1996 epidemiological survey of dermatophytoses in Japan. Epidemiological Investigation Committee for Human Mycoses in the Japanese Society for Medical Mycology]

An epidemiological investigation on dermatophytoses in Japan for the year 1996 was carried out with the following results. The number of dermatomycoses patients visiting the fifteen cooperating institutes that year was 8,402. New outpatients with this condition accounted for 13.1% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,395 and were composed of: tinea pedis 4,764 (64.4%), tinea unguium 1,487 (20.1%), tinea corporis 558 (7.5%), tinea cruris 369 (5.0%), tinea manuum 195 (2.6%), tinea capitis 11, kerion Celsi 7, tinea barbae 1 and other forms 3. Of these, 113 were children under 15 years of age. Species and incidences of the 2,615 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,828 (69. 9%), T. mentagrophytes 743 (28.4%) Epidermophyton floccosum 20 (0. 8%), Microsporum (M.) canis 13 (0.5%), M. gypseum 5, T. violaceum 2, and 4 undetermined strains. Candidiasis was found in 722 individuals: intertrigo 299, erosio interdigitalis 95, erythema infantum 89, oral candidiasis 63, paronychia et onychia 56, genital candidiasis 56, onychomycosis 24, chronic mucocutaneous candidiasis 1 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 265 and those with Malassezia folliculitis 15. There were five cases of deep dermal mycoses: three of sporotrichosis, one of chromomycosis and one of aspergillosis. The results of superficial dermatophytoses for the year 1996 differed from those of 1991-92 in the following points: Tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number. M. canis infection tended to decrease gradually. In the age-distribution of tinea, in every clinical form the peak of distribution curve shifted to a more elderly age group.     

Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain

This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified as Trichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) and Trichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes (44.8%), followed by Epidermophyton floccosum (7%) and T. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).     

1997 Epidemiological survey of dermatophytoses in Japan]

An epidemiological investigation on dermatophytoses in Japan for the year 1997 was carried out with the following results. The number of dermatomycoses patients visiting the fourteen cooperating institutes that year was 8,284. New outpatients with this condition accounted for 13.3% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,314 and were composed of: tinea pedis 4,901 (63.8%), tinea unguium 1,592 (20.7%), tinea corporis 557 (7.2%), tinea cruris 395 (5.1%), tinea manuum 215 (2.8%), tinea capitis 12, kerion celsi 3, tinea barbae 1 and granuloma trichophyticum 1. Of these, 117 were children under 15 years of age. Species and incidences of the 2,273 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,628 (71.6%), T. mentagrophytes 617 (27.2%), Epidermophyton floccosum 9 (0.4%), Microsporum (M.) canis 2, M. gypseum 2, T. glabrum 1, and 15 undetermined strains. Candidiasis was found in 714 individuals: intertrigo 302, erosio interdigitalis 108, erythema infantum 85, oral candidiasis 51, paronychia et onychia 51, genital candidiasis 50, onychomycosis 15 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 242 and those with malassezia folliculitis 15. There were nine cases of deep dermal mycoses. The results of superficial dermatophytoses for the year 1997 differed from those of 1991-92 in the following points: tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number continuously. M. canis infection tended to decrease. In the age distribution of tinea, in every clinical form the peak of distribution curve gradually shifted to a more elderly age group.     

An epidemiological survey of dermatomycoses in Japan, 2002]

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.     

Epidemiological investigation of tinea pedis in groups of healthy students, research workers and females wearing boots]

The infection rate, causative dermatophytes, and dermatophyte dissemination of tinea pedis in young healthy Japanese were studied by direct microscopic examination, slant cultures, and foot-press culture method. Questionnaires on subjective symptoms and treatments were also distributed. Among fifty-eight medical students with a mean age of 23.9 years, thirteen (22.4%) showed positive by direct microscopic examination and T. mentagrophytes was more dominant than T. rubrum by slant cultures. In one hundred and sixteen student feet, twelve were infected and disseminating dermatophytes, four were infected but not disseminating, three were not infected but adhering dermatophytes. The infection rate of tinea pedis was thus 24.1%. Among thirty-seven research workers (mean age: 34.8), twenty-one (56.8%) showed positive by direct microscopic examination. All the dermatophytes isolated by slant cultures were T. mentagrophytes. In seventy-four feet, twenty-nine were infected and disseminating, ten were infected but not disseminating, and three were adhering dermatophytes. The infection rate was 64.9%. Among thirty-one females wearing boots (mean age: 21.0), seven (22.6%) were infected and T. mentagrophytes was more dominant. In sixty-two feet, eight were infected and disseminating, one was infected but not disseminating, and five were adhering dermatophytes. The infection rate of tinea pedis was quite high and T.r/T.m rate was low in the three groups. Most of the patients had had no treatment and were disseminating dermatophytes.     

