Prevalence and risk factors for superficial fungal infections among Italian Navy Cadets

BACKGROUND: Limited studies on the prevalence and risk factors for superficial mycoses are available. OBJECTIVE: The aim of this paper was to evaluate the prevalence and risk factors for superficial mycoses (dermatophytes and Candida spp.) in a sample of young Italian people resident at a military school. METHODS: A total of 1,024 young cadets from the Italian Navy Petty Officers School in Taranto, including 975 (95.21%) males and 49 (4.79%) females, mean age 22.5 +/- 3.0 years (range 18-30), were consecutively examined by the same observer. A complete dermatological examination was performed on all the subjects, and skin scrapings for microscopy and fungal culture were obtained from suspected lesions. All the subjects completed a questionnaire providing information on sports practice, swimming-pool attendance, marching, wearing shower sandals, frequent use of 'gummed' shoes, history of severe traumas to the nails, presence of hyperhidrosis and history of superficial mycoses. The affected subjects were also asked if they were aware of their condition. Data were analysed by the Statistical Analysis System, version 8.0. The Fisher exact test and odds ratios were calculated. RESULTS: A total of 33 subjects (3.2%) were found to suffer from a mycologically confirmed fungal infection (3% by dermatophytes and 0.2% by Candida albicans): tinea pedis/Candida intertrigo of the feet was suspected in 126 (12.1%) subjects and confirmed in 30 (2.9%), including 28 cases of tinea pedis and 2 cases of Candida intertrigo; tinea cruris/Candida intertrigo of the groin was suspected in 28 (2.7%) subjects, but confirmed in only 1 case (0.1%); onychomycosis was suspected in 64 (6.1%) subjects and confirmed in 2 cases (0.2%). The organism most frequently responsible in tinea pedis was Trichophyton mentagrophytes var. interdigitale (82.1%). The same species (50%) and T. mentagrophytes var. mentagrophytes (50%) were associated with tinea unguium, Epidermophyton floccosum was the only species detected in tinea cruris. Non-dermatophytic filamentous fungi (Penicillium spp., Fusarium spp., Aspergillus spp. and Paecilomyces spp.), not considered pathogenic, were isolated in 48 samples. None of the risk factors analysed were significantly associated with fungal infection. Only 2 subjects out of the 33 people affected were aware of their condition. They both had tinea pedis. CONCLUSION: The prevalence of mycoses in sailors living in an Italian military school was lower than rates detected in other military populations. This may be due to the cadets' lifestyle and environmental conditions. The most frequent infection was tinea pedis, mainly caused by T. interdigitale. None of the investigated risk factors were significantly associated with the disease, and most of the affected individuals were not aware of their condition.     

Prevalence of superficial fungal infections among sports-active individuals: results from the Achilles survey, a review of the literature

OBJECTIVE: To examine the effect of sport activities on the prevalence of foot disease in the Achilles survey, conducted during the spring of 1997 and 1998 in several European countries. SUBJECT: Foot diseases, especially fungal infections (tinea pedis and onychomycosis). METHODS: A questionnaire and a clinical examination regarding individuals presenting to a general practitioner for disorders irrespective of possible foot problems. RESULTS: More than 50% of subjects visiting a general practitioner had clinical evidence of foot disease, and approximately two-thirds of these had clinical evidence of a superficial fungal infection. The survey evidenced a significant age-dependent association between sporting activities and the prevalence of foot diseases and superficial fungal infection, especially in children. CONCLUSIONS: The results of this pan-European survey indicate that sporting activities can have an unfavourable effect on the individual regarding the occurrence of foot disease and superficial fungal infection. The results indicate a need to pay more attention to foot disease, to predict and prevent future diseases and further complications.     

