White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis.

Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

Dermatofitoses: agentes etiológicos, formas clínicas, terapêutica e novas perspectivas de tratamento / Dermatophytoses: etiologic agents, clinical forms, therapy and new perspectives of treatment

As dermatofitoses têm ocorrência mundial, sendo mais prevalentes em países de clima tropical e subtropical. Dados epidemiológicos indicam que essas micoses estão entre as infecções fúngicas de maior ocorrência. O quadro clínico mais comum de dermatofitose inclui despigmentação, placas anulares, prurido e perda de cabelo, com lesões tipicamente conhecidas como tineas, ocasionadas por fungos filamentosos dermatofíticos de três gêneros anamórficos: Microsporum, Trichophyton e Epidermophyton. O tratamento das dermatofitoses, em geral, está relacionado ao uso de antifúngicos tópicos e/ou sistêmicos, apresentando como problemática o surgimento de espécies multirresistentes. Esta revisão aborda as dermatofitoses e seus agentes etiológicos de forma aprofundada em aspectos epidemiológicos, apresentando a importância clínica do tema, com ênfase na causa, prevenção, tratamento e prognóstico dessa micose cutânea (AU)

Dermatophytoses have worldwide occurrence with higher prevalence in tropical and subtropical countries. Epidemiological data show that these mycoses are among the most frequent fungal infections. The most common symptoms of dermatophytoses include depigmentation, annular plaques, itching and hair loss, with lesions such as tinea, caused by dermatophytic filamentous fungi of three anamorphic genera: Microsporum, Trichophyton and Epidermophyton. Topical and/or systemic antifungalmedications are used in the treatment of dermatophytoses in general, resulting in problems such as the emergence of multidrug-resistant species. This review discusses dermatophytoses and their etiological agents with a focus on epidemiological aspects, presenting the clinical importance of the issue, with emphasis on cause, prevention, treatment and prognosis of this skin mycosis (AU)

Superficial Fungal Infections.

Superficial fungal infections grow in dark and moist areas and invade various parts of the body. These infections are easily treatable in immunocompetent individuals. In immunosuppressed individuals, the presentation can be quite severe, requiring use of more potent antifungal agents. The treatment for these conditions consists of topical antifungal agents, creams, and oral systemic medications. The use of prednisone can alter the appearance of superficial fungal infections, making them difficult to diagnose. It is important for primary care providers to become adept at understanding the epidemiology, transmission, clinical presentation, diagnosis techniques, and treatment options available.

The Tinea Hospital in Granada, 1679-1923: an institution with a long history.

The Tinea hospital in Granada, Spain, was a charitable health facility founded in the 17th century and still treating patients well into the 20th century. The hospital accepted patients from anywhere, not only those residing in the surrounding area. We describe the hospital's founding and the characteristics of the patients and caregivers. We also discuss how tinea was considered at the time, including the typology and treatment protocols applied as well as diet and hygiene measures used. It is striking that a hospital so focused on treating a single disease did not produce studies on the condition or on the application of contemporary knowledge to guide treatment.

Superficial fungal infections.

Tinea capitis, tinea corporis, and pityriasis versicolor are common superficial fungal infections in the pediatric population. • Tinea capitis is the most common dermatophyte infection worldwide. In North America, the cause is almost exclusively T tonsurans. Diagnosis of tinea capitis usually can be made by clinical features alone, especially when occipital or postauricular lymphadenopathy is present. Skin scrapings prepared with potassium hydroxide for microscopic examination, or a cotton swab for fungal culture, usually are diagnostic. • Treatment of tinea capitis requires systemic antifungal therapy. Terbinafine and griseofulvin are both effective against T tonsurans and are FDA-approved for this indication in children. • Adjunctive topical therapy for the patient and household contacts decreases transmission of this infection. • Topical antifungal therapy usually is effective for tinea corporis and pityriasis versicolor. However, recurrences of pityriasis versicolor are common.

Clinical forms of dermatophytosis (ringworm infection).

Dermatophytic infections of the skin, hairs and nails are very common and are very variable in aspect. In skin, inflammatory symptoms are often absent, but in other cases they may be very pronounced, in particular when caused by zoophilic dermatophytes. In onychomycosis, it is very difficult to make the differential diagnosis with other causes of onychodystrophy on purely clinical grounds; indeed, even in case of fungal infection, the causative agent can be suspected on clinical grounds only in a minority of cases. The clinical presentation of skin infections, infections of the scalp and beard, and the nails are presented more in detail.

