormalities that could help identify these diseases in aged care facilities (long-term care facilities (LTCFs) and nursing homes). METHOD: A multicentre, cross-sectional observational study was conducted in a LTCF and two nursing homes. A dermatologist observed the skin abnormalities in the participants' interdigital and plantar areas, to screen for tinea pedis, and in the participants' toenails, to screen for tinea unguium. If abnormalities were noted, samples such as scales or toenails were collected and examined using direct microscopy. The accuracy of the macroscopic observation for each skin abnormality was examined. RESULTS: A total of 173 residents were recruited. The accuracy of clinical diagnosis using macroscopic observation was relatively low. The sensitivities and specificities for clinical diagnosis were 0.37 and 0.95 for tinea pedis in the interdigital areas, 0.47 and 0.94 for tinea pedis in the plantar areas, and 0.80 and 0.61 for tinea unguium in toenails, respectively. Scales in the plantar areas and discoloration of the toenails were more frequently observed in residents with tinea pedis and tinea unguium than in those without them. CONCLUSION: Several skin abnormalities were observed in the residents recruited in this study, but there was insufficient correlation with tinea pedis and tinea unguium to be used for screening.

Naftifine Hydrochloride Gel 2%: An Effective Topical Treatment for Moccasin-Type Tinea Pedis.

BACKGROUND: Naftifine hydrochloride (naftifine) is a topical antifungal of the allylamine class, displaying fungicidal and fungistatic activity. Naftifine is generally used to treat interdigital tinea pedis; however, systemic therapy is often prescribed by healthcare providers for moccasin tinea pedis. Well-controlled clinical data on topical antifungal therapy for moccasin tinea pedis is limited. OBJECTIVE: The objective of this analysis is to present data from two pooled randomized, vehicle-controlled studies that evaluated efficacy of once daily topical naftifine gel 2% and vehicle at end of treatment (week 2) and at 4 weeks post-treatment in subjects with moccasin tinea pedis. METHODS: At visit 1, subjects were randomized to naftifine gel 2% or vehicle groups and subjects underwent baseline mycology culture, KOH, and symptom (erythema, scaling, and pruritus) severity grading. Naftifine gel 2% and vehicle treatment were applied once daily for 2 weeks and the subjects returned at weeks 2 and 6 for efficacy evaluation (mycology culture and grading of symptom severity). A total of 1174 subjects were enrolled with interdigital tinea pedis with or without moccasin infection. Of these subjects, 674 subjects had interdigital presentation while 500 subjects had moccasin infection in addition to the interdigital presentation. All 1174 subjects with interdigital presentation satisfied the inclusion criteria of a minimum of moderate erythema and scaling, and mild pruritus. Of the 500 subjects who had moccasin presentation, 380 satisfied the same inclusion criteria as mentioned above. Since data was analyzed as observed cases, between 337 and 349 subjects had data available for analysis of efficacy. Mycologic cure is defined as a negative dermatophyte culture and KOH, treatment effectiveness is defined as mycologic cure and symptom severity scores of 0 or 1, and complete cure is defined as mycologic cure and symptoms severity scores of 0. RESULTS: At week 6, the cure rates in the naftifine arm vs. the vehicle were statistically higher (P < 0.0001) for mycological cure rate (65.8% vs. 7.8%), treatment effectiveness (51.4% vs 4.4%), and complete cure rate (19.2% vs 0.9%). CONCLUSION: Two weeks application of topical naftifine gel 2% is an effective monotherapy treatment for moccasin tinea pedis.

Índice de severidad y afectación en la tiña pedis / Severity index involvement in tinea pedis

INTRODUCCIÓN: la tiña pedis es una infección por dermatofitos que afecta a los pies e invade frecuentemente los espacios interdigitales, bordes laterales y plantas, la cual tiene una alta incidencia, tendencia a las recidivas y rebeldía a los tratamientos. OBJETIVO: evaluar la severidad de la tiña pedis escamosa a través del índice de severidad y afectación de la tiña pedis (ISATP), MÉTODOS: estudio de evaluación en 347 pacientes a los que se les diagnosticó tiña pedis escamosa, que se atendieron por la especialidad de Dermatología del Hospital Militar Central "Dr. Carlos J Finlay", entre septiembre de 2010 y septiembre de 2012. Se aplicó el algoritmo ISATP, desarrollado a partir del índice de severidad y área de psoriasis (PASI). RESULTADOS: predominó el ISATP moderado con 46,6 %. La mayor frecuencia se encontró en el grupo de 46 a 55 años (55,9 %) y en el sexo masculino (73,1 %). Según el color de la piel, los pacientes de piel blanca (40,0 %) tuvieron el primer lugar. El ISATP severo prevaleció en el grupo etario de 56 a 65 años (50,0 %), en el sexo masculino (93,5 %) y en los pacientes de color de la piel negra (65,7 %). CONCLUSIONES: se comprobó que el algoritmo empleado, ISATP, es útil para definir los grados de severidad de las tiñas pedis escamosas de los pacientes en leves, moderados y severos; además permite relacionarlos con variables definidas de edad, sexo y color de la piel.

