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.     

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.     

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.     

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.     

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.     

Dermatophyte flora at the dermatology clinic of Kimitsu Chuo Hospital from 1994 through 1999]

Kimitsu Chuo Hospital is located in the middle of Chiba Prefecture along Tokyo Bay. An epidemiological survey of dermatophytosis was made at the dermatology clinic of the hospital from January 1994 through December 1999. Dermatophytosis patients numbered 2,580 and disease types were composed of: tinea pedis 1,656 (64.2%), tinea unguium 377 (14.6%), tinea corporis 308 (11.9%), tinea cruris 139 (5.4%), tinea manuum 92 (3.6%), tinea capitis 6 (0.2%) and tinea profunda 2 (0.1%). Species frequencies in the 1,610 strains isolated from these patients were as follows: 929 (57.7%) of Trichophyton rubrum, 651 (40.4%) of T. mentagrophytes, 9 (0.6%) of Microsporum gypseum, 8 (0.5%) of M. canis, 8 (0.5%) of Epidermophyton floccosum and 5 (0.3%) of T. violaceum. The ratio of T.R/T.M was 1.43 in all the isolates, and 0.81 in the isolates from tinea pedis. These ratios were lower than those of the epidemiological survey of dermatomycoses in Japan in 1997. T. mentagrophytes was characteristically dominant in this hospital and resulted from a drastic increase in tinea pedis caused by this species in the summer season.     

Dermatomycosis in and around Aurangabad

A total of 175 cases of dermatophytoses were studied. Out of all the clinical types, Tinea corporis (T. corporis) was found to be the predominant clinical type (24.57%) followed by tinea cruris (T. cruris) (22.28%). Incidence of Tinea barbae (T. barbae) and Tinea imbricata (T. imbricata) was the least (2.85%) and 0.57% respectively. Out of 175 cases of dermatophytoses, 66 (37.71%) cases were positive on microscopic examination, out of which 27 (40.90%) cases were positive by culture also. Out of the 175 cases of dermatophytoses, 109 (62.28%) were engative on microscopic examination, out of which 13 (11.92%) were culture positive. In this study, Trichophyton was the commonest genus of dermatophyte isolated, with Trichophyton rubrum (T. rubrum) being the commonest species (28.12%), followed by Trichophyton mentagrophyte. (T. mentagrophyte) (25.0%) Trichophyton soudanense (T. soundanense), which is a rare species (not reported from any studies) was isolated from cases of T. corporis and T. cruris.     

Dermatophytosis of the external auditory meatus]

Dermatophytosis of the external auditory meatus is believed to be a fairly rare disease. In the past three and a half years we have had seven cases of dermatophytosis in the external auditory meatus. All cases except one were associated with tinea of other lesions. Case 1: A 44-year-old man had tinea of the auricle, tinea pedis and tinea unguium. Case 2: A 14-year-old boy, the son of case 1 had no tinea elsewhere on his body, including the auricle. He scratched the auditory meatus with an earpick which his father had used. Case 3: A 62-year-old man had tinea of the auricle, tinea pedis and tinea unguium. Case 4: A 50-year-old man had tinea of the auricle, tinea pedis and tinea unguium. Case 5: A 36-year-old man had tinea of the auricle, tinea pedis, tinea unguium and tinea cruris. Case 6: A 30-year-old woman had tinea of the auricle. Case 7: A 68-year-old man had tinea of the auricle, tinea pedis, tinea unguium and tinea manuum. Endoscopic examination (except for cases 4 and 7) revealed dry cerumen from cartilaginous to bony region of the external auditory meatus. Direct examination using KOH method of the cerumen in all cases demonstrated numerous fungal elements. Fungal cultures identified Trichophyton rubrum except for cases 3 and 6. All cases were successfully treated with oral itraconazole or terbinafine. We suggest that tinea of the external auditory meatus is frequently associated with that of the auricle.     

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).     

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%).     

Dermatophytes and immigration

An epidemiological study of dermatophytes was achieved during the years 1983-1984 in the Mycology Laboratory of Saint-Louis' Hospital. Immigrants represent an important part of the people who came to consult us: 28 per cent in 1983. The two most important immigrant peoples show different features: Black African people, who were mass contaminated by tinea agents (Trichophyton soudanense and Microsporum langeronii), were not much contaminated by epidermophytic agents (Trichophyton rubrum, Trichophyton interdigitale, Epidermophyton floccosum). Conversely, in people from the Maghreb, if tinea (Trichophyton violaceum) were not numerous, epidermophyties were found in the same proportion than in native people. The transmission of various dermatophytes from one population to another seems quite easy to detect for tinea agents: Trichophyton soudanense, Microsporum langeronii and Trichophyton violaceum can contaminate native people. Microsporum canis often contaminates the children from the Maghreb, and rarely Black African children. But the transmission of epidermophytes is much more difficult to study, due to a lack of documents in the African countries involved. The Scytalidium and Hendersonula pathology recently discovered in France is almost exclusively restricted to Black immigrants from the West Indies and Africa.     

