Dermatophyte infections in hereditary palmo-plantar keratoderma. Frequency and therapy

The frequency of dermatophyte infections in hereditary palmo-plantar keratoderma ( HPPK ) of the Unna - Thost variety was investigated in 280 patients admitted to the Department of Dermatology, Central Hospital, Boden , during 1977-1981, and was found to be 35.0%. The distribution of fungi did not differ from that found for the total number of dermatophytes. An almost complete therapeutical resistance was found especially in Trichophyton rubrum infections, when patients were treated with micronized griseofulvin and topical econazole cream. Treatment of dermatophyte infections in HPPK with 50% propylene glycol in distilled water gave poor results but when 1% econazole nitrate was added negative cultures were found in 86.4% of the patients treated for 3 weeks.     

Microbiology of the interdigital web

The microbiology of the interdigital toe areas is a complex subject that has been partially elucidated by the results of many investigations. Stable resident populations must be maintained in these moist and warm skin surfaces in order to prevent colonization of potential pathogens and overgrowth of innocuous residents. This balanced population of normal flora can be upset by conditions of increased hydration or prolonged occlusion. Population densities invariably increase as the moisture content of skin increases. ^2,4,16 Fluorescent diphtheroids, nonlipophilic diphtheroids, and gram-negative bacilli preferentially flourish under such conditions. Concomitantly, hydrated skin also is macerated easily, and this predisposes individuals to develop superficial mycotic infections of the foot. ^1,5 Stable resident populations thereby become affected by the diffusible antibiotic-like substances produced by dermatophytic fungi, ^28–30 Resistant populations of aerobic cocci, nonlipophilic diphtheroids, and gram-negative bacilli become dominant over sensitive cocci and diphtheroids in such dermatophyte infections. Whereas the keratinolytic activity of dermatophytes was initially responsible for the pruritic, scaling lesions of mild athlete's foot, it is the proteolytic activity of brevibacteria and gram-negative bacilli that is responsible for the development of severe lesions. ^5,32 Coincidently, large populations of such microorganisms generate copious amounts of metabolic by-products such as carbon dioxide and methanethiol, that are toxic to fungi.6'30 Dermatophytes thus become quite difficult to isolate in many cases of severe athlete's foot. ^13,14,32 In such exacerbated intertriginous infections, treatment with drying agents and antibacterial substances is quite effective in alleviating symptomatology.^16,32 However, dermatophytes may persist or reinfect the interdigital web and thus maintain an asymptomatic form of chronic athlete's foot. In order to prevent further exacerbations, the interdigital web surfaces must be kept dry, and antimycotic therapy must be instituted to ultimately free the individual of the dermatophytic agent. Only under these circumstances will stable populations of resident normal flora and healthy interdigital web surfaces be maintained.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药。方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗。症状积分下降指数（SSRI）≥90％的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周。长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次。结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组（t值分别为3.076和2.367,P值均 < 0.05）。长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组（χ2值分别为4.426、7.683、8.199,P值均 < 0.05）。治疗期间不良反应发生率3.1％,无严重不良事件。结论外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用。     

Sulconazole versus clotrimazole in the treatment of dermatophytosis

Seventy-eight patients with dermatophyte infections were treated for 4 weeks with cither sulconazole nitrate 1% cream or 1% clotrimazole cream in a randomized, double-blind, parallel study. After 4 weeks of treatment dermatophytes could no longer be isolated from 92%, of clotrimazole-treated patients and 90%, of those treated with sulconazole. Both treatment groups showed 96%, eradication of the fungus 4 weeks after the end of treatment. One clotrimazole patient relapsed after giving a negative culture at the end of treatment and became positive 4 weeks later. There were no relapses for patients treated with sulconazole but one patient failed to respond clinically to 4 weeks of treatment. Three clotrimazole-treated patients relapsed clinically from week 4 to week 8. Significantly less erythema was observed in the sulconazole group compared to the clotrimazole group at week 8. A statistically significant difference in favour of sulconazole was observed also for maceration. Side-effects to clotrimazole were reported by three patients, one of whom required to be withdrawn from the study. None of the patients who received sulconazole complained of adverse effects. Sulconazole nitrate cream was shown to be a safe and effective treatement for dermatophyte infections of the skin and may offer some superiority to clotrimazole.     