Importance of mycological confirmation of clinically suspected cases of tinea corporis, tinea pedis and tinea cruris.

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven (positive by one or both methods). Most of tinea corporis, tinea pedis and tinea cruris cases (68.9%, 79.1%& 83.9% respectively) were diagnosed by both methods (P>0.05). For cases of tinea corporis and tinea cruris, males were more than females (51.4%, 48.6% and 58.1%, 41.9% respectively) while females exceeded males (72.1%, 27.9% respectively) in cases with tinea pedis (P<0.05). Trichophyton rubrum (T. rubrum) was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4 %, for tinea pedis and 64.6% for tinea cruris. T. mentagrophytes var. interdigitale was mostly isolated from cases of tinea pedis (23.3%). The majority of T. violaceum was isolated from cases of tinea corporis (12.2%). The main isolation of E. floccosum was from cases of tinea cruris (16.1%) Microsporum canis (M. canis) was only isolated from one case (1.4%) of tinea corporis while Candida albicans (C. albicans) alone (9.3%) or with T. rubrum (7.0%) was isolated only from cases of interdigital tinea pedis. (P<0.05). The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions (78.4%, 76.7% and 54.8% respectively) (P<0.05) and received prior therapy for the condition (79.7%, 76.7% and 58.1% respectively, (P>0.05). In conclusion, early accurate diagnosis (on mycological basis) is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control.

Cutaneous infections dermatophytosis, onychomycosis, and tinea versicolor.

Cutaneous fungal infections cause significant morbidity for healthy and ill patients. The incidence of some dermatomycoses is increasing, despite availability of newer and better topical and systemic treatments. Fungal remnants last months to years under the ideal conditions, allowing continued spread of infection. Mycoses treated in one area may recur because of organism travel from concomitant areas of infection. Failure of patients and physicians to recognize a fungal etiology early may lead to more extensive, severe, or difficult-to-treat infections. Finally, a patient's concurrent illnesses may play a part in susceptibility and ability to manage fungal infections. For these reasons, scientists have studied and developed newer antifungal agents with better efficacy and greater convenience in dosing. These drugs, however, still have side effects and medication interactions that may limit their use in some patients. Better efforts to educate patients and physicians alike may aid in faster recognition and treatment of dermatophytoses. More research is needed to continue to develop drugs suitable for use in a broader range of patients and diagnostic tests that may be quicker or more specific than conventional ones.

KP-103, a novel triazole derivative, is effective in preventing relapse and successfully treating experimental interdigital tinea pedis and tinea corporis in guinea pigs.

The therapeutic efficacy of KP-103, a triazole derivative, for 10 guinea pigs with interdigital tinea pedis or tinea corporis was investigated. Topical KP-103 solution (0.25 to 1%) was dose-dependently effective in treating both dermatophytoses. A 1% KP-103-treatment rendered all infected skins culture-negative on day-2 posttreatment. A high negative-culture rate was obtained with 1% solutions of butenafine and lanoconazole but not with 1% neticonazole solution. The follow up study performed on day-30 and day-9 posttreatment demonstrated that the relapse rates for 1% KP-103-treated animals with tinea pedis and for those with tinea corporis were 20 and 30%, respectively, and that these values were the same as those for 1% butenafine-treated animals, but lower than those for 1% lanoconazole-treated animals (55 and 80%, respectively). When a single dose of 1% KP-103 was applied to the back skin 48 hr before fungal inoculation, 9 of the 10 animals were protected from the dermatophytosis, suggesting that active KP-103 is retained in skin tissue for at least 48 hr after dosing. Moreover, it was suggested that KP-103 retains a high activity in the horny layer because of its lower keratin-affinity. The effectiveness of KP-103 against dermatophytoses may be due to the favorable pharmacokinetic properties in the skin tissues, together with its potent antifungal activity.

Development of an oligonucleotide probe specific for Trichophyton rubrum.