INTRODUCTION: tinea pedis is a dermatophyte infection that affects feet and areas between toes, it often invades edges, sides and plants, it has a high incidence, tendency to relapse and rebellious to treatment. OBJECTIVE: assess the severity of flaky tinea pedis through the rate of severity and impairment of tinea pedis (ISATP). METHODS: an assessment study was conducted in 347 patients who were diagnosed with flaky tinea pedis. They were assisted in Dermatology services at Military Central Hospital, from September 2010 to September 2012. The ISATP algorithm was applied. It was developed from psoriasis area and severity rate (PASI). RESULTS: moderate ISATP prevailed (46.6 %). It was most frequently found in the age group of 46-55 years (55.9 %), and in males (73.1 %). Depending on the color of skin, white patients (40.0 %) had the highest frequency. Severe ISATP prevailed in the age group of 56-65 years (50.0 %) in males (93.5 %) and in patients with black skin color (65.7 %). CONCLUSIONS: the algorithm used, ISATP, is useful to define the degree of severity of squamous tinea pedis in patients as mild, moderate and severe; also, it allows defining variables relate to age, sex and skin color.

Índice de severidad y afectación en la tiña pedis / Severity index involvement in tinea pedis

Introducción: la tiña pedis es una infección por dermatofitos que afecta a los pies e invade frecuentemente los espacios interdigitales, bordes laterales y plantas, la cual tiene una alta incidencia, tendencia a las recidivas y rebeldía a los tratamientos. Objetivo: evaluar la severidad de la tiña pedis escamosa a través del índice de severidad y afectación de la tiña pedis (ISATP). Métodos: estudio de evaluación en 347 pacientes a los que se les diagnosticó tiña pedis escamosa, que se atendieron por la especialidad de Dermatología del Hospital Militar Central Dr. Carlos J Finlay, entre septiembre de 2010 y septiembre de 2012. Se aplicó el algoritmo ISATP, desarrollado a partir del índice de severidad y área de psoriasis (PASI). Resultados: predominó el ISATP moderado con 46,6 por ciento. La mayor frecuencia se encontró en el grupo de 46 a 55 años (55,9 por ciento) y en el sexo masculino (73,1 por ciento). Según el color de la piel, los pacientes de piel blanca (40,0 por ciento) tuvieron el primer lugar. El ISATP severo prevaleció en el grupo etario de 56 a 65 años (50,0 por ciento), en el sexo masculino (93,5 por ciento) y en los pacientes de color de la piel negra (65,7 por ciento). Conclusiones: se comprobó que el algoritmo empleado, ISATP, es útil para definir los grados de severidad de las tiñas pedis escamosas de los pacientes en leves, moderados y severos; además permite relacionarlos con variables definidas de edad, sexo y color de la piel(AU)

Introduction: tinea pedis is a dermatophyte infection that affects feet and areas between toes, it often invades edges, sides and plants, it has a high incidence, tendency to relapse and rebellious to treatment. Objective: assess the severity of flaky tinea pedis through the rate of severity and impairment of tinea pedis (ISATP). Methods: an assessment study was conducted in 347 patients who were diagnosed with flaky tinea pedis. They were assisted in Dermatology services at Military Central Hospital, from September 2010 to September 2012. The ISATP algorithm was applied. It was developed from psoriasis area and severity rate (PASI). Results: moderate ISATP prevailed (46.6 percent). It was most frequently found in the age group of 46-55 years (55.9 percent), and in males (73.1 percent). Depending on the color of skin, white patients (40.0 percent) had the highest frequency. Severe ISATP prevailed in the age group of 56-65 years (50.0 percent) in males (93.5 percent) and in patients with black skin color (65.7 percent). Conclusions: the algorithm used, ISATP, is useful to define the degree of severity of squamous tinea pedis in patients as mild, moderate and severe; also, it allows defining variables relate to age, sex and skin color(AU)

Efficacy and safety of once-daily luliconazole 1% cream in patients ≥12 years of age with interdigital tinea pedis: a phase 3, randomized, double-blind,vehicle-controlled study.

BACKGROUND: Interdigital tinea pedis is one of the most common clinical presentations of dermatophytosis. OBJECTIVE: This phase 3 study evaluated the safety and efficacy of luliconazole cream 1% in patients with tinea pedis. METHODS: A total of 321 male and female patients aged ≥12 years with tinea pedis and eligible for modified intent-to-treat analysis were randomized 1:1 to receive luliconazole cream 1% (n=159) or vehicle (n=162) once daily for 14 days. Efficacy was evaluated at days 28 and 42 (i.e., days 14 and 28 posttreatment) based on clinical signs (erythema, scaling, pruritus) and mycology (KOH, fungal culture). The primary outcome was complete clearance at day 42. Safety evaluations included adverse events and laboratory assessments. RESULTS: Complete clearance at day 42 was achieved in 26.4% (28/106) of patients treated with luliconazole cream 1% compared with 1.9% (2/103) of patients treated with vehicle (P< 0.001). Similar safety profiles were obtained for luliconazole cream 1% and vehicle. LIMITATIONS: This study was conducted in a relatively small population under controlled clinical trial conditions. CONCLUSION: Luliconazole cream 1% applied once daily for 14 days is well tolerated and more effective than vehicle in patients with tinea pedis.