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.     

Analysis of 25 cases of microsporum canis infection encountered at a dermatology clinic in Kumamoto during a recent 3-year period

Twenty-five cases of dermatophytoses caused by Microsporum canis were encountered during a 3-year period (January 2008-December 2010). Their diagnosis was based on detection of fungal elements by direct microscopy and identification of M. canis by fungal culture. There were 17 women and 8 men ; they ranged in age from 4 to 85 years (mean, 34.6). The affected site was the head (n=5), face (n=8), neck (n=5), arm (n=8), leg (n=5), and trunk (n=5) ; exposed sites were those most often affected. A lone eruption was seen in 13 and multiple eruptions in 12 patients. The disease type was tinea corporis in 21 patients, tinea capitis in 5, and a combination of tinea corporis and tinea capitis in one. The disease showed familial onset in 10 patients (5 pairs), including 2 sibling pairs, 2 mother-child pairs, and 1 grandmother-granddaughter pair. Twenty-four patients had a history of contact with animals, and animals kept at home may have served as the infection source (cats in 23 patients and a dog in one). Hairbrush culture of the pets was positive in 9 patients. The patients with a lone eruption were treated with topical antifungal agents, while those with multiple eruptions of tinea capitis and tinea corporis were treated with oral itraconazole or terbinafine hydrochloride for 2-14 weeks, combined with topical antifungal therapy. Although reports of dermatophytoses caused by M. canis have been decreasing, our experience indicates the necessity of considering possible transmission of this disease from pets such as cats.     

Dermatophytosis in Tulugudu Island, Ethiopia.

The objective of this investigation was to assess the prevalence of dermatophytoses in children in a geographically restricted area in the Ethiopian countryside, and to determine the aetiological agents of these infections. Demographical and clinical-dermatological data were collected from all children 4-15 years of age on Tulugudu Island, Southern Ethiopia. Mycological specimens were taken and species identification determined through morphological observations and biochemical tests, complemented with sequencing of rDNA ITS2 region when necessary. Of 171 children, 96% shared combs, 85% shared beds and 97% had animal contact. Family size was > 5 persons in 50% of the test subjects and prevalence of tinea capitis was elevated in this group (P < 0.005). Dermatophytoses were clinically diagnosed in 136 cases (79.5%). Tinea capitis (T. capitis) was the most common manifestation with 104 cases (76.5%). T. capitis was combined with dermatophytic infections at other sites in 19 cases. Tinea faciae and Tinea corporis were found in four and two cases, respectively, and pediculosis capitis was diagnosed in 2.9% of the test subjects. Of 135 samples from hair (n = 112), skin (n = 19) and finger-nail (n = 4), 74.1% were microscopy-positive for dermatophytes, 73% were positive in culture, giving an overall prevalence of dermatophytoses in 57.3% of all children examined. Trichophyton violaceum was identified in 80.6% of cultures, Trichophyton verrucosum in 16.3% and Trichophyton tonsurans in 2.0%. One isolate was identified as a white variant of T. violaceum. Tinea capitis was highly prevalent in children on Tulugudu Island, Southern Ethiopia. The anthropophilic species T. violaceum dominated as an aetiological agent. Zoophilic dermatophytes were relatively rarely isolated from clinical specimens, despite the children's frequent contact with animals.     

Les onychomycoses chez les enfants à Sfax (Tunisie)

Onychomycosis is considered to be an age related infection. It is a rare disorder in children. This survey was carried out to determine the epidemiological, clinical and causative species of fungal nail infections in children with age less than 16 years old attending our laboratory during five years (2001–2006).MethodsWe undertook a retrospective study about 2431 children consulting us for suspicion of dermatomycosis. The specimens were examined microscopically and cultured on Sabouraud medium agar.ResultsSuperficial mycoses were mycologically proved in 1390 children. One hundred and twenty-eight (9.2%) of them were onychomycosis, representing 48.5% of 272 cases of nail alterations. Mean age was 11 years. The incidence increased steadily with increasing age. Nail infections were most commonly caused by dermatophytes (57%), toenail was the main location (54.8%). Dermatophytic onyxis were associated with tinea capitis in 37.5% of fingernails cases and tinea pedis in 47.5% of toenails cases. Trichophyton rubrum was the most frequently isolated (65.8%), followed by Trichophyton violaceum (15.1%), Microsporum canis (9.6%) and Trichophyton interdigitale (1.4%).Yeasts were isolated in 41.4% of cases, predominated in fingernails (90.6%). The most important species were Candida albicans (49, 1%), Candida tropicalis (22.7%) and Candida parapsilosis (16.9%). Moulds were isolated in two cases (1.6%).DiscussionAs in adults, onychomycosis is probably the main nail disease in children. A source of infection should be researched (coexistence of tinea capitis, tinea pedis, dermatomycosis of family members…). It is appropriate to suspect onychomycosis in children to perform mycological diagnosis and undertake early treatment.     

