Disinfection trials with terbinafine-susceptible and terbinafine-resistant dermatophytes.

BACKGROUND: Treatment of tinea pedis and onychomycosis is complicated by high rates of reinfection and the emergence of terbinafine-resistant strains of Trichophyton spp. Effective disinfection of contaminated socks is an important measure. Appropriate washing reduces the risk of reinfection and is paramount in treating tinea pedis and onychomycosis. OBJECTIVES: The aim of this study was to describe the effect of commonplace disinfection methods using socks pieces inoculated with terbinafine-resistant or terbinafine-susceptible isolates of Trichophyton spp. METHODS: Sock pieces were inoculated with seven terbinafine-resistant isolates of Trichophyton spp. with known mutations in the SQLE-gene (T. rubrum (n = 3), T. interdigitale (n = 1) and T. indotineae (n = 3)) and six terbinafine-susceptible isolates of Trichophyton spp. (T. rubrum (n = 3) and T. interdigitale (n = 3)). Methods of disinfection included soaking in a quaternary ammonium (QAC) detergent (0.5, 2 and 24 h), freezing at -20°C (0.5, 12 and 24 h), domestic and steam washing (both at 40°C with detergent). Sock pieces were cultured for 4 weeks following disinfection. The primary end point was no growth at the end of week 4. RESULTS: Soaking in a QAC-detergent for 24 h procured at disinfectant rate of 100% (13/13), whilst soaking in 0.5 and 2 h had a disinfectant rate of 46.2% (6/13) and 84.6% (11/13), respectively. Domestic washing (40°C with detergent) produced a disinfectant rate of 7.7% (1/13). Freezing at -20°C (0.5, 12 and 24 h) and steam washing (40°C with detergent) had no disinfectant properties. CONCLUSIONS: Soaking in a QAC-detergent for 24 h effectively disinfected sock pieces contaminated with dermatophytes.

Tinea pedis-An embarrassing problem for health and beauty-A narrative review.

Fungal infections present with a broad spectrum of diseases in humans (from relatively mild superficial infections of the skin and mucous membranes to the invasive or chronic infections of internal organs, which have a high mortality rate). Globally, up to 1.6 million people die each year as a result of various types of mycoses. Currently, many scientific studies focus on the best possible understanding of the aspects of the epidemiology and pathogenesis of invasive mycoses and effective methods to combat them. However, mycoses of the skin and its appendages remain a relatively less explored area. In some communities, superficial mycoses are a frequent problem as they affect nearly 70% of the population, an example of which is the athlete's foot. It involves the nails (onychomycosis) and skin (tinea pedis). It is mainly caused by keratin-decomposing dermatophyte fungi. Less often, infections are caused by non-dermatophyte moulds (Fusarium, Aspergillus, Scopulariopsis) or yeasts. Several factors have been listed as having substantial influence on the development of dermatophytosis, including those related to climate, season, geographical region, as well as to demography, socioeconomic and cultural customs, professions or contact with animals. In this review, we summarise the current knowledge about aetiology, epidemiology, diagnostics and therapy of tinea pedis with a special focus to the role of podologic management in spreading, prevention and therapy of mycoses. The article presents up-to-date knowledge on the management of the patient from the diagnosis, treatment and skincare, to counselling on how to prevent fungal skin infections in the long term.

Consumer preferences of antifungal products for treatment and prevention of tinea pedis.

Tinea pedis is a common condition seen in clinical practice and has a significant impact on quality of life. Recommendations of over-the-counter antifungal products based on consumer preferences may guide dermatologists in treating patients with tinea pedis and preventing onychomycosis recurrences. Our study aimed to determine consumer preferences of antifungal products for tinea pedis, focusing on features that may guide purchases and usage. A search was performed for antifungal products used to treat athlete's foot on Amazon.com as of 2018, and the top one percentile of over-the-counter products were sorted by rating and number of reviews. Functionality was the most cited positive feature (42% of comments) followed by cosmetic characteristics (14%). The median price of all products was $1.80 (range $0.33-$95.42), with solutions and balms associated with higher costs and soaks being the least expensive. Our study showed that the range of antifungal products available online for treatment and prevention of tinea pedis is large and variable in terms of type/vehicle, price, and ingredients. Physicians must counsel patients on the efficacy and Food and Drug Administration approval of listed ingredients, especially for those products associated with numerous supplementary claims.

Epidemiological Study on Trichophyton Disseminating from the Feet of the Elderly.