Comparison of the in vitro antifungal activities of clotrimazole, miconazole, econazole and exalamide against clinical isolates of dermatophytes

The in vitro antifungal activities of clotrimazole, miconazole nitrate, econazole nitrate, and exalamide against 64 clinical isolates of various dermatophyte species obtained from out-patients seen at the Nippon Medical School Hospital were simultaneously compared using a liquid microculture method. The rank order of activity against the 64 isolates of dermatophytes was clotrimazole > econazole nitrate > miconazole nitrate > exalamide. For a given antimycotic, the minimal inhibitory concentration was affected by the dermatophyte species.     

Efficacy and safety of terbinafine 1% solution in the treatment of interdigital tinea pedis and tinea corporis or tinea cruris

Two randomized, double-blind, vehicle-controlled, multicenter studies assessed the efficacy and safety of a new terbinafine 1% solution for the treatment of interdigital tinea pedis and tinea corporis or tinea cruris (tinea corporis/cruris). Patients with interdigital tinea pedis applied terbinafine 1% solution or vehicle twice daily for 1 week with 7 weeks of follow-up (N = 153), and patients with tinea corporis/cruris applied terbinafine 1% solution or vehicle once daily for 1 week with 3 weeks of follow-up (N = 66). Efficacy was assessed mycologically and clinically at the end of treatment and throughout follow-up. In the tinea pedis study, 66% of patients were effectively treated with terbinafine compared with 4% of the group treated by vehicle (P < .001; Mantel-Haenszel test). In the tinea corporis/cruris study, treatment was effective in 65% of the terbinafine group compared with 8% of the vehicle group (P < .001). There were no significant differences in the frequency of cutaneous adverse events between the 2 groups in either study. We conclude that one week of therapy with terbinafine 1% solution is highly effective, superior to vehicle, and safe for use in superficial fungal infections.     

HUMAN INFECTIONS DUE TO TRICHOPHYTON EQUINUM VAR. AUTOTROPHICUM IN VICTORIA

Two cases of human ringworm caused by the dermatophyte Trichophyton equinum var. autotrophicum are reported from victoria. This fungus has been recorded as a cause of ringworm in horses in Australia but infections in man are rare and this is the first report giving details of human infections in Australia. In one of these cases the fungus was also isolated from the patient's horse. Treatment with econazole nitrate was successful in this case.     

Topical griseofulvin in the treatment of dermatophytoses

Whether griseofuilvin, which pioneered oral antifungal therapy, works topically has long been an open question. The effectiveness of a 1% griseofulvin spray formulation and the vehicle alone against experimentally induced Trichophyton mentagrphytes lesions on the forearms of 16 healthy volunteers and in the treatment of 100 tinea pedis patients (various dermatophytes) was evaluated in a double-blind study. After treatment of teh58 induced lesions twice daily for 14 days with topical griseofulvin (28) of placebo(30),80% of lesions receiving griseofulvin were mycologically negative compared with 30% in the placebo group (p<0.001), In the tinea pedis patients who applied medication once daily for 4 week and 80.9% 2 weeks post-treatment. Resurgence of dermatophytes quickly followed the end of treatment in the placebo group only, which had a mycological cure rate of 34%(week6) Administration of a ropical formulation of griseofulvin thus may be an effective treatment for interdigital dermatophyte infections.     