Tinea corporis due to Trichophyton violaceum: A report of two cases

Dermatophytes are Fungi which infect keratinized tissues, that is, skin epidermis, hair and nails. Trichophyton violaceum is an anthropophilic, cosmopolitan dermatophyte. It primarily causes tinea capitis and less commonly tinea corporis and tinea unguium. We present a report of two cases of tinea corporis due to T. violaceum in children. Infections due to T. violaceum are important because of its transmissibility within families and community and its potential to spread and establish in new geographical areas.     

Tinea capitis in a paediatric population

Tinea capitis is an increasing problem in Europe. The pattern of infection is changing with an increase in pathogenic anthropophilic dermatophytes particularly Trichophyton tonsurans. We aimed to determine the frequency of tinea capitis in a paediatric population attending dermatology outpatients and examine the clinical spectrum of disease. A retrospective analysis was performed of all laboratory proven tinea capitis cases presenting to the dermatology outpatient department at The Children's University Hospital, Temple Street over an 18-month period (1st January 2004 to 30th of June 2005 inclusive). Sixty-two children had tinea capitis of whom 53 (85.5%) were of African descent. Thirty-five (56%) were male and 27 female (44%). The average age at presentation was 4.02 years (age range 1-163 months) with five cases occurring in children less than one year of age. The most common pathogen was the anthropophilic dermatophyte Trichophyton tonsurans, accounting for 47 (75.8%) of all cases of tinea capitis. Eight (12.9%) were secondary to Microsporum ferrigineum, 2 (3.2%) secondary to Trichophyton violaceum, both Trichophyton soudanese and Trichophyton verruosum accounted for 1.6% each. The zoophilic organism Microsporum canis was diagnosed in 3 cases (4.8%). Presenting signs included scaling of the scalp (35.47%), scaling of the scalp and alopecia (53.24%), and alopecia and kerion (11.29%/o). The duration of symptoms was recorded in 52 patients with the average duration 8.38 months (range 0.5-72 months). In 20 cases an associated skin involvement on other areas of the body was recorded. All patients at diagnosis were either on no, suboptimal or inappropriate treatment. The prevalence of tinea capitis is increasing in this hospital based cohort. The main pathogen is now Trichophyton tonsurans. Children of African descent are at increased risk of infection. The diagnosis is poorly recognized and needs to be highlighted as a public health issue. There is a need for community based prevalence studies.     

Tinea unguium

Although onychomycoses are caused by dermatophytes, yeasts or non-dermatophyte molds, tinea unguium describes chronic fungal infections by dermatophytes only. Tinea unguium is a common fungal infection of the nail plate or nail bed with increasing prevalence worldwide. It is not self-limited and shows a higher frequency among the elderly population. In Japan, approximately 10% of the entire population is estimated to have tinea unguium. During the period when only griseofulvin was available for treatment, it was a very difficult disease to treat. Since in the 1990's, however, the introduction of new oral antifungals, itraconazole and terbinafine, initiated a new era in the treatment of tinea unguium. Many excellent textbooks, review articles, and original articles have already been published. This paper considers the circumstances in Japan, epidemiology, causative agents including non-dermatophyte molds, differential diagnosis, diagnostic techniques, the quality of life of the patients with tinea unguium, and then the treatment options are reviewed again.     

Mycology in the Philippines, revisited.

The warm tropical climate of the Philippines and its interaction with cultural practices, occupation and immune responsiveness contribute to the increased susceptibility of Filipinos to fungal infections. An investigation to determine the prevalence of fungal infections in dermatology training institutions over a 4-year period was conducted. The results showed that fungal infections rank as the second leading cause of consultation with a prevalence of 12.98%. Pityriasis versicolor (25.34%), tinea corporis (22.63%), tinea cruris (16.7%) and tinea pedis (16.38%) were the most frequently encountered cases. Fungal culture yield is low and Candida sp. is the most common isolate, obtained predominantly from specimens taken from the oral mucosa and nails. Candidiasis is still the most common opportunistic infection followed by coccidioidomycosis, cryptococcosis and aspergillosis. Imidazoles are the most commonly prescribed systemic and topical treatment by Filipino dermatologists. Initial data collected would serve as reference for future research and may be used to compare with epidemiologic data obtained from other Asian countries.     

Tinea unguium in Lahore, Pakistan.

During a period of 1 year, out of 202 clinically suspected cases of tinea unguium, 53 (26%) were confirmed by mycological cultures for dermatophytes. Trichophyton rubrum was the most common fungus isolated in 46 (87%) patients, followed by T. violaceum in four (7%), T. interdigitale in two (4%) and Epidermophyton floccosum in one (2%). The disease was more common in adult males and fingernails were found to be affected more often than toenails. The distal and lateral variety was seen in 41 (77%) patients, total secondary dystrophic type in 11 (21%) and proximal subungual type in one (2%). Clinical diagnosis alone is not reliable and mycological confirmation is mandatory for this potentially curable disease.