OBJECTIVES: To grasp the colonization status of Trichophyton in terms of spreading rate, we investigated the intergenerational epidemiological difference in the spreading rate of Trichophyton from teenagers to the elderly aged over 65. In addition, the elderly people were divided into two groups: those living at nursing homes and those living at their homes. We compared the two groups in terms of the difference in the spreading rate of Trichophyton. METHODS: Spreading rate was investigated by identifying the fungi collected by the cotton swab sampling method. The correlation between the responses to the questionnaire survey, which was conducted after the sample collection, and the spreading rate of Trichophyton was analyzed. RESULTS: The spreading rate of Trichophyton was 23.3%. It was confirmed that the spreading rate in general adults was 9.1%, whereas that in elderly people was 40.8%, which is significantly high. Also, it was confirmed that T. mentagrophytes shows a higher spreading rate among general adults, whereas T. rubrum shows a higher spreading rate among the elderly. Between the elderly living at nursing homes and those living at their homes, although no statistically significant difference was confirmed, the former tended to show a higher spreading rate than the latter. Also, the results of this study showed that spreading rate of Trichophyton and the detachment of the skin of the toes were significantly related. CONCLUSIONS: We found that the risk of spreading of Trichophyton increases with age. Particularly among elderly people aged over 65, taking some actions that prevent the spread of tinea pedis is recommended.

Onychomycosis: Strategies to Minimize Recurrence.

Recurrence (relapse or re-infection) in onychomycosis is common, occurring in 10% to 53% of patients. However, data on prevalence is limited as few clinical studies follow patients beyond 12 months. It has been suggested that recurrence after continuous terbinafine treatment may be less common than with intermittent or continuous itraconazole therapy, probably due to the fungicidal activity of terbinafine, although these differences tended not to be significant. Relapse rates also increase with time, peaking at month 36. Although a number of factors have been suggested to play a role in recurrence, only the co-existence of diabetes has been shown to have a significant impact. Data with topical therapy is sparse; a small study showed amorolfine prophylaxis may delay recurrence. High concentrations of efinaconazole have been reported in the nail two weeks' post-treatment suggesting twice monthly prophylaxis with topical treatments may be a realistic option, and may be an important consideration in diabetic patients with onychomycosis. Data suggest that prophylaxis may need to be continued for up to three years for optimal effect. Treating tinea pedis and any immediate family members is also critical. Other preventative strategies include avoiding communal areas where infection can spread (such as swimming pools), and decontaminating footwear.

Detection of dermatophytes in human nail and skin dust produced during podiatric treatments in people without typical clinical signs of mycoses.

Pedicures are the most common cosmetic foot treatment. Many pedicurists and podiatrists suffer from respiratory infections and diseases such as asthma, sinusitis, chronic cough and bronchitis. Skin and nail dust may play an important role in the development of occupational diseases and the transmission of mycosis to other clients. To examine the presence of dermatophytes in nail and skin dust produced during podiatric treatments of people without typical symptoms of mycosis and to assess the epidemiological hazards of tinea pedis for podiatrists as well as other clients. Seventy-seven samples underwent direct microscopy and culture. The results of direct microscopy were positive in 28/77 samples (36.36%) and doubtful in 3/77 (3.9%). Fungi were cultured from 36/77 samples (46.75%), including 8/77 (10.3%) positive for dermatophytes (Trichophyton rubrum-6 isolates and Trichophyton mentagrophytes-2). Material collected during podiatric treatments is potentially infected by pathogenic fungi; thus, there is a need to protect both workers who perform such treatments, as well as other clients, to prevent the transmission of pathogens in the Salon environment. Exposure to this occupational hazard may increase not only the risk of respiratory infections but also increase asthmatic or allergic reactions to Trichophyton.

Luliconazole Retention in Stratum Corneum and Prevention of Fungal Infection in a Guinea Pig Tinea Pedis Model.

OBJECTIVE: To compare drug concentrations in the stratum corneum following daily application of luliconazole and terbinafine cream in a guinea pig tinea pedis model. METHODS: Luliconazole 1% cream or terbinafine 1% cream were topically applied once daily to hind limbs of guinea pigs for 14 days. Drug concentration in stratum corneum of plantar skin was measured by HPLC-UV on days 1, 3, 7, 10, and 14. Separately, creams were applied daily for 5 days to the hind limbs of guinea pigs and skin drug release determined. In addition, drug retention in the stratum corneum was assessed by infecting guinea pigs with Trichophyton mentagrophytes, 14 and 21 days after a single application of luliconazole or terbinafine creams. RESULTS: Luliconazole stratum corneum concentrations were higher than those of terbinafine throughout the study. Concentrations of luliconazole and terbinafine were 71.6µg/g and 36.6µg/g, respectively, after a single application (P<.05), reaching steady state after 10 days. Cumulative release of luliconazole from the stratum corneum was 4.5 times greater than with terbinafine. Unlike terbinafine, no fungal invasion of the stratum corneum was seen 14 days post-treatment with luliconazole. CONCLUSIONS: Drug concentrations of luliconazole in the stratum corneum and subsequent release are greater than those achieved with terbinafine and may contribute to clinical efficacy. Luliconazole may also provide greater protection against disease recurrence.