Onychomycosis and other superficial fungal infections of the foot in the elderly: a pan-European survey

BACKGROUND: The escalating ageing population in the western world has led to an increased incidence of superficial fungal infections. The most common infections include onychomycosis, tinea pedis and tinea cruris. With the increasing life expectancy, the prevalence of onychomycosis and other superficial fungal infections is likely to increase further without adequate prevention and treatment. Objective: To study the prevalence of foot mycoses in Europe. METHOD: The Achilles project represents a survey of 90,085 subjects from 16 European countries. RESULTS: Approximately half of the total screened population had evidence of fungal foot infection, with tinea pedis and onychomycosis affecting one quarter of these individuals. Advancing age showed an unfavourable effect on the prevalence of these infections. CONCLUSION: As the number of aged people in developed countries continues to increase, skin diseases will constitute a greater pharmaco-economic concern of worldwide healthcare. Better recognition by clinicians and patients of mycotic foot disease will help prevent direct morbidity and further complications.     

Epidemiological and Etiological Study of Foot Mycosis in Tunisia

BackgroundTinea pedis and onychomycosis are among the commonest fungal diseases in the world. Recently, there has been an increase in the numbers of fungal agents implicated in these conditions.ObjectiveTo analyze the epidemiology of fungal foot diseases and to identify associated etiological factors in outpatients attending the Department of Dermatology of Charles Nicolle Hospital in Tunis, Tunisia.Patients and MethodsOne hundred and forty eight patients were assessed for the presence of fungal foot diseases during the period between January and April 2009. The mean age was 41.5 years (range: 2–87 years) and sex ratio was 0.8. A complete dermatological examination was performed on all subjects, and specimens of the feet were taken from patients presenting signs of tinea pedis or onychomycosis for microscopy and fungal culture.ResultsFungal foot infection was suspected in 71 subjects, and the diagnosis was confirmed in 67 cases (45.3%) by positive microscopy or culture. Older age and family history of mycosis were predisposing factors for foot fungal infection. The condition was caused by dermatophytes in 57.1% of cases and Candida species in 35.7%. Trichophyton rubrum and Candida parapsilosis were the predominant dermatophyte and yeast species, respectively.     

Prevalence and risk factors for tinea pedis in Israeli soldiers

BACKGROUND: Tinea pedis is a common infection in soldiers. However, prevalence and risk factors for tinea pedis in soldiers were investigated in only a few studies. OBJECTIVES: To investigate the prevalence and risk factors for tinea pedis in Israeli soldiers. METHODS: A cross-sectional study including interviews, clinical skin examination and mycological tests was performed in Israeli soldiers. The presence of tinea pedis was assessed using the Athlete's Foot Severity Index (AFSI), a scoring system that was developed in order to evaluate the presence and severity of tinea pedis. In soldiers with clinical evidence of tinea pedis (AFSI > 1), scrapings were taken for direct microscopic examination (20% KOH preparation) and fungal culture. Statistical analyses were performed using chi-square or Fisher's exact test for dichotomous variables (as needed), or t-tests for continuous variables. Logistic regression was used for multivariate analyses of dichotomous variables. RESULTS: Two hundred and twenty-three soldiers were included in the study: 205 men (91.9%) and 18 women (8.1%). Mean age was 19.6 years (SD 1.0 year). Clinical point prevalence was 60.1%. Mycological point prevalence was 27.3%. Further analyses were performed using the clinical point prevalence. Univariate analyses demonstrated that the prevalence of tinea pedis varied with the setting of military training (basic training: 70.3%, advanced infantry training: 81.5%, armor commander training: 56.4% and armor officer training: 34.8%) and was associated with male gender, frequency of sock changes and the length of military service. A multivariate analysis demonstrated that tinea pedis was associated with the setting of the military training (OR 1.6, 95% CI 1.2-2.1) and male gender (OR 4.3, 95% CI 1.4-13.8); however, there was no association with hygiene measures (e.g. frequency of changing socks or sleeping with socks) or the length of military service. CONCLUSION: Tinea pedis is highly prevalent in Israeli soldiers. Association of tinea pedis with the setting of military training suggests that contagious spread may be an important risk factor. We suggest that environmental interventions should be planned to in order to decrease the morbidity of tinea pedis among soldiers.     

