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).     

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.     

足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用

目的探讨足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用。 方法对2016年7月至2017年7月武汉钢铁(集团)公司第二职工医院足病科收治的符合入选标准的387例糖尿病患者进行足部综合干预。由足病修复师对糖尿病足高危人群进行筛查、宣教及专人干预,对患者足部外观、足部周围神经及周围血管等情况进行检查,通过微信群、复诊、回访加强对患者及家属的足部相关知识教育,提高患者的自我防护意识;收集患者的相关信息,建立患者管理档案,开展糖尿病足分级管理;对糖尿病足高危因素进行筛查,依据患者的年龄、基础状况确定血糖的控制目标并将其控制在目标范围内,调节患者血压和血脂,戒烟,制定合适的饮食、运动及生活方式方案。根据以上内容对患者进行为期1年的干预,对筛查发现有足部疾病的患者,及早采取相应的治疗及预防措施。分别于患者入院时、足部综合干预1年期间每个月对患者足部外观异常情况(有无足癣、甲癣、胼胝、鸡眼及足部畸形的发生),足部周围神经(触觉、温度觉、震动觉、痛觉、跟腱反射)以及周围血管情况(皮肤温度、足背动脉搏动、胫后动脉搏动、足部水肿、足部青紫、足部溃疡及足部麻木或疼痛)进行检查并记录,对患者入院时及足部综合干预1年后末次检查时的上述指标情况进行比较。数据比较采用χ²检验。 结果末次检查时,患者足部的足癣、甲癣、胼胝的发生率分别为35.66%(138/387)、59.17%(229/387)、24.81%(96/387),均明显低于入院时[77.52%(300/387)、72.35%(280/387)、53.23%(206/387)],差异均有统计学意义(χ²＝138.081、14.974、65.754,P<0.05);末次检查时,患者足部周围神经检查结果中10 g尼龙丝触觉、温度觉、震动觉、痛觉、跟腱反射检查异常发生率分别为14.47%(56/387)、37.73%(146/387)、13.70%(53/387)、14.47%(56/387)、17.05%(66/387),均明显低于入院时[60.72%(235/387)、81.91%(317/387)、29.20%(113/387)、40.31%(156/387)、42.64%(165/387)],差异均有统计学意义(χ²＝176.503、157.235、27.658、65.015、60.530,P<0.05);末次检查时,患者足部周围血管检查结果中皮肤温度改变、足背动脉搏动异常、胫后动脉搏动异常、足部水肿、足部青紫及足部麻木或疼痛发生率分别为12.40%(48/387)、28.17%(109/387)、34.11%(132/387)、28.94%(112/387)、30.23%(117/387)、11.11%(43/387),均明显低于入院时[32.30%(125/387)、64.34%(249/387)、62.53%(242/387)、77.00%(298/387)、78.30%(303/387)、17.83%(69/387)],差异均有统计学意义(χ²＝44.188、101.918、62.655、118.143、180.159、7.106,P<0.05),而患者足部溃疡发生率末次检查时为6.72%(26/387),低于入院时[9.82%(38/387)],比较差异无统计学意义(P>0.05)。 结论足病修复师综合干预可以通过安全有效地降低足癣、甲癣、胼胝的发生率以及降低足部周围神经和周围血管检查相关项目结果异常的发生率,从而延缓糖尿病足高危因素对糖尿病患者的损伤,进一步防止糖尿病足溃疡的发生。     

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.     

Onychomycosis--epidemiology, diagnosis and management

Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or nondermatophyte molds and represents about 30% of mycotic cutaneous infections. Increasingly onychomycosis is being viewed as more than a mere cosmetic problem. In spite of improved personal hygiene and living environment, onychomycosis continues to spread and persist. The prevalence rate of onychomycosis is determined by age, predisposing factor, social class, occupation, climate, living environment and frequency of travel. Onychomycosis in immunocompromised patients can pose a more serious health problem. Dermatophytes are the most frequently implicated causative agents in onychomycosis. Previously regarded as contaminants, yeasts are now increasingly recognised as pathogens in fingernail infections, as are some moulds. Clinical diagnosis of onychomycosis is based on the patients' history; a physical examination, microscopy and culture of nail specimens. The treatment of onychomycosis has been attempted throughout the ages, but only in the last two decades have safe, effective systemic treatments been available for this chronic superficial fungal disease. Oral Griseofulvin and Ketoconazole; once the agents of choice for the treatment of onychomycosis, have been superseded by newer systemic compounds that have a higher cure and lower relapse rates, cause fewer side effects and are suitable for short-term dosing.     

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.     

Mycoses in Thailand: current concerns.

Scytalidium dimidiatum is the leading cause of fungal foot diseases in Thailand, in contrast to similar studies in which dermatophytes have been identified as the predominant pathogens. By contrast, the prevalence of Candida albicans in our study was only 2.6 approximately 3.0%. Scytalidium fungal foot infection is clinically indistinguishable from that caused by dermatophytes and should be included as a possible cause of treatment failure in tinea pedis and onychomycosis. Without proper culture identification, clinically diagnosed patients would be treated with a standard antifungal regimen leading to minimal response and be interpreted as drug resistant cases resulting in switching of drugs and more aggressive management procedures. Tinea capitis is another health problem in young children. However, for Microsporum canis and some ectothrix organisms, the effectiveness of treatment may be less than endothrix infection. Griseofulvin is still the mainstay antifungal although itraconazole and terbinafine are as effective. Pulse regimen may be another option with advantages of increased compliance and convenience. Two pulses of terbinafine may be sufficient for treating most cases of Microsporum infection, although additional treatment may be needed if clinical improvement is not evident at week 8 after initiating therapy. Chromoblastomycosis is another subcutaneous infection that requires long treatment duration with costly antifungal drugs. The most common pathogen in Thailand is Fonsecaea pedrosoi. Preliminary study of pulse itraconazole 400 mg/d 1 week monthly for 9-12 consecutive months showed promising results. The prevalence of Penicillium marneffei infection is alarming in HIV infected patients living in endemic areas. Diagnosis relies on direct examination of the specimens and confirmation by culture. Treatment regimens include systemic amphotericin B or itraconazole followed by long-term prophylaxis. Treatment outcome depends on the immune status of the patient.     