Analysis of dermatophyte flora at a private clinic in Sapporo during the period 1992 to 2001]

Statistical analysis was made of a total of 5530 patients (6798 cases) of dermatophytoses presenting at our private clinic during the period 1992 to 2001. The number of patients and cases represents 8.0% and 9.8% of the entire outpatient population during that time, respectively. Sex ratio (male/female) was 1.5. Among the 6798 dermatophytoses cases, tinea pedis was most frequent (65.8%), followed by tinea unguium (20.7%), tinea cruris (7.2%), tinea corporis (3.9%), tinea manuum (2.4%) and tinea barbae (0.04%). The incidence of tinea unguium increased, whereas that of tinea pedis, tinea cruris, and tinea corporis decreased during this ten year period, and 35.8% of dermatophytoses patients had more than two clinical subtypes simultaneously. Three thousand seven hundred ninety-five dermatophytes were isolated during the survey. : Trichophyton rubrum (TR)(79.4%), Trichophyton mentagrophytes (TM)(19.5%), Microsporum canis (MC)(0.7%), Epidermophyton floccosum (EF) (0.3%), and Microsporum gypseum (MG) (0.1%). Compared with our previous analysis reported for the period 1982 to 1991, the frequency of dermatophytoses increased, especially among aged individuals. Of the clinical subtypes, tinea pedis and tinea unguium were higher, but tinea cruris and tinea corporis were lower, and tinea capitis was not seen in the current survey. Among dermatophytes, TR was increased and other types of fungi were decreased. TR was 4.08 times more common than TM; this ratio is higher than our previous report.     

Statistical study of dermatomycosis for 30 years (1968-1997) in sendai national hospital]

A statistical study on dermatomycoses for the 30 years from 1968 to 1997 in the dermatologic section of Sendai National Hospital was carried out with the following results. The total number of dermatomycosis patients was 14,259 and accounted for 9.59% of all new outpatients during this period. These cases of dermatomycoses were composed of the following: dermatophytoses 10,656, candidiasis 3,287, malassezia infection 566, sporothrichosis 20, aspergillosis 7, and chromomycosis 1. Annual changes in number of dermatophytoses varied in each clinical type: tinea corporis and tinea cruris had increased by the end of the 1970s, and there after decreased gradually until recent years. Tinea pedis and tinea unguium, on the contrary, increased after the 1980s. Age distribution of all clinical forms of dermatophytoses changed gradually, and its peak of the distribution curve shifted to an older site each year, while the number of younger generation patients decreased. Mycologically Trichophyton (T.) rubrum was mainly isolated from all types of dermatophytoses, and T. mentagrophytes followed. The ratio of these two species (R/M) in tinea pedis was 1.25, and the ratio of T. mentagrophytes was relatively high. Epidermophyton floccosum was continuously isolated, but its frequency in recent years has decreased. Microsporum canis infection increased from the middle period of this research, but after 1990 decreased gradually. The other dermatophytes were found sporadically. In recent years the species isolated have become more simplified. Among candidiasis, infantile candidiasis increased dramatically in the 1970s but soon decreased. Intertrigo type also increased in the same period and then decreased to an intermediate level. Paronychia, onychia and erosio interdigitale were constantly found in small numbers, while malassezia infection remained at a constant level and was found more in male patients.     