Epidemiological survey of foot diseases in Japan: Results of 30 000 foot checks by dermatologists

There has been no epidemiological survey of foot diseases in Japan. In this study we determined the prevalence of foot diseases, especially tinea pedis (TP) and tinea unguium (TU) in Japan. We conducted a randomized survey of outpatients who visited a dermatologist during the third week of May in 1999, 2000 and 2006. The most frequently reported condition was “fungal infection” in 8737 (40.0%) of 21 820 patients in 1999/2000, and 3848 (49.4%) of 7783 patients in 2006. The patients who visited a dermatologist for reasons other than superficial fungal infection but were diagnosed with TP or TU comprised 18.6% of the study population in 2000 and 24.1% in 2006. Of the patients with TP or TU, 63.2% used topical medication only. This survey showed that often patients are not aware of fungal infections and that their treatment is sometimes insufficient. Dermatologists should actively examine and treat patients with TP and TU.     

Characteristics of superficial fungal infections in the Riyadh region of Saudi Arabia

Background The prevalence and characteristics of superficial fungal infections (SFIs) vary with climatic conditions, lifestyle, and population migration patterns. This study was undertaken to determine the characteristics of SFIs amongst patients visiting the dermatology clinic of Riyadh Military Hospital, Riyadh, Saudi Arabia, during the period 2003–2005. Methods One hundred and nineteen patients with confirmed SFI (37 males and 82 females), aged between 5 months and 67 years, were included in this study. The diagnosis of SFI was based on clinical presentation confirmed by laboratory analysis. The type of mycotic pathogen and the site of infection were recorded as a function of age and sex. Results Onychomycosis (40.3%) was the most frequent infection, followed by tinea capitis (21.9%), tinea pedis (16%), tinea cruris (15.1%), and tinea corporis (6.7%). Tinea capitis was most prevalent (15.1%) in children (male to female ratio, 1 : 1.57), whereas tinea pedis was most common (11.8%) in adults (male to female ratio, 1 : 2.5). Trichophyton mentagrophytes and Microsporum canis were the most common dermatophytes responsible for tinea infections, and T. mentagrophytes, Candida spp., and Aspergillus spp. were mainly responsible for onychomycosis. Conclusion The prevalence of SFI was twofold greater in females than males. Children were most commonly affected by tinea capitis, whereas adults generally suffered from tinea pedis. The frequency of onychomycosis was nearly three times higher in adults. This study clearly shows that SFIs are of concern in both genders and in all age groups.     

Species distribution and frequency of isolation of yeasts and dermatophytes from toe webs of diabetic patients

The paper identifies fungal species, looking at the incidence of fungal isolation and risk factors influencing the development of fungal infection and colonization of interdigital spaces of the feet in 509 diabetic outpatients. Using standard mycologic diagnostic methods, fungi were detected in toe webs of 122 (24%) diabetic patients. The finding of fungi was twice as common in interdigital spaces of one (85/16.7% of the patients) than both feet (37/7.3% of the patients). Yeasts were the most common isolates (95/18.7% of the patients), followed by dermatophytic moulds (24/4.7% of the patients), whereas coexistence of yeasts and dermatophytes was the most infrequent finding (3/0.6% of the patients). From toe webs, 24 fungal species, 21 yeast species belonging to nine genera (Candida, Rhodotorula, Cryptococcus, Trichosporon, Saccharomyces, Blastoschizomyces, Geotrichum, Debaryomyces, and Ustilago) as well as three species of dermatophytes of the genera Trichophyton and Epidermophyton were isolated. The most frequently isolated fungi were Candida parapsilosis (59/11.6% of the patients) and Trichophyton mentagrophytes (16/3.1% of the patients). Although there was no correlation between the incidence of toe web space colonization with yeasts and dermatophytosis with the criteria of patient sex and age, and duration of diabetes, the difference in the incidence according to type of diabetes was statistically significant. In non insulin dependent diabetes mellitus patients, the incidence of fungal isolation from toe webs was statistically significantly higher (30.1%) than in insulin dependent diabetes mellitus patients (19.8%).     