强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效观察

目的观察强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹的临床疗效。方法采用随机法将99例患者分为两组,治疗组50例,予强力脉痔灵2片口服,同时外用曲安奈德益康唑乳膏,均2次/d,连用3周。对照组49例,仅外用曲安奈德益康唑乳膏,连用3周。两组均治疗结束时观察近期疗效,痊愈者随访3个月观察远期疗效。结果治疗组近期疗效有效率80.00%,对照组为71.43%,差异无显著性(P>0.05);痊愈病例随访3个月,治疗组复发率20.0%,对照组57.9%,差异有显著性(P<0.01)。结论强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效好。     

贝复新联合曲安奈德益康唑乳膏治疗面部湿疹临床研究

目的:评价贝复新联合曲安奈德益康唑乳膏治疗面部湿疹的临床疗效及安全性。方法:107例患者随机分为治疗组(57例)和对照组(50例),治疗组外用贝复新联合曲安奈德益康唑乳膏,对照组仅外用曲安奈德益康唑乳膏。结果:治疗2周后,治疗组症状体征评分为1.23±1.65,明显低于对照组的2.22±2.14,差异有统计学意义(P0.05)。治疗组有效率为87.72%,高于对照组的70%,差异有统计学意义(P0.05)。两组患者均未见明显不良反应。结论:贝复新联合曲安奈德益康唑乳膏治疗面部湿疹优于单用曲安奈德益康唑乳膏。     

Treatment of pityriasis capitis (dandruff) with econazole nitrate.

63 patients of both sexes with pityriasis sicca or steatoides were examined for presence of Pityrosporum ovale on the scalp. Only those cases in which very numerous yeasts were seen in all squamae present in the preparation were considered positive. According to the severity or duration of pityriasis, 60% of the patients in this population represented severe cases and 38% refractory cases. A solution of econazole nitrate was applied as a spray, morning and evening, for a period of 10 to 20 days (mean). The overall assessment of the clinical effects of econazole nitrate indicated 56 favourable results, with complete disappearance of objective clinical signs in 47 cases; the course of pruritus proceeded roughly parallel with that of the objective signs. The mycological checking of the clinical results, performed at least 7 days after the conclusion of therapy, disclosed 6 failures and 57 successes. In 17 patients, the microscopic examination of squamae was complemented by culture before and after treatment: in all cases, the culture, positive before econazole nitrate therapy, became negative after treatment, thus confirming the results of direct examination. These data suggest that Pityrosporum ovale plays a pathogenetic part in pityriasis simplex capitis.     

银屑病皮损鳞屑中两种微生物的检测及外用派瑞松效果

目的探讨银屑病发病与金黄色葡萄球菌(简称金葡菌)、糠秕孢子菌感染的关系及观察外用派瑞松治疗效果。方法对银屑病病人皮损进行细菌培养及真菌真接镜检,并外用派瑞松治疗。结果银屑病患者金葡菌和糠秕孢子菌带菌率均高于正常对照(P<0.01;P<0.05),治疗后带菌率明显下降;治愈率和有效率分别为18.0%,72.0%。结论金葡菌、糠秕孢子菌在银屑病的发病和发展中起一定作用,派瑞松是治疗银屑病较好的药物之一。     

Evaluation of in vitro activity of ciclopirox olamine,butenafine HCl and econazole nitrate against dermatophytes,yeasts and bacteria

