Management and morbidity of cellulitis of the leg.
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Ascending cellulitis of the leg is a common emergency. An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy. Case notes were reviewed for 92 patients admitted to hospital under adult specialties. Mean duration of inpatient therapy was 10 days. A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis. Pathogens were rarely identified, group G streptococci being the single most frequent organism. Benzylpenicillin was administered in only 43 cases. Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently. Ascending cellulitis of the leg has substantial short-term and long-term morbidity. Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect. The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful. (+info)
Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain.
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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). (+info)
Lactoferrin given in food facilitates dermatophytosis cure in guinea pig models.
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Dermatophytosis is the most common skin infection caused by dermatophytic fungi, such as Trichophyton spp. We studied the in vitro and in vivo antifungal effects of lactoferrin against Trichophyton. Human and bovine lactoferrin, and a bovine lactoferrin-derived peptide, lactoferricin B, showed in vitro antifungal activity that was dependent on the test strain and medium used. In guinea pigs infected on the back with Trichophyton mentagrophytes (i.e. those with tinea corporis), consecutive daily po administration of bovine lactoferrin did not prevent development of symptoms during the early phase of infection, but facilitated clinical improvement of skin lesions after the peak of the symptoms. The fungal burden in lesions was less in guinea pigs that had been given lactoferrin than in untreated controls 21 days after infection. In guinea pigs infected on the foot with T. mentagrophytes (i.e. those with tinea pedis), the fungal burden of the skin on the heel portion of the infected foot 35 days after infection was lower in animals fed lactoferrin than in controls. These results suggest the potential usefulness of lactoferrin as a food component for promoting dermatophytosis cure. (+info)
In vitro antifungal activity of KP-103, a novel triazole derivative, and its therapeutic efficacy against experimental plantar tinea pedis and cutaneous candidiasis in guinea pigs.
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The in vitro activity of KP-103, a novel triazole derivative, against pathogenic fungi that cause dermatomycoses and its therapeutic efficacy against plantar tinea pedis and cutaneous candidiasis in guinea pigs were investigated. MICs were determined by a broth microdilution method with morpholinepropanesulfonic acid-buffered RPMI 1640 medium for Candida species and with Sabouraud dextrose broth for dermatophytes and by an agar dilution method with medium C for Malassezia furfur. KP-103 was the most active of all the drugs tested against Candida albicans (geometric mean [GM] MIC, 0.002 microg/ml), other Candida species including Candida parapsilosis and Candida glabrata (GM MICs, 0.0039 to 0.0442 microg/ml), and M. furfur (GM MIC, 0.025 microg/ml). KP-103 (1% solution) was highly effective as a treatment for guinea pigs with cutaneous candidiasis and achieved mycological eradication in 8 of the 10 infected animals, whereas none of the imidazoles tested (1% solutions) was effective in even reducing the levels of the infecting fungi. KP-103 was as active as clotrimazole and neticonazole but was less active than lanoconazole and butenafine against Trichophyton rubrum (MIC at which 80% of isolates are inhibited [MIC(80)], 0.125 microg/ml) and Trichophyton mentagrophytes (MIC(80), 0.25 microg/ml). However, KP-103 (1% solution) exerted therapeutic efficacy superior to that of neticonazole and comparable to those of lanoconazole and butenafine, yielding negative cultures for all samples from guinea pigs with plantar tinea pedis tested. This suggests that KP-103 has better pharmacokinetic properties in skin tissue than the reference drugs. Because the in vitro activity of KP-103, unlike those of the reference drugs, against T. mentagrophytes was not affected by hair as a keratinic substance, its excellent therapeutic efficacy seems to be attributable to good retention of its antifungal activity in skin tissue, in addition to its potency. (+info)
A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong.