Superficial fungal infections in 102 renal transplant recipients: a case-control study

BACKGROUND: Renal transplant recipients are predisposed to superficial fungal infections caused by graft-preserving immunosuppressive therapy. Reports have documented a wide range of prevalence rates for superficial fungal infections in this patient group. OBJECTIVE: The aim of this study was to determine the prevalence and clinical and mycological features of superficial fungal infections in renal transplant recipients at our center. METHODS: One hundred two consecutively registered renal transplant recipients (34 women, 68 men) and 88 healthy age- and sex-matched persons acting as controls (30 women, 58 men) underwent screening for the presence of superficial fungal infection. Skin scrapings and swabs were obtained from the dorsum of the tongue, upper part of the back, toe webs, and any suspicious lesions. Nail clippings were also collected. All samples were examined by direct microscopy and were stained with calcofluor white. The samples were cultured in Sabouraud dextrose agar, mycobiotic agar, and dermatophyte test medium. Candida species were identified on the basis of germ-tube production, spore formation in cornmeal agar, and results of biochemical testing. Dermatophytes were identified on the basis of colonial and microscopic morphologic features in conjunction with results of physiologic evaluation (in vitro hair perforation test, urease activity, temperature tolerance test, and nutritional test). RESULTS: Sixty-five (63.7%) of the 102 renal transplant recipients had cutaneous-oral candidiasis, dermatophytosis, or pityriasis versicolor, whereas only 27 (30.7%) of controls had fungal infection. Pityriasis versicolor was the most common fungal infection in the patient group (36.3%), followed by cutaneous-oral candidiasis (25.5%), onychomycosis (12.7%), and fungal toe-web infection (11.8%). Pityriasis versicolor and oral candidiasis were significantly more common among the renal transplant recipients, whereas the frequency of dermatophytosis in patients and controls was similar. Candida albicans was the main agent responsible for oral candidiasis, and Trichophyton rubrum was the most common dermatophyte isolated. Analysis showed that age, sex, and duration of immunosuppression did not significantly affect the prevalence of superficial fungal infection. Cyclosporine treatment and azathioprine therapy were identified as independent risk factors for superficial fungal disease. CONCLUSIONS: The prevalence of opportunistic infections with Pityrosporum ovale and C albicans is increased among renal transplant recipients, probably owing to the immunosuppressed state of this patient population. However, renal transplant recipients are not at increased risk of dermatophytosis.     

Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand

Two thousand patients who visited the outpatient department at the Institute of Dermatology, Bangkok, were assessed for the presence of foot diseases by questionnaire and physical examination. Abnormalities were detected in 741 individuals (37.1%). Nonfungal conditions were more prevalent (31.4%), mainly consisting of eczema (254 cases, 12.7%) and psoriasis (176 cases, 8.8%). Fungal disease was observed in 119 cases (6.0%). There were 76 cases (3.8%) with tinea pedis and 33 cases (1.7%) with onychomycosis. The identified organisms causing tinea pedis were 57.9% nondermatophyte moulds, 36.8% dermatophytes, and 2.6%Candida spp. The corresponding organisms causing onychomycosis were 51.6% nondermatophyte moulds, 36.3% dermatophytes, and 6.0%Candida spp. Among nondermatophytes, Scytalidium dimidiatum was the leading pathogen while Trichophyton rubrum and T. mentagrophytes were the predominant dermatophytes identified. Diabetes mellitus, peripheral vascular disease and activities related to foot trauma were noted to be predisposing factors for onychomycosis. Footwear, particularly sandals and cut shoes, was the only factor relevant to individuals with tinea pedis (P < or = 0.05). In contrast with other published data on fungal foot infections, this study disclosed a higher prevalence of nondermatophyte organisms, predominantly S. dimidiatum, as the major cause of tinea pedis and onychomycosis. An increase in awareness is necessary to identify such cases, prevent misdiagnosis and initiate appropriate treatment.     