Background In many instances, a cutaneous fungal infection may exist concomitantly with bacterial involvement. In this study we compared the in vitro activity of three antifungal agents against the dermatophytes, yeasts and bacteria recovered most commonly from cutaneous mycoses and bacterial infections. Methods Using a microdilution method adapted from the National Committee for Clinical Laboratory Standards (NCCLS), we determined the minimum inhibitory concentrations (MICs) of ciclopirox olamine, econazole nitrate and butenafine HCl against a panel of dermatophyte fungi and yeasts (n = 39) and bacterial isolates (n = 45). Results All three antifungals demonstrated comparable activity against the dermatophytes tested, with a MIC range of 0.03–0.25 µg/ml for ciclopirox, < 0.001–0.25 µg/ml for econazole and 0.03–0.25 µg/ml for butenafine. For yeasts, ciclopirox showed activity against all isolates, with an MIC range of 0.001–0.25 µg/ml, whereas econazole had a broader range of 0.125–> 0.5 µg/ml. Butenafine displayed limited activity against the yeast Candida albicans and no activity against Malassezia furfur. For the antibacterial activity studies, ciclopirox demonstrated activity against all isolates tested with a range of 0.06–2 µg/ml, while econazole showed activity against Gram‐positive bacteria only, with a MIC range of 0.004–0.25 µg/ml. Butenafine HCl had a limited activity against bacterial isolates tested, showing activity against β‐hemolytic Streptococcus Group A and Corynebacterium only. Neither econazole nitrate nor butenafine HCl demonstrated activity against any of the Gram‐negative strains evaluated in this study. Conclusions The data suggest that ciclopirox olamine has the broadest in vitro activity, in comparison to econazole and butenafine HCl, against bacteria, yeasts and bacteria. These findings may have implications in the use of these antimycotics in the treatment of mixed cutaneous infections where bacteria or yeasts are present in addition to dermatophytes.     

窄谱中波紫外线照射治疗寻常型银屑病60例疗效观察

目的观察窄谱中波紫外线(NB-UVB)照射治疗寻常型银屑病的临床疗效。方法分别采用单独照射NB-UVB和照射NB-UVB联合外用1%硝酸益康唑乳膏两种方法各治疗30例寻常型银屑病患者,并以银屑病ESI指数评价疗效。结果两组患者治疗后ESI评分显著下降(P<0.05),两种治疗方法总有效率相比较,P>0.05,无显著性差异。结论单独照射NB-UVB或照射NB-UVB联合外用1%硝酸益康唑乳膏两种治疗方法均可有效治疗寻常型银屑病,但两者疗效无显著性差异。     

Clotrimazole vs haloprogin treatment of tinea cruris

A study to compare the efficacy of clotrimazole 1% solution with that of haloprogin 1% solution for the treatment of tinea cruris was conducted among military personnel on active duty in a hot, humid climate. Eighty patients with documented dermatophyte infections were treated with the topical antifungal agents. Analysis of the response to treatment for 14 days demonstrated that clotrimazole was significantly more effective clinically and mycologically than haloprogin. With no further treatment, significantly more patients treated with clotrimazole remained free of the disease four weeks later.     

Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison

Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.     

Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison.

Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.     

Brief treatment guide for onychomycosis

Most onychomycosis infections result from dermatophyte organisms and present as distal lateral subungual onychomycosis (DLSO). Mild to moderate infections may be effectively treated with topical lacquer medications; however, there is no general consensus on what constitutes mild infection. In general, mild infections involve relatively small areas of the nail plate without infection of the nail matrix or lunula. Characteristics such as nail thickness, the number of nails affected, and the degree of onycholysis will also be taken into account in the categorization of nail severity and may increase the severity to moderate or severe even where nail plate area involvement is low. Similarly, although an infection may be mild, for patients with underlying health issues such as diabetes or immunodeficiency, oral therapy may be recommended as it typically provides the higher treatment efficacy required by these conditions. Severe infections may be treated with oral antifungal agents or combinations of oral agents and oral antifungals or oral and topical lacquer antifungals. Débridement is a technique that may be used in nearly any degree of infection to aid treatment efficacy by reducing the burden of fungal infection. Other treatment issues discussed include superficial white onychomycosis, nondermatophyte mold infection, and infection prophylaxis. Treatment is discussed considering a dermatophyte infection of DLSO presentation, unless otherwise stated. Infections should be confirmed by laboratory culture to eliminate any other diagnosis. Therapy recommendations concentrate on those agents approved in Canada for onychomycosis: oral terbinafine, oral itraconazole, and ciclopirox 8% nail lacquer.