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OBJECTIVE: To study the epidemiology of foot diseases, including tinea pedis and onychomycosis in clinic attendees in Hong Kong. METHODS: Two groups were included: the institutional group consisted of clinical evaluation and mycological investigations by dermatologists; and the private group consisted of clinical evaluation only by the private physicians. Patients who had a regular visit to the clinics were randomly invited to have a clinical examination of their feet. RESULTS: A total of 1014 patients were studied. The prevalence rate of foot disease, fungal infections, tinea pedis and toe nail onychomycosis were respectively 50.7%, 26.9%, 20.4% and 16.6%. More male and elderly patients were affected except that the sex prevalence in toe nail onychomycosis was not shown to be significant. Vascular disease, diabetes mellitus and obesity were the three most prevalent predisposing factors in foot disease, fungal disease and fungal nail disease. Dermatophytes, in particular Trichophyton rubrum, were shown to be the most common pathogen in both skin and nail infections. CONCLUSIONS: Foot diseases, especially tinea pedis and toe nail onychomycosis, are common in patients attending local clinics in Hong Kong. Both physicians and patients should be more aware of foot problems and have more active approaches and management strategies. (+info)
Therapeutic efficacy of topically applied KP-103 against experimental tinea unguium in guinea pigs in comparison with amorolfine and terbinafine.
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The therapeutic efficacy of KP-103, a novel topical triazole, in a guinea pig tinea unguium model was investigated. Experimental tinea unguium and tinea pedis were produced by inoculation of Trichophyton mentagrophytes SM-110 between the toes of the hind paw of guinea pigs. One percent solution (0.1 ml) of KP-103, amorolfine, or terbinafine was topically applied to the nails and whole sole of an infected foot once daily for 30 consecutive days, and terbinafine was also orally administered at a daily dose of 40 mg/kg of body weight for 30 consecutive days, starting on day 60 postinfection. The fungal burdens of nails and plantar skin were assessed using a new method, which makes it possible to recover infecting fungi by removing a carryover of the drug remaining in the treated tissues into the culture medium. Topically applied KP-103 inhibited the development of nail collapse, significantly reduced the fungal burden of the nails, and sterilized the infected plantar skin. On the other hand, topical amorolfine and topical or oral terbinafine were ineffective for tinea unguium, although these drugs eradicated or reduced the fungal burden of plantar skin. The in vitro activities of amorolfine and terbinafine against T. mentagrophytes SM-110 were 8- and 32-fold, respectively, decreased by the addition of 5% keratin to Sabouraud dextrose broth medium. In contrast, the activity of KP-103 was not affected by keratin because its keratin affinity is lower than those of the reference drugs, suggesting that KP-103 largely exists in the nails as an active form that was not bound to keratin and diffuses in the nail without being trapped by keratin. The effectiveness of KP-103 against tinea unguium is probably due to its favorable pharmacokinetic properties in the nails together with its potent antifungal activity. (+info)
Skin disease among staff in a large Korean nursing home.
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Although previous studies have documented reasonably high rates of skin disease among nursing home staff, the prevalence among Korean workers is not well known. For this investigation we selected a large Korean nursing home and distributed a skin disease questionnaire to all staff. Questions included job title, job description, employment history, working hours, patient contact and the occurrence of skin disease over the past 12 months. Workers who reported a dermatological problem then underwent skin examinations conducted by specialist occupational physicians and a dermatologist. Contact dermatitis was the most common skin disease detected, with 4.8% of staff currently suffering from it and 6.0% reporting it in the previous 12-month period. Tinea pedis was another common condition, affecting 3.6% on our examination day. However, only two-thirds of them (2.4%) recounted a past history of tinea pedis. Scabies was diagnosed among 2.4% of staff and reported as a previous infection by 6.0%. Overall, the prevalence of dermatitis and scabies were quite low when compared to previous studies, while fungal infection rates were similar to other investigations. Further research into this growing occupational demographic is indicated. (+info)
Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy.
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The aetiology of vesicular eruptions on the palms and on the sides of the fingers (pompholyx) is unclear. The present study was undertaken to establish whether tinea pedis, atopic dermatitis or nickel allergy is a risk factor for development of vesicular eruptions. Three-hundred-and-ninety-eight individuals (included from an ongoing population study on hand eczema in twins) were included. A history of previous hand eczema and atopic dermatitis was taken, and a clinical examination including a patch test with nickel was performed. A test sample for tinea pedis was taken from the fourth interdigital space on the right foot. The relative risk for vesicular eruptions present in individuals with tinea pedis was 3.58 (confidence limits 1.19-10.82, p < 0.05). For individuals with atopic dermatitis, relative risk was 1.44 (confidence limits 0.34-6.07, n.s.) and for those with nickel allergy it was 0.45 (confidence limits 0.06-3.36, n.s.). A relationship between tinea pedis and vesicular eruptions on the hands was statistically confirmed in the present study. In this part of the population study material, no association with atopic dermatitis or nickel allergy was observed. (+info)