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.     

Prevalence and epidemiology of onychomycosis

The prevalence of onychomycosis has been estimated at approximately 6.48% (95% confidence interval 6.09-6.88%) within the Canadian population. Dermatophytes are the most commonly cultured organisms, appearing in approximately 75 to 91% of nails with fungal involvement, with Trichophyton rubrum and Tricophyton mentagrophytes most commonly isolated. However, Candida spp and nondermatophyte molds are also sometimes cultured. The most common presentation is distal and lateral subungual onychomycosis (DLSO), which can involve 75% of patients with pedal onychomycosis. The distribution of DLSO, superficial white onychomycosis, and proximal subungual onychomycosis (PSO) has been reported to be 360:59:1 in patients with mycologic confirmation of onychomycosis; however, some reported that the incidence of PSO is slightly higher in immunocom-promised individuals. Age, gender, family history, and the presence of tinea pedis are all elements associated with a nail fungal infection. In addition, many conditions, including diabetes mellitus, immune disorders, and vascular disease, have been associated with the presence of onychomycosis. When choosing the best treatment regimen for individuals with onychomycosis, it is very important to consider all of the factors involved, including the infecting species, the presentation of the disease, the level of disease progression, and its predisposing factors.     

兰州地区浅部真菌病及病原菌种类分析

目的　了解兰州地区浅部真菌病发病情况及病原菌菌种分布特点。方法　对临床拟诊为浅部真菌病的患者 14 43例 ,取标本行 10 %KOH涂片镜检、分离培养及菌种鉴定。登记镜检阳性患者的相关临床资料 ,分析浅部真菌病的发病特点。结果　真菌镜检阳性 5 94例 (4 1.2 % ) ,主要为足癣 2 3 0例 (3 8.7% )、甲真菌病 165例 (2 7.8% )、手癣 80例(13 .5 % ) ;分离菌株 2 2 1株 ,其中红色毛癣菌 97株 (4 3 .9% )、须癣毛癣菌 65株 (2 9.4% )、念珠菌 3 1株 (14 .0 % ) ,其他菌种2 8株 (12 .7% )。结论　兰州地区浅部真菌病中足癣最常见 ;致病菌以红色毛癣菌占首位 ,须癣毛癣菌位于第二 ,念珠菌居第三。     

Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002

BACKGROUND: Cutaneous fungal infections are common in the United States, and causative organisms include dermatophytes, yeasts, and nondermatophyte molds. These organisms are in constant competition for their particular environmental niche, often resulting in the emergence of one or more predominant pathogens and displacement of other less competitive species. Changes in the incidence of fungal pathogens can be followed from laboratory culture results of infected cutaneous tissues over time. These data can be used to ascertain past and present trends in incidence, predict increases in antifungal resistance and the adequacy of our current pharmacologic repertoire, and provide insight into future developments. OBJECTIVE: This study identifies epidemiologic trends and the predominant organisms causing superficial fungal infections in the United States. METHODS: A total of 15,381 specimens were collected from clinically suspected tinea corporis, tinea cruris, tinea capitis, tinea faciei, tinea pedis, tinea manuum, and finger and toe onychomycosis from 1999 through 2002. Specimens were submitted to the Center for Medical Mycology in Cleveland, Ohio, for fungal culture and identification, and the incidence of each species was calculated. RESULTS: Dermatophytes remain the most commonly isolated fungal organisms except from clinically suspected finger onychomycosis, in which case Candida species comprise >70% of isolates. Trichophyton rubrum remains the most prevalent fungal pathogen, and increased incidence of this species was observed in finger and toe onychomycosis, tinea corporis and tinea cruris, tinea manuum, and tinea pedis. As the causal agent of tinea capitis, T tonsurans continues to increase in incidence, achieving near exclusionary proportions in the United States. CONCLUSION: Consideration of the current epidemiologic trends in the incidence of cutaneous fungal pathogens is of key importance to investigational efforts, diagnosis, and treatment.     

