Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases.

Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice, treatment should be based on topical antifungal medication. A short course of topical corticosteroid or topical calcineurin inhibitors has an anti-inflammatory effect in seborrhoeic dermatitis. Systemic antifungal therapy may be indicated for widespread lesions or lesions refractory to topical treatment. Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable.

[Severe skin rash in patients treated with terbinafine]. / Medikamentelt eksantem udløst af terbinafin.

We report on five cases of severe skin rash in patients treated with oral terbinafine. Four patients were treated without mycological testing. Two patients were diagnosed with candidiasis on the skin or in the fingernails and were incorrectly treated with terbinafine.

Prevalence of toe nail onychomycosis in diabetic patients.

Onychomycosis among diabetic patients has been reported in some studies to be of high prevalence. This study aimed to investigate the prevalence of onychomycosis among diabetic patients at a Danish University Hospital. Clinical and mycological examinations were performed on type 1 and 2 diabetic patients from in- and out-patient clinics. A total of 271 patients were enrolled, 72% males, mean age 61.3 years, 26% of the patients had diabetes type 1. The prevalence of toe nail onychomycosis (positive culture and/or microscopy) was 22% (n = 59) of which 55 cases were caused by dermatophytes (93%) and 4 cases by yeasts (7%). A correlation was found between onychomycosis and age (p =0.02) and severity of nail changes (p <0.001), respectively. However, no significant correlation was found to gender, type of diabetes, lower extremity arterial disease, neuropathy, toe amputation or oedema. Onychomycosis occurred with a high prevalence in diabetic patients, especially among older patients and those with severe nail changes.

An outbreak of borderline oxacillin-resistant Staphylococcus aureus (BORSA) in a dermatological unit.

From February through July, 2000, there was an accumulation of mecA-negative borderline resistant Staphylococcus aureus (BORSA) in the Department of Dermatology. BORSA was isolated in 37 samples from 11 patients. The isolates were typed by antibiogram, phage type, pulsed-field gel electrophoresis (PFGE), and spa genotyping that confirmed that they were indistinguishable from one another. In May, 2000, an intervention was initiated focusing on infection control. In-patients with BORSA were discharged and antibiotic treatment was stopped, if possible. Emphasis was put on disinfection of shared utensils and individualization of previously shared creams and lotions. After the intervention, BORSA was isolated from another 3 patients before the outbreak was terminated. A case-control study was undertaken to identify possible risk factors for being a BORSA patient. Compared to the controls, the patients with BORSA had more severe skin disease, were more often hospitalized, and had more bed days.

The prevalence of onychomycosis in patients with psoriasis and other skin diseases.

Onychomycosis among psoriasis patients is reported with varying prevalence. This prospective, controlled study investigates the occurrence of onychomycosis among inpatients with psoriasis versus inpatients with other skin diseases. The inclusion period was 15 months. Scrapings from clinically abnormal nails (both fingernails and toenails) were examined using microscopy and culture. The prevalence of onychomycosis in patients with psoriasis was 17/79 = 21.5% compared to 18/142 = 12.7% for patients with other skin diseases (p = 0.13). In 17 mycologically positive psoriasis patients, dermatophytes, yeasts and moulds were isolated in 8, 10 and 4 cases, respectively, and in 18 mycologically positive patients with other skin diseases in 12, 7 and 5, respectively. Onychomycosis occurred more frequently in men than in women (psoriasis patients (p = 0.02), patients with other skin diseases (p = 0.03)). Psoriasis patients had a higher frequency of abnormal nails (82.3%) compared to patients with other skin diseases (37.3%) (p < 0.01) and more severe affection of their toenails than patients with other skin diseases (p < 0.01). It is concluded that the frequency of onychomycosis among inpatients with psoriasis compared to inpatients with other skin diseases is not significantly different.

[Systematic treatment of tinea pedis--evidence for treatment? A result of a Cochrane review]. / Systemisk behandling af tinea pedis--evidens for behandling? Et resultat af en Cochrane-oversigt.

BACKGROUND: About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES: To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH STRATEGY: Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB-Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted. SELECTION CRITERIA: Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture. DATA COLLECTION AND ANALYSIS: Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers. MAIN RESULTS: Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% confidence intervals 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported. REVIEWERS' CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.

An outbreak of tinea capitis in a child care centre.

We describe an outbreak of tinea capitis in a kindergarten. Individuals with relation to the institution were examined clinically and mycologically (n-98), Microsporum audouinii was cultured from 12 people, out of whom eight patients had tinea capitis, four patients had tinea corporis, and three patients had both. The problems with spread of anthropophilic infections and the difficulties with treatment of Microsporum dermatophytes are discussed.

IgA pemphigus: the first two Scandinavian cases.

IgA pemphigus is a rare neutrophilic acantholytic skin disorder with only approximately 70 cases reported in the indexed literature to date. Here we describe two patients with IgA pemphigus (subcorneal pustular dermatosis type and intraepithelial neutrophilic type) that to our knowledge are the first Scandinavian patients with this disease. Initially, both patients were misdiagnosed as subcorneal pustular dermatosis of Sneddon and Wilkinson and only subsequent careful immunofluorescence studies (in one case with confocal laser scanning microscopy) led to the correct diagnosis. Apart from the expected IgA depositions on epidermal cell surfaces, both patients demonstrated some degree of intercellular IgG-specific immunofluorescence. No circulating IgA autoantibodies were detected. One patient was treated with the standard regime comprising dapsone and prednisolone, whereas in the other case a novel methotrexate and prednisolone combination treatment showed marked clinical efficacy.

[An outbreak of tinea capitis in a child care center]. / Udbrud af tinea capitis i en børneinstitution.

We describe an outbreak of tinea capitis in a kindergarten. Individuals with relation to the institution were examined clinically and mycologically (n = 98). Microsporum audouinii was cultured from 12 people, out of whom eight patients had tinea capitis and seven patients had tinea corporis. Three patients had both tinea capitis and tinea corporis. The problems with spread of anthropophilic infections and the difficulties with treatment of Microsporum dermatophytes are discussed.