Onychomycosis to Fungal Superinfection: Prevention Strategies and Considerations.

Onychomycosis is the most common fungal skin infection, and it is frequently seen in the setting of other concomitant fungal infections, the most common being tinea pedis. Infected nails become a reservoir of fungal organisms that may infect the skin, and vice versa. Early, effective treatment of the nails is necessary for preventing not only permanent structural damage but also the spread and superinfection of the surrounding skin and soft tissue. Moreover, treatment of the skin is important for preventing re-infection of the nails.

"Sunlight is said to be the best of disinfectants"*: the efficacy of sun exposure for reducing fungal contamination in used clothes.

BACKGROUND: Tinea pedis is a common chronic skin disease; the role of contaminated clothes as a possible source of infection or re-infection has not been fully understood. The ability of ultraviolet light to inactivate microorganisms has long been known and UV is used in many applications. OBJECTIVES: To evaluate the effectivity of sun exposure in reducing fungal contamination in used clothes. METHODS: Fifty-two contaminated socks proven by fungal culture from patients with tinea pedis were studied. The samples were divided into two groups: group A underwent sun exposure for 3 consecutive days and group B remained indoors. At the end of each day fungal cultures of the samples were performed. RESULTS: Overall, there was an increase in the percentage of negative cultures with time. The change was significantly higher in socks that were left in the sun (chi-square for linear trend = 37.449, P < 0.0001). CONCLUSIONS: Sun exposure of contaminated clothes was effective in lowering the contamination rate. This finding enhances the current trends of energy saving and environmental protection, which recommend low temperature laundry.

Sanitization of contaminated footwear from onychomycosis patients using ozone gas: a novel adjunct therapy for treating onychomycosis and tinea pedis?

BACKGROUND: Ozone gas possesses antimicrobial properties against bacteria, viruses, and yeasts. Previously, we demonstrated the efficacy of ozone in killing ATCC strains of the dermatophyte fungi Trichophyton rubrum and Trichophyton mentagrophytes. OBJECTIVE: To test the efficacy of ozone gas in sanitizing onychomycosis patient footwear contaminated with fungal material as a means of minimizing the risk of reinfection. METHODS: Swabs of footwear from onychomycosis patients were cultured prior to and after ozone exposure to test the ability of ozone to sanitize these items. RESULTS: We identified contamination of footwear from most onychomycosis patients, a potential source of reinfection in these individuals. Furthermore, ozone gas was effective in sanitizing contaminated footwear. CONCLUSION: Ozone gas is effective in sanitizing footwear and represents a novel adjunct therapy to be used in conjunction with antifungal medications and/or devices to better treat onychomycosis and tinea pedis patients in both the short and the long term.

The effect of domestic laundry processes on fungal contamination of socks.

Tinea pedis is a common chronic skin disease. The role of contaminated clothes as a possible source of reinfection is not fully understood. This study was conducted to evaluate the efficacy of domestic laundering at different temperatures in the eradication of fungal pathogens from contaminated socks. Samples from 81 socks worn by patients suffering from tinea pedis underwent domestic laundering at either 40 °C or 60 °C. The socks were dried at room temperature; fungal cultures were taken from two samples from, respectively, the toe and heel areas of the socks. Samples from socks washed at 40 °C revealed 29 (36%) positive fungal cultures, of which 14 came from the toe and 15 from the heel areas of socks. Trichophyton rubrum was isolated in four specimens, and Aspergillus spp. were found in 20 (70%) specimens. Samples from the same socks washed at 60 °C revealed five (6%) positive fungal cultures, of which three came from the toe and two from the heel areas of socks. Only Aspergillus spp. were detected. Yeasts were eradicated at 40 °C. Contravening current trends for energy saving and environmental protection, laundering at low temperatures is not effective in eradicating fungal pathogens, which requires high-temperature laundering at 60 °C.

Seeing is believing: the direct and contingent influence of pictures in health promotion advertising.

Because pictures, compared with words, are more effective in triggering vivid imagery, their effects should increase in situations in which they play a crucial role in facilitating imagery. This study accordingly explored the relative effects of information presented in pictorial formats and verbal formats in health promotion advertising. Symptoms presented in pictorial formats increased perceptions of the severity of a disease, whereas prevention options presented in pictorial formats enhanced efficacy in preventing the disease. This study also examined two contingent situations: when people were oriented toward visual processing, and when imagery could not be easily triggered without the help of pictures, such as when symptoms or prevention options were difficult or unpleasant to imagine. The findings of three studies supported the offered predictions.

Surface modified and medicated polyurethane materials capable of controlling microorganisms causing foot skin infection in athletes.