Tinea pedis in European marathon runners

BACKGROUND: Epidemiological studies suggest that 15% of the population in industrial countries suffer from tinea pedis (athlete's foot) and that persons who do sports are a high-risk population. OBJECTIVE: To investigate the responsibility of dermatophytes in interdigital lesions of the feet in European marathon runners and to identify associated risk factors. SUBJECTS AND METHODS: Runners of the 14th Médoc Marathon (n = 147) were interviewed on risk factors for tinea pedis and underwent physical and mycological examinations. RESULTS: Interdigital lesions of the feet were found in 66 runners (45%). A dermatophyte was isolated in 45 runners (31%), 12 of whom were asymptomatic. Trichophyton interdigitale and T. rubrum accounted for 49% and 35.5%, respectively, of the cases of tinea pedis. Thirty-three (22%) of the 102 runners free of dermatophyte infection had lesions resembling those of tinea pedis. Increasing age and use of communal bathing facilities were predictive of T. rubrum culture. CONCLUSIONS: Marathon runners are at high risk for tinea pedis, but dermatophytes are responsible for only half of the foot lesions found in runners. The existence of asymptomatic carriers calls for prophylactic measures.     

Ciclopirox gel in the treatment of patients with interdigital tinea pedis

Background Tinea pedis (athlete’s foot) is the most common fungal infection in the general population. Ciclopirox, a broad‐spectrum hydroxypyridone antifungal, has proven efficacy against the organisms commonly implicated in tinea pedis: Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum. Objective Two multicenter, double‐blind, clinical studies compared the efficacy and safety of ciclopirox gel with that of its vehicle base in subjects with moderate interdigital tinea pedis with or without plantar involvement. Methods Three hundred and seventy‐four subjects were enrolled and randomized to one of two treatment groups: ciclopirox gel 0.77%, or ciclopirox gel vehicle, applied twice daily for 28 days, with a final visit up to day 50. The primary efficacy variable was Treatment Success defined as combined mycological cure and clinical improvement 75%. Secondary measures of effectiveness were Global Clinical Response, Sign and Symptom Severity Scores, Mycological Evaluation (KOH examination and final culture result), Mycological Cure (negative KOH and negative final culture results) and Treatment Cure (combined clinical and mycological cure). Results At endpoint (final post‐baseline visit), 60% of the ciclopirox subjects achieved treatment success compared to 6% of the vehicle subjects. At the same time point, 66% of ciclopirox subjects compared with 19% of vehicle subjects were either cleared or had excellent improvement. Pooled data showed that 85% of ciclopirox subjects were mycologically cured, compared to only 16% of vehicle subjects at day 43, 2 weeks post‐treatment. Conclusions Ciclopirox gel 0.77% applied twice daily for 4 weeks is an effective treatment of moderate interdigital tinea pedis due to T. rubrum, T. mentagrophytes and E. floccosum and is associated with a low incidence of minor adverse effects.     