Statistically designed nonionic surfactant vesicles for dermal delivery of itraconazole: characterization and in vivo evaluation using a standardized Tinea pedis infection model.

The study aims to statistically develop a hydrogel of itraconazole loaded nonionic surfactant vesicles (NSVs) for circumventing the shortcomings and adverse effects of currently used therapies. Influential factors were screened using first-order Taguchi design, thereafter, optimization was performed via D-optimal design involving screened factors (surfactant type, content and molar ratio of cholesterol: surfactant). Response variables investigated were percent drug entrapment, vesicle size, drug skin retention and permeation in 6h. Suspensions of NSVs were gelled to improve topical applicability. Characterization of formulations was performed using vesicle shape, size, surface charge, texture analysis and rheology behavior. Ex vivo studies in rat skin depicted that optimized formulation augmented drug skin retention and permeation in 6h than conventional cream and oily solution of itraconazole. Standardized Tinea pedis model in Wistar rats exhibited in vivo antifungal efficacy of optimized formulation, observed in terms of physical manifestations, fungal-burden score and histopathological profiles. Also, a unique investigation involving studying local oxidative stress of infected paw skins as an indicator of fungal infection was performed. Rapid alleviation of infection in animals treated with optimized hydrogel was observed in comparison to commonly prescribed therapies. Therefore, the optimized NSVs may be a promising and efficient alternative to available antifungal therapies.

Use of naftifine hydrochloride 2% cream and 39% urea cream in the treatment of tinea pedis complicated by hyperkeratosis.

The treatment of tinea pedis with hyperkeratosis has always been challenging due to presence of thick scales even after the resolution of active fungal infection. Patients usually identify hyperkeratosis with active disease. Therefore, a regimen of an antifungal and a keratolytic agent would be useful not only clearing the skin clinically but also addressing patients' perceptions.

Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study.

AIM: The aim of this study was to assess the effectiveness of a preventative foot care nursing programme for diabetic patients. BACKGROUND: Foot complications are common in diabetic patients and prevention of such complications requires foot care. However, there is little information on the effectiveness of foot care nursing on the incidence and recurrence of diabetic foot. METHODS: We developed a diabetic foot care programme based on the International Working Group on the Diabetic Foot. We studied 88 patients who attended our foot care programme for 2 years, and collected data from April 2005 to March 2009. Patients were divided into four groups according to the risk classification, and received foot care. We evaluated the incidence of foot ulceration or recurrence and non-ulcerated foot condition. Characteristics of the patients were analysed using the paired t-test and McNemar's test, and changes in severity of tinea pedis and grade of callus were analysed using Wilcoxon's signed rank sum test. RESULTS: The programme reduced the severity score of tinea pedis (P < 0·001) and improved callus grade (P < 0·001). All these were evaluated by Wilcoxon's signed rank sum test. None of the patients of risk-group-3 (history of foot ulceration) showed recurrence of callus-related foot ulcers. Six high-risk patients developed foot ulceration during the programme because of minor injury, but the ulcers healed without development of gangrene. CONCLUSION: A nurse-based foot care programme is effective in preventing diabetic foot in diabetic patients.

A case-control analysis and laboratory study of the two feet-one hand syndrome in two dermatology hospitals in China.

BACKGROUND: Two feet-one hand syndrome (bilateral plantar tinea pedis with coexistent unilateral tinea manuum) is commonly seen in dermatology clinics, but the cause of the unilateral hand involvement remains unresolved. AIMS: To investigate the unilateral hand involvement in this syndrome. METHODS: This was a case-control study. The experimental group comprised 113 patients with bilateral tinea pedis and unilateral tinea manuum and the control group comprised 44 patients with tinea pedis only, without tinea manuum. Clinical data were recorded and pathogens were identified by fungal examination. The predominant pathogen, Trichophyton rubrum, was genotyped by PCR amplification of tandem repeat elements from the ribosomal DNA nontranscribed spacer region. RESULTS: Scratching habits were significantly different between the groups, and there was a significant relationship between tinea manuum and the hand reportedly used to scratch the feet. In analysis of isolates from the feet and the involved hand, 94.5% of pairs were of the same species, and 80% of pairs had the same genotypes. CONCLUSIONS: Contact between hands and feet probably results in the transmission of dermatophytes from the feet to the scratching hand.