Reactive oxygen species and the bacteriostatic and bactericidal effects of isoconazole nitrate.

Bacterial superinfections often occur in dermatomycoses, resulting in greatly inflamed or eczematous skin. The objective of this study was to evaluate the antibacterial efficacy of isoconazole nitrate (ISN), a broad-spectrum antimicrobial imidazole, commonly used to treat dermatomycoses. Several gram-positive bacteria minimal inhibitory concentrations (MICs) for ISN (ISN solution or ISN-containing creams: Travogen or corticosteroid-containing Travocort) and ampicillin were obtained using the broth-dilution method. Speed of onset of the bactericidal effect was determined with bacterial killing curves. Reactive oxygen species (ROS) were visualised by staining cells with singlet oxygen detector stain. Compared with ampicillin MICs, ISN MICs for Bacillus cereus, Staphylococcus haemolyticus and Staphylococcus hominis were lower and ISN MICs for Corynebacterium tuberculostearicum and Streptococcus salivarius were similar. Incubation with ISN led to a 50% kill rate for Staphylococcus aureus and methicillin-resistant strains (MRSA). Post-ISN incubation, 36% (30 min) and 90% (60 min) of S. aureus cells were positive for ROS. Isoconazole nitrate has a broad bacteriostatic and bactericidal action, also against a MRSA strain that was not reduced by the corticosteroid in the Travocort cream. Data suggest that the antibacterial effect of ISN may be ROS dependent. An antifungal agent with robust antibacterial activity can provide a therapeutic advantage in treating dermatomycoses with suspected bacterial superinfections.

Misdiagnosed zoophile tinea faciei and tinea corporis effectively treated with isoconazole nitrate and diflucortolone valerate combination therapy.

There have been few published reports on the human transmission of Trichophyton mentagrophytes, a zoophilic fungus frequently occurring in pets. Here we report on 2 girls, living with a pet dwarf rabbit, who presented with inflammatory skin lesions positive for T. mentagrophytes and subsequently diagnosed as zoophile tinea faciei and tinea corporis. The patients were successfully treated with systemic terbinafine and 2-week therapy with Travocort cream containing isoconazole nitrate 1% and diflucortolone valerate 0.1%.

Effective treatment of tinea corporis due to Trichophyton mentagrophytes with combined isoconazole nitrate and diflucortolone valerate therapy.

Trichophyton mentagrophytes is the dermatophyte species most commonly reported in cases of guinea pig-associated dermatophytosis (or guinea pig fungus) a condition that more often affects children than adults. In this case, a 13-year-old girl with recent direct contact with guinea pigs presented with a previously undertreated inflammatory skin lesion on the left side of her upper body, which was positive both for Trichophyton mentagrophytes and Staphylococcus epidermidis. The condition was subsequently diagnosed as tinea corporis due to Trichophyton mentagrophytes with concomitant bacterial infection and effectively treated with 2 weeks of twice-daily application of Travocort cream containing isoconazole nitrate 1% and diflucortolone valerate 0.1%. Visible improvement in the lesion was apparent after only 1 week of treatment.

Epidemiological trends in skin mycoses worldwide.

Fungal infections of the skin and nails are a common global problem. The high prevalence of superficial mycotic infections shows that 20-25% of the world's population has skin mycoses, making these one of the most frequent forms of infection. Pathogens responsible for skin mycoses are primarily anthropophilic and zoophilic dermatophytes from the genera Trichophyton (T.), Microsporum (M.) and Epidermophyton (E.). There appears to be considerable inter- and intra-continental variability in the global incidence of these fungal infections. Trichophyton rubrum, T. interdigitale (mentagrophytes var. interdigitale), M. canis, M. audouinii, T. tonsurans and T. verrucosum are the most common, but the attack rates and incidence of specific mycoses can vary widely. Local socio-economic conditions and cultural practices can also influence the prevalence of a particular infection in a given area. For example, tinea pedis (athlete's foot) is more prevalent in developed countries than in emerging economies and is likely to be caused by the anthropophilic germ T. rubrum. In poorer countries, scalp infections (tinea capitis) caused by T. soudanense or M. audouinii are more prevalent. This review summarises current epidemiological trends for fungal infections and focuses on dermatomycosis of glabrous skin on different continents.