Effect of temperature, humidity and minor injury to the penetration of dermatophytes into human stratum corneum]

We evaluated the minimum period for penetration of Trichophyton mentagrophytes into human stratum corneum using an experimental model of tinea pedis. Fungal elements were applied to the surface of stratum corneum which were obtained from a healthy human heel, and samples were incubated under a designated condition of temperature and humidity. Thirty-five degrees, which is the approximate temperature of the surface of human skin, seemed more suitable for penetration than 27C. The result also indicated that humidity was a more significant factor than temperature. In the following examination using T. mentagrophytes and T. rubrum, the minimum period for penetration at 100% humidity was 1 day with the former and 1.5 days with the latter. At 95% humidity, T. mentagrophytes penetrated into human stratum corneum on day 1.5 and T. rubrum penetrated on day 4. Humidity of the 4th interdigital space in daily life was calculated to be below 95% using a hygro-thermometer. Therefore, to wash the feet daily can prevent development of tinea pedis. When we applied fungal elements to a cut side of stratum corneum, fungi penetrated within a day at 100% and 95% humidity. In addition, fungi were able to penetrate at below 85% humidity, which they were unable to do when applied them to the surface side. We stress that minor injury of stratum corneum is also a significant factor of the development of tinea pedis.     

Effects of temperature, humidity, minor injury and washing on penetration of dermatophytes into human stratum corneum]

We evaluated the minimum time for penetration of Trichophyton mentagrophytes into human stratum corneum using an experimental model of tinea pedis. After fungal elements were applied on the surface of stratum corneum obtained from a healthy human heel, samples were incubated under designated conditions of temperature and humidity. The penetration of fungal elements was much faster at 35 degrees C than 27 degrees C despite the fact that the latter is an optimal temperature for fungal growth. At 35 degrees C and 100% humidity the minimum time required for penetration was one day. When we applied fungal elements on an abraded surface of stratum corneum, fungi penetrated within a half day under the same conditions. This suggests that minor injury of stratum corneum is a significant factor for infection. The development of tinea pedis does not occur frequently in daily life. We examined the effect of washing the surface of stratum corneum to which T. mentagrophytes had been applied. The samples were incubated under conditions simulating daily life: i.e. with 80% humidity for 8 hours, and 100% humidity for 16 hours. After washing, nearly all the fungal elements had been removed from the surface of stratum corneum within one day. The data suggests that to prevent tinea pedis, daily washing of soles and interdigital regions is effective.     

Statistical study of dermatomycosis - observations in Sendai National Hospital over a 30 year period]

A statistical 30-year study of dermatomycosis in Sendai National Hospital (1968-1997) revealed many changes in the prevalent diseases: Tinea pedis and tinea unguium constantly increased during this period, and the ratio of the former associated with nail infection finally reached 30% of all tinea pedis patients. On the contrary, tinea corporis and cruris showed a remarkable decreasing tendency. Patient age distribution of each disease also showed distinctive changes, generally increasing in the older generation and decreasing in the younger. The number of patients with tinea pedis and unguium gradually increased among the middle and older generations, with the peak of the age-distribution curve shifting upward year after year. On the other hand, cases of tinea cruris among the younger generation were few in the latest years, and middle-age patients remained at a low number. In the first stage of this study the kinds of atiologic dermatophytes consisted of multiple species, but after middle period the isolation of Epidermaphyton floccosum decreased. Microsporum canis appeared first in 1976 but in the recent several years has completely disappeared. In the last few years of the period studied Trichophyton rubrum and Trichophyton mentagrophytes were the only isolates found from among all types of dermatophytoses. Infantile candidiasis remarkably increased in 1970-1975 but thereafter decreased rapidlly. Candidial intertrigo also increased in the same period but did not decrease as much thereafter and continued at the same intermediate level. The number of other types of candidiases were not greatly changed throughout the 30-year period. Malassezia infection also showed no remarkable changes, and only 20 cases of sporothrichosis were found. One case of the deep seated form of cutaneous aspergillosis was found, and this was also true of chromomycosis caused by Fonceaea pedrosoi.     

Seven days of intermittent terbinafine 250 mg treatment in Tinea pedis]

Tinea pedis responds well to topical antifungal therapy, however, relapse of the disease is not uncommon. Long-term application of antifungals is usually necessary to control relapse. We conducted an open trial of a 7 day intermittent course of oral terbinafine treatment at 250 mg/day for plantar type and interdigital type of tinea pedis. Seventy-five patients of plantar type and 49 patients of interdigital tinea pedis were treated with a 7 day course of terbinafine 250 mg/day. Clinical assessments were made at baseline and every 4 weeks. Another 7 day course of the same amount of terbinafine were given depending on the clinical and the mycological response. Of the 75 plantar type tinea pedis with 8 patients excluded, 66 of the remaining 67 (98.5%) were evaluated as cured. Of the 49 interdigital tinea pedis (3 excluded), 43 of 46 patients (93.5%) cured. Relapse of the disease was observed in 4 of 51 patients at 1 year after treatment, 4 of 25 at 2 years, and 2 of 9 at 3 years in the plantar type, and in 4 of 30 at 1 year, 0 of 14 at 2 years, and 0 of 6 at 3 years in the interdigital tinea pedis group. Intermittent terbinafine therapy is thus effective in the treatment of tinea pedis.     