江西省农村地区浅部真菌病现场调查及致病菌的研究

目的 了解江西省农村地区居民浅部真菌病构成情况及致病菌的种类。方法 2006年9月至2007年6月对江西省的11个地市、54个县区的66个乡（镇）、村居民以义诊的形式进行浅部真菌病现场调查，同时对513例具有典型临床表现且真菌镜检阳性的皮损进行真菌培养。结果 共调查浅部真菌病患者1284例，其中务农者947例，占73.75%。浅部真菌病包括足癣736例（57.32%）、手癣202例（15.73%）、甲真菌病72例（5.61%）、体癣47例（3.66%）、股癣29例（2.26%）、花斑癣23例（1.79%）、头癣1例、皮肤念珠菌病1例、手足癣135例（10.51%）、手癣合并指甲真菌病12例、足癣合并趾甲真菌病10例、手足癣合并指趾甲真菌病8例、体股癣3例、手癣合并体癣2例，以及手足癣合并体癣、足癣合并花斑癣、足癣合并体癣各1例。分离出致病真菌480株，其中红色毛癣菌301株、白念珠菌88株、须毛癣菌41株、其他菌50株。结论 浅部真菌病的致病菌以红色毛癣菌占优势，白念珠菌第二，各地市之间菌种分布构成差异无统计学意义。     

Prevalence and awareness of tinea pedis in Italian sailors

BACKGROUND: It is difficult to carry out studies on the prevalence of tinea pedis in the community. Some studies are performed on selected groups of subjects, exposed to the same risk factors, i.e. schoolchildren, public bathers, athletes and military men. OBJECTIVE: The aim of this work was to detect in a sample of military men the prevalence of tinea pedis and the awareness of their condition, and to relate the infection to risk factors of the group as well. METHODS: 410 male Italian navy cadets in an Italian navy petty officers school were clinically examined and mycological cultures were performed, employing the skin scrapings obtained from suspected lesions. RESULTS: Dermatophytes were isolated from toe clefts in 10 subjects, giving a point prevalence of 2.4% (95% confidence interval 1.3-4.4%). The isolated dermatophytes were Trichophyton mentagrophytes (70%), Trichophyton rubrum (20%) and Epidermophyton floccosum (10%). None of the subjects was aware of his disease. No significant association was observed between tinea pedis and risk factors (i.e. hyperhidrosis and habits). CONCLUSION: The prevalence in our sample was lower than that observed in previous studies on military men. That can be attributed to the general amelioration of hygienic conditions and strengthening of preventive habits. Therefore the prevalence of tinea pedis in Italian sailors seems to be reduced but still rather relevant. That is important because these subjects are a reservoir of ringworm infection.     

Tinea pedis and erythrasma in Danish recruits: Clinical signs, prevalence, incidence, and correlation to atopy

Prior to military service, 665 recruits were examined clinically and microbiologically for tinea pedis and erythrasma and 546 of these were reexamined at the end of military service. The prevalence of clinical signs, erythrasma, and dermatophyte infection at the first investigation was 58.8%, 51.3%, and 6.2%, respectively, and at the second investigation, 81.1%, 77.1%, and 7.0%, respectively. The incidence of tinea pedis was 4.2% during the 9 months of military service. Of those infected at the first visit 41% had persistent infection mainly due to Trichophyton rubrum, whereas new infections were largely caused by Trichophyton mentagrophytes. Some of those persistently infected had signs of chronicity at the follow-up visit, indicating that chronic dermatophytosis may become established in the early twenties. The prevalence of atopy was 15.0% in all the recruits but was almost 50% in those with persistent tinea pedis.     

Interdigital tinea pedis (dermatophytosis simplex and complex) and treatment with ciclopirox 0.77% gel

The most common presentation of tinea pedis (athlete's foot) is that involving the interdigital spaces. Tinea pedis interdigitalis may present as asymptomatic dermatophytosis simplex or dermatophytosis complex, which is symptomatic, with secondary bacterial infection. In the dermatophytosis complex presentation there may be inflammation, maceration and odor, with bacterial involvement. Ciclopirox gel offers advantages in the treatment of tinea pedis, especially in the dermatophytosis complex presentation, with antifungal, antibacterial, and anti-inflammatory activity; furthermore, the gel formulation is fast drying, which is an advantage when the toe web area is moist.