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.     

Predisposing factors,clinical features and treatment outcomes of Fusarium onychomycosis and comparison of its characteristics with Neoscytalidium onychomycosis

BackgroundFusarium spp. are common organisms causing onychomycosis. Research on the clinical presentations and treatment of this condition is limited.ObjectiveThis study evaluated the demographic data, clinical characteristics, and treatment outcomes of Fusarium onychomycosis.MethodsA retrospective study was conducted at Siriraj Hospital, Thailand. Patients with onychomycosis, at least 2 repeated positive mycological cultures for Fusarium spp., and a photo at diagnosis (January 2014–December 2019) were included. Demographic data and clinical characteristics of Fusarium onychomycosis were analyzed and compared with those of Neoscytalidium onychomycosis, the other common nondermatophytes onychomycosis in tropical countries.ResultsSeventeen patients with twenty-four nails were analyzed. Fusarium onychomycosis was significantly related to a history of pedicure (p = 0.04). Predominant lateral involvements of subungual hyperkeratosis onychomycosis, but without concurrent foot infections, were significantly found in Fusarium onychomycosis (p < 0.001 for each). Among the treatments, urea was 80% effective. Topical amphotericin B was 75% effective. Both amorolfine 5% nail lacquer and long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet laser were 66.7% effective. Lastly a combination of long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet laser and amorolfine 5% nail lacquer was 50% effective.ConclusionsImportant predisposing factors and clinical manifestations of Fusarium onychomycosis were a history of pedicure and predominant lateral-nail involvement, but no concomitant fungal foot infections. Topical treatment (urea cream, amphotericin B, or amorolfine nail lacquer) showed excellent outcomes.     

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.     

Tinea pedis: The etiology and global epidemiology of a common fungal infection

Abstract

Tinea pedis, which is a dermatophytic infection of the feet, can involve the interdigital web spaces or the sides of the feet and may be a chronic or recurring condition. The most common etiological agents are anthropophiles, including Trichophyton rubrum sensu stricto, which is the most common, followed by Trichophyton interdigitale and Epidermophyton floccosum. There has been a change in this research arena, necessitating a re-evaluation of our knowledge on the topic from a multidisciplinary perspective. Thus, this review aimed to provide a solid overview of the current status and changing patterns of tinea pedis. The second half of the twentieth century witnessed a global increase in tinea pedis and a clonal spread of one major etiologic agent, T. rubrum. This phenomenon is likely due to increases in urbanization and the use of sports and fitness facilities, the growing prevalence of obesity and the aging population. For optimal patient care and management, the diagnosis of tinea pedis should be verified by microbiological analysis. In this review, we discuss the epidemiology, clinical forms, complications and mycological characteristics of tinea pedis and we highlight the pathogenesis, prevention and control parameters of this infection.     

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.     

Monthly cycles of 1-week therapy with itraconazole for patients with Tinea pedis]

Monthly cycles of 1-week therapy with oral itraconazole at 200 mg daily for tinea pedis was assessed to determine its acceptability to patients. Thirty-four patients (17 men and 17 women) with intractable tinea pedis, with informed consent, took 200 mg of itraconazole once daily for one week over a month period until mycological studies showed negative results for up to 4 months. The overall mycological effectiveness was about 80% after this therapy. Information was also gathered on the influence of this therapy on the patients quality of life by questionnaires. Nineteen (70%) among the 27 patients who answered the questionnaire preferred this 1-week administration of itraconazole over a month-long period compared with continuous daily therapy. Twenty-two (81%) preferred this therapy over topical treatment. We recommend to this therapy be added for the treatment of intractable tinea pedis.     

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.     

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.     

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.     

Guidelines for clinical evaluation of topical antifungal agents]

The Japanese Society for Medical Mycology (JSMM) decided in 2002 to establish guidelines for the clinical evaluation of antifungal agents. The JSMM committee presents here guidelines for the clinical evaluation of topical antifungal agents in the dermatology field. Guidelines for the Clinical Evaluation of Antibiotic Agents established by the Japanese Society of Chemotherapy were referred to, and the diseases subjected to clinical evaluation include tinea (tinea pedis and tinea glabrosa), cutaneous candidiasis, and pityriasis versicolor. Among superficial mycoses, tinea pedis is viewed as the pivotal disease because it is intractable and is the most common. Therefore, the clinical efficacy of antifungal agents for external use in this condition should be established, and tinea pedis is subjected to phase III clinical studies. If efficacy of the antifungal agents is confirmed in the treatment of tinea pedis, a comparative study need not necessarily be performed for tinea glabrosa. If the number of patients is adequate for statistical analysis, a comparative study should be considered for both cutaneous candidiasis and pityriasis versicolor. However, if the number of patients is low, the efficacy of the agents should be evaluated based on their antifungal activity on pathogens and the results of open trials, and a comparative study is not necessarily performed for such diseases. The safety should be strictly evaluated.     

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.     

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.     

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.