Combined effect of heat, essential oils and salt on fungicidal activity against Trichophyton mentagrophytes in a foot bath.

This work was originally undertaken to determine the effective conditions of essential oils against Trichophyton mentagrophytes in vitro for the treatment of tinea pedis in a foot bath. Agar blocks implanted with T. mentagrophytes were immersed in 0.1% aqueous agar containing two-fold dilutions of essential oils with or without sodium chloride at 27 degrees C, 37 degrees C and 42 degrees C for 10 and 20 min. The number of surviving mycelia on the agar blocks was determined from the standard curves of the colony diameter and original inocula of the conidia. At the same time, the thermal effect on the cellular morphology was examined using SEM. Most fungal mycelia (99.7%) were killed after treatment at 42 degrees C for 20 min without essential oil. The fungicidal activity of essential oils was markedly enhanced by treating at 42 degrees C for 20 min as compared with that at 27 degrees C, showing 1/4 - 1/32-fold reduction of minimum fungicidal concentration (MFC to kill 99.99%). The order of the fungicidal activity of 11 essential oils was oregano, thyme thymol, cinnamon bark > lemongrass > clove, palmarose, peppermint, lavender > geranium Bourbon, tea tree > thyme geraniol oils. MFCs were further reduced to 1/2 - 1/8 by the addition of 10% sodium chloride. The salt effect was explained, at least partly, by an increase in mycelial adsorption of antifungal constituents in the presence of sodium chloride. Considerable hyphal damage was done at 27 degrees C by the essential oils, but no further alteration in morphology of the hyphae treated at 42 degrees C with or without oil was observed by SEM. The inhibitory effect of heat and oils was also observed against mycelia of T. rubrum and conidia of T. mentagrophytes. Thermotherapy combined with essential oils and salt would be promising to treat tinea pedis in a foot bath.     

Current types of human dermatophytoses transmitted from animals]

Microsporum canis, Trichophyton verrucosum and T. mentagrophytes are the most common dermatophytes isolated from human and animals. M. canis infection in human is closely related to companion animals such as cats and dogs. According to a recent epidemiological survey in Japan, human M. canis infection is decreasing. T. verrucosum is usually transmitted from cows to human. T. verrucosum infection in human is not restricted to daily farming prefectures, however, suggesting that this species has already been spread widely in Japan. T. mentagrophytes is one of the most common pathogens in human tinea. Recent molecular methods show the infection is caused by one teleomorph of T. mentagrophytes, Arthroderma benhamiae, which has already been spread throughout Japan by companion animals. This pathogen is believed not to have existed in Japan until 1980. The chance of human fungal infection caused by unusual pathogens is increasing because of the changes in types of companion animals. Animal dermatophytoses is now an important issue not only for veterinary doctors but also for dermatologists.     

Restriction fragment length polymorphism analysis of ribosomal DNA intergenic regions is useful for differentiating strains of Trichophyton mentagrophytes