Foot odor and foot infection are major problems of athletes and persons with hyperhidrosis. Many shoes especially sports shoes have removable cushion insoles/foot beds for foot comfort. Polyurethane (PU) foam and elastomer have been used as cushion insole in shoes. In the present work, new insole materials based on porous viscoelastic PU sheets having hydrophilic property and antimicrobial drug coating to control foot infection and odor were developed. Bacteria and fungus that are causing infection and bad odor of the foot of athletes were isolated by microbial cell culturing of foot sweat. The surface of porous viscoelastic PU sheets was modified using hydrophilic polymers and coated with antimicrobial agent, silver sulfadiazine (SS). The surface modified PU sheets were characterized using ATR-FTIR, TGA, DSC, SEM, contact angle measurement and water absorption study. Results had shown that modified PU sheets have hydrophilicity greater than that of original PU sheet. FTIR spectra and SEM pictures confirmed modification of PU surface with hydrophilic polymers and coating with SS. Minimum inhibitory concentration studies indicated that SS has activity on all isolated bacteria of athletic foot sweat. The maximum inhibition was found for Pseudomonas (20mm) followed by Micrococci (17 mm), Diphtheroids (16 mm) and Staphylococci (12 mm). During perspiration of foot the hydrophilic polymers on PU surface will swell and release SS. Future work will confirm the application of these materials as inserts in athletic shoes.

Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device.

BACKGROUND: Onychomycosis and tinea pedis (athlete's foot) are infections of the nails and skin caused by pathogenic fungi collectively known as dermatophytes. These infections are difficult to treat, and patients often relapse; it is thought that a patient's footwear becomes infected with these fungal organisms and, thus, is an important reservoir for reinfection. Therefore, it is important to find an effective means for killing the dermatophytes that may have colonized the inner surface of the shoes of patients with superficial fungal infections. In this study, we developed an in vitro model for culturing dermatophytes in footwear and used this model to evaluate the effectiveness of a commercial ultraviolet shoe sanitizer in eradicating the fungal elements residing in shoes. METHODS: Leather and athletic shoes (24 pairs) were inoculated with either Trichophyton rubrum or Trichophyton mentagrophytes (10(7) colony-forming units/mL) strains and were placed at 35°C for 4 to 5 days. Next, we compared the ability of swabbing versus scraping to collect microorganisms from infected shoes. Following the optimized method, shoes were infected and were irradiated with one to three cycles of radiation. The inner surfaces of the shoes were swabbed or scraped, and the specimens were cultured for dermatophyte colony-forming units. RESULTS: Leather and canvas shoes were infected to the same extent. Moreover, scraping with a scalpel was overall more effective than was swabbing with a cotton-tipped applicator in recovering viable fungal elements. Irradiation of shoes with one, two, or three cycles resulted in reduction of fungal colonization to the same extent. CONCLUSIONS: The developed infected shoe model is useful for assessing the effectiveness of ultraviolet shoe sanitizers. Also, ultraviolet treatment of shoes with a commercial ultraviolet C sanitizing device was effective in reducing the fungal burden in shoes. These findings have implications regarding breaking foot infection cycles.

Heat resistance of dermatophyte's conidiospores from athletes kits stored in Nigerian University Sport's Center.

The incidence and heat resistance of conidiospores produced by dermatophytes isolated from athlete's kits (canvasses, stockings and spike shoes) stored in Nigerian University Sport's Centre were investigated. Epidermophyton floccosum, Microsporum oudouinii, Microsporum canis, Trichophyton concentricum, Trichophyton mentagrophytes and Trichophyton rubrum were isolated and their incidence on the athlete's kits varied with the species and type of kits. Among the isolates T. mentagrophytes, T. rubrum and E. floccosum with 25%, 23% and 20% prevalence rates respectively, were the most common isolates, and are often associated with tinea pedis (athletes foot). Canvasses with the highest incidence of dermatophytes (25 out of 34 fungal isolates) were the most contaminated kits and could serve as effective articles for the transmission of tinea pedis among athletes in Nigeria. The common etiological agents screened, produced asexual spores (conidiospores) that exhibited high resistance to heat treatment at 80 degrees C. Of the three isolates, E. floccosum, with a decimal reduction time (D-value) of D80 = 4.4 min was the most resistant followed by T. mentagrophytes with D80 = 4.0 min and then T. rubrum with D80 = 3.2 min. The spores elimination pattern indicates that increasing the heating duration would decrease the decimal reduction time and possibly denature the fungal propagules but may damage the skin during treatment with hot water compresses. The findings have shown that the use of hot water compresses is palliative but heat treatment especially vapour-heat treatment offers adequate preventive measures if applied for periodic treatment of contaminated kits. However, determining the correct condition for effective decontamination will require detailed understanding of the heat resistance of fungal spores. Otherwise treatment of kits with detergent and chaotropic agent such as urea and guanidinium salt is preferred to heat treatment.