A species-specific DNA probe was developed to detect the dermatophyte species Trichophyton rubrum. The selected oligonucleotide sequence is derived from the highly variable internal transcribed spacer 2 region of the ribosomal DNA operon. The specificity of the non-radioactive labelled oligonucleotide probe was tested against related dermatophytes, other eukaryotic microorganisms and against human DNA. No cross-hybridization was found, and hybridization signals were invariably detected in all T. rubrum strains investigated. In addition, no homologous sequences were found searching the EMBL database. Experiments to establish a method for isolating DNA directly from clinical specimens gave successful amplification and hybridization products in about 30% of the samples.

Fluconazol oral 150 mg semanal en el tratamiento de pacientes con tinea corporis o tinea cruris / Oral fluconazole 150 mg weekly in the treatment of patients with tinea corporis and tinea cruris

Cincuenta y tres pacientes (31 hombres y 22 mujeres) entre 13 y 70 años de edad completaron el estudio. Un paciente fue excluido para la evaluación clínica por falla en el aislamiento del patógeno, pero fue incluido en el análisis de tolerancia. Dieciocho pacientes (35 por ciento), presentaron ambas patologías (tiña corporis y cruris). El T.rubrum fue el dermatofito más frecuentemente aislado (83 por ciento) y luego el E.flucossum en el 13 por ciento. El cluconazol se administro a razón de una cápsula (150 mg) por semana. Sesenta y cinco por ciento de los pacientes recibieron 3 semanas de tratamiento; 25 por ciento recibieron 4 semanas, 8 por ciento 2 semanas y sólo 2 pacientes recibieron 5 semanas. Se observó cura clínica y micológica en el 86 por ciento de los pacientes. Tres pacientes presentaron efectos adversos moderados durante el tratamiento (náuseas, palpitaciones y resequedad de los labios). El fluconazol fue efectivo y bien tolerado para pacientes con t.corporis, cruris o ambos

Ecology and epidemiology of dermatophyte infections.

Our knowledge of ecology and epidemiology of dermatophytes and the factors influencing their transmission has helped us understand better the natural history of dermatophytoses. It seems that the anthropophilic agents of scalp infection are being eradicated in developing nations. The exception is Trichophyton tonsurans-related tinea capitis in North America. Microsporum canis is a prevalent agent of tinea capitis in many regions of the world, and this could be related to close association of humans with their pets. Trichophyton violaceum is endemic in certain parts of Eastern Europe, Africa, Asia, and South America but not in North America. Trichophyton rubrum is the most common cause worldwide of tinea pedis, nail infection, tinea cruris, and tinea corporis. Although the incidence of tinea capitis is declining in developed nations, tinea pedis and onychomycosis are becoming more common. The increased use of athletic shoes both by men and women and communal bathing could be contributing factors. Five or six species account for most dermatophytoses globally.

Estudio clínico-etiológico de las dermatomicosis. casos diagnosticados en el IMT, 1976-1986 / Dermatomicosis clinic-etiology study. Cases diagnosed in IMT

De 949 casos estudiados entre 1976 y 1986 en el Instituto de Medicina Tropical "Daniel A. Carrión", Univ. San Marcos, se presentan 482 con diagnóstico etiológico de alguna Dermatomicosis con el objetivo principal de aclarar la relación entre el aspecto clínico y el etiológico. Asimismo, se señalan las variantes epidemiológicas y clínicas, los medios de diagnóstico utilizados y el tratamiento que tentativamente se ha aplicado

Tiñas o dermatofitosis: Consideraciones clínicas y micologicas / Tineas or dermatophytoses: Mycotic and clinical considerations

Las tiñas o dermatomicosis constituyen las micosis superficiales más frecuentes en nuestro medio. Su distribución es mundial y pueden ser afectados niños y adultos. Las dermatofitosis son producidas por un grupo de hongos denominados dermatofitos. Las especies más frecuentes en Venezuela, son: Microsporum canis. M. Trichophyton rubrum, T.mentagrophytes. T. tonsurans, Epidermophyton floccosum. Las lesiones producidas a nivel de piel reciben el nombre de acuerdo al sitio o substrato afectado. Generalmente son denominadas las lesiones con nombre en latin Tinea capitis, T. corporis, T. Pedis y T. unguium. La presente revisión tiene por finalidad hacer una actualización de los agentes causales de las tiñas, ya que se ha observado variación en los agentes causales más frecuentemente aislados de las diferentes localizaciones. Así por ejemplo, T. rubrum constituye en algunas investigaciones en egente causal más frecuente de la pedis y no el T. mentagrophytes, que era el agente tradicional