Twenty isolates of Tricophyton mentagrophytes var. mentagrophytes and 47 isolates of T. mentagrophytes var. interdigitale, identified by morphological characteristics, were screened by restriction fragment length polymorphism (RFLP) analysis of the PCR-amplified internal transcribed spacer (ITS) region of ribosomal DNA (rDNA). Sixty isolates (14 of 20 T. mentagrophytes var. mentagrophytes isolates and 46 of 47 T. mentagrophytes var. interdigitale isolates) shared an identical ITS RFLP profile and were further investigated by using a probe targeted to the rDNA nontranscribed spacer (NTS) region. Polymorphisms were observed in the NTS regions of both T. mentagrophytes var. mentagrophytes and T. mentagrophytes var. interdigitale isolates. Twenty-three individual RFLP patterns (DNA types P-1 to P-12 and A-1 to A-11) were recognized and divided into two groups depending on the presence (P) or absence (A) of a 2.5-kb band, which correlated to a large extent with the morphological variety. Eleven of 14 T. metagrophytes var. mentagrophytes isolates were A types, and all of the 46 T. mentagrophytes var. interdigitale isolates were P types. A majority of strains (23 of 60 [38.3%]) were characterized by one RFLP pattern (pattern P-1), and eight types (P-1 to P-6, P-8, and P-9) accounted for 75% (45 of 60) of all strains, including all of the T. mentagrophytes var. interdigitale isolates. The remaining 15 types were represented by one only isolate and included all of the T. mentagrophytes var. mentagrophytes isolates. We conclude that RFLP analysis of the rDNA NTS region is a valuable technique for differentiation of T. mentagrophytes strains. Furthermore, by use of this method, there appears to be a greater degree of diversity among T. mentagrophytes var. mentagrophytes isolates than among T. mentagrophytes var. interdigitale isolates.     

Experimental studies on the penetration into the human stratum corneum of the dermatophyte]

We present results on the experimental penetration of Trichophyton mentagrophytes and T. rubrum under designated condition of humidity into human stratum corneum obtained from a healthy human heelregion. When mycelia were applied to the surface side of stratum corneum and then incubated at 100 % humidity, T. mentagrophytes and T. rubrum were observed in the stratum corneum on day 1 and day 1.5, respectively. At 95% humidity, T. mentagrophytes and T. rubrum penetrated on day 1.5 and day 4, and at 90% humidity, they penetrated on day 3 and day 7, respectively. At less than 85% humidity, no fungal elements of either strain were observed in stratum corneum for up to 7 days. These datasuggest that at least 90% humidity is necessary for these two fungi to penetrate into stratum corneum within a few days. However, when T. mentagrophytes was applied to the cutting side of the stratum corneum and thenincubated at more than 70% humidity, the mycelia were able to penetrate within a day. The same results were obtained when T. rubrum was applied on the cutting side and incubated at 95 and 100% humidity. T. rubrum was also able to penetrate into the stratum corneum within several days at 70 and 80% humidity. These results may indicate that not only persistent moisture but also minor injuries of stratum corneum are the most important factors in the development of tinea pedis.     

Mycoses frequency in three communities in the North mountain of the State of Puebla

In order to know mycosis frequency in the North of the State of Puebla, Mexico, in habitants from the communities of Ayotoxco, Mazatepec and Zacatipan were studied. Previous medical study biological samples were submitted to direct examination, smear and culture. Histoplasmin and sporotrichin skin test were applied to 57 individual from Zacatipan. From 110 patients 146 mycological studies were performed. Eighty six cases (59%) of mycosis were detected: 43 finger or toenails onychomycosis, 25 tinea pedis, seven tinea capitis, four cases of tinea manum and, finally, five cases of seborrhoeic dermatitis and two of pitiriasis versicolor. We isolated: 18 streins of dermatophytes, mainly Trichophyton rubrum and T. mentagrophytes (11 and 5 strains respectively); 12 cultures of non-dermatophytes filamentous fungi; six cases of mycelia sterile; six yeast strains, most of them Candida spp but none C. albicans. From 57 patients to whom skin tests were applied, five of them (8.8%) were positive to both antigens; ten positive (17.6%) only to histoplasmin and eight (14%) to sporotrichin. This study showed that rural population from Puebla present a high frequency of superficial mycosis (61% of mycological studies). Considering the percentage of positive skin test we suppose that there are many not diagnosed sporotrichosis and histoplasmosis cases.     

Etiology of dermatophytoses amongst children in northeastern Nigeria.

A survey of dermatophytoses was carried out amongst primary school children in Borno State, Nigeria, during February 1997 to January 1998. A total of 2,193 children aged 4-16 years were screened. Out of these, 154 (7.0%) were proved to be mycologically positive by microscopy, culture or both. Incidence was significantly higher (P <0.05) in young children aged 7-11 years (8.1%) and 4-6 years (6.9%) than in older children aged 12-16 years (3.6%). There was a significant difference in the incidence of dermatophytoses amongst children in urban and rural areas (P <0.05). Tinea capitis was the predominant clinical type followed by tinea corporis. Trichophyton schoenleinii was the most prevalent etiological agent (28.1%), followed by T. verrucosum (20.2%) and Microsporum gallinae (18.4%). Other species recovered included T. mentagrophytes (16.7%), T. tonsurans (10.5%), T. yaoundei (4.4%) and M. gypseum (1.8%).     

Prevalence and patient's consciousness of tinea pedis and onychomycosis]

Epidemiological studies on tinea pedis and onychomycosis have been performed across Europe and East Asia. The prevalence of these conditions was 20%, respectively, and it increased with advancing age, more men than women had fungal infection of the feet. The prevalent predisposing factors were sports participation, average temperature, and family history of tinea pedis. The predisposing diseases were hypercholesterolemia, cardiovascular disease, diabetes mellitus, and osteoarticular disease. We conducted an epidemiological investigation to determine the prevalence and circumstances of untreated and unsuspected tinea pedis and onychomycosis. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as past history of tinea pedis and/or onychomycosis, age, disposition of toes, and predisposing disease, as well as the type of shoes worn daily. We suspected that a patient's local and systemic conditions affected each other, creating good conditions for tinea pedis and onychomycosis so that the prevalence has increased. More understanding of occult athlete's foot will lead to prevention and improvement in treatment and diagnosis.     

Superficial fungal infections seen at the National Skin Centre, Singapore.

Cutaneous fungal infections are common in Singapore. The National Skin Centre is a tertiary referral centre for dermatological diseases in the country, and sees more than 2,500 cases of superficial fungal infections annually. AIM: This study analyses data collated from the centre's medical record office as well as fungal culture results from the mycology laboratory. RESULTS: From 1999 to 2003, there were a total of 12,903 cases of superficial fungal infections seen at the centre. The majority of patients (n=9335) (72.3%) were males. The most common infection was tinea pedis (n=3516) (27.3%), followed by pityriasis versicolor (n=3249) (25.2%) and tinea cruris (n=1745) (13.5%). Candidal infections were also common (n=1430), the majority of which were cases of candidal intertrigo. There were very few cases of tinea capitis, which is uncommon in Singapore. The number of cases of onychomycosis has shown a rising trend over the past 5 years. Trichophyton rubrum was the most prevalent fungal pathogen isolated from all cases of superficial fungal infections of the skin, except for tinea pedis, where Trichophyton interdigitale was the most frequently isolated organism. Dermatophytes remain the most commonly isolated fungal pathogens isolated in toenail onychomycosis, whilst Candida species accounted for the majority of isolates in fingernail onychomycosis. CONCLUSION: Current epidemiologic trends of superficial fungal infections in Singapore show some similarities to recent studies from the United Kingdom and United States.     

Les teignes du cuir chevelu dans la région de Sfax (Tunisie)

IntroductionTinea capitis is still considered a public health problem in our country, and is the most common type of dermatophytosis in children.The aim of this study was to determine the clinical, epidemiological and mycological characteristics of tinea capitis in Sfax region.Patients and methodsA retrospective study realized on 12,533 mycological examinations of the scalp in 13-years period (from January 1995 to December 2007).ResultsIn all, 5264 cases of tinea were diagnosed. The prevalence was 405 cases per year. The sex-ratio was 1.25. The average age was eight years and four months.Two hundred and fifty-three (4.8%) cases were diagnosed in adults. Trichophytic tinea was the most frequent (68.3%) followed by microsporic tinea (29.3%) and inflammatory tinea (2.3%). Five cases of favus type were diagnosed.Other family members were infected by tinea in 10% of cases. The isolated dermatophytic flora was: Trichophyton violaceum (68%), Microsporum canis (29.2%), T. mentagrophytes (1.34%), T. verrucosum (0.7%), T. tonsurans (0.3%), T. rubrum (0.2%), M. audouinii (0.1%), T. schoenleinii (0.1%), M. gypseum (two cases), and T. quinckeanum (one case).Our patients had tinea corporis and finger onychomycosis associated respectively in 15% and 0.6% of cases.ConclusionIn our region, T. violaceum continues to be the leading cause of tinea capitis. Zoophilic agents become more prevalent. This finding may be explained by changing behaviours and activities of the population, who kept a larger number of domestic animals at homes. Some dermatophytic agents, which are uncommon pathogens of tinea capitis in our country, were detected.