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Dermatophytes are a group of parasitic fungi that live at the expense of the keratin in the skin, nails and hair. They are generally confined to the stratum corneum of the epidermis and skin appendages, particularly in the tropics, where heat and humidity provide the ideal conditions for the growth of fungi that cause cutaneous infections. The dermatophytes that usually cause only superficial infections of the skin are grouped into three genera: Trichophyton, Microsporum, and Epidermophyton. They can be classified into three groups according to their normal habitats: anthropophilic species, zoophilic species and geophilic species. Dermatophyte infections are subclassified in Latin names according to the sites of skin involved, e.g. Tinea faciei, Tinea manuum, Tinea corporis, Tinea cruris, Tinea pedis, Tinea capitis, Tinea unguium. Trichophyton rubrum is the most common cause worldwide for superficial dermatophytosis. By their metabolic activity they produce inflammatory responses in the form of erythema, scaling, postulation and micro-abscess formation giving rise to itching and discomfort. The high prevalence rate of superficial dermatophytic infection has shown that 20-25% of the world’s population. The diagnosis was confirmed on the basis of clinical presentation, KOH examination of skin and would light examination. The article also discusses the main treatments for superficial dermatophytosis, with a practical approach to the most commonly used topical and systemic drugs, referring also to their dosage and duration of use in different types of the dermatophytic infection. Keywords: Dermatophytosis; Trichophyton rubrum; Tinea; KOH examination.

Introduction Palmoplantar dermatoses are skin diseases affecting specifically palms and soles is a common clinical entity encountered by dermatologists. This may cause discomfort and embarrassment to the patients because its location interferes significantly with normal day-to-day activities. Palmoplantar dermatosis affects a heterogeneous population, ranging from bare-handed workers in the slaughterhouse to medical personnel wearing gloves in the operating room. The present study endeavors to classify palmoplantar dermatoses based on their morphology and the clinical distribution pattern. Materials and methods The present study is a descriptive cross-sectional study conducted for six months at Osmania General Hospital, India. A total number of 80 patients having palmoplantar dermatoses who met the study inclusion criteria were included. After taking proper informed consent, data were collected from patients on a fixed proforma sheet. Results The study comprised 44 (55%) male and 36 (45%) female patients. The mean duration of palmoplantar dermatoses was 2.92 years. Itching and painful fissures are the most common symptoms patients complained of and psoriasis is the most common clinical type seen in 32 (40%) patients followed by eczemas in 30 (37.5%) patients and fungal infections in 10 (12.5%) patients. Conclusion The term palmoplantar dermatoses includes a heterogeneous group of skin disorders but no exact classification is present and classes differ based on the diseases to be kept in a group. Physicians should be well aware of the clinical features of these dermatoses and diagnosis is very important for early intervention and correct management, thereby helping improve patients' quality of life.

Ringworm infection is a common but frequently misdiagnosed skin disease. An 81-year-old woman presented with a complaint of mild itch of the third and fourth fingers of her right hand and the toes of both feet. A crusted rash was seen on the right hand and both feet. The results of potassium hydroxide testing were positive for filamentous fungi. The diagnosis of two feet-one hand syndrome was made. The rash was treated successfully by topical ketoconazole. Recognition of this typical distribution of the rash may help make a prompt diagnosis of ringworm infection.

Fish tank granuloma is a rare skin infection caused by Mycobacterium marinum. It occurs after exposure of skin abrasions to contaminated water or infected fish. The majority of M. marinum infections today are fish tank-related. The most common presentation is a solitary nodule, often with sporotrichoid spread. Other presentations do not occur often. The diagnosis is often delayed because of lack of suspicion, nonspecific histopathological findings, and frequently unsuccessful cultivation. Here we present the case of a 37-year-old male with M. marinum skin infection, presenting as erythematous scaling plaques. Because the initial results of laboratory and histopathological examinations were negative for a fungal infection or nontuberculous mycobacteria, the patient was treated empirically with several systemic antibiotics and antifungals without any success. Finally, the diagnosis of fish tank granuloma was confirmed 3 months after the initial presentation of the patient. After the introduction of treatment with rifampicin and clarithromycin, complete clinical remission was observed after 6 months of therapy.

Introduction: Dermatophytes are a group of morphologically related keratinophilic fungi that invade keratinized tissue (skin, hair, and nails) of humans and warm-blooded animals to produce clinical lesions (dermatophytosis). Clinical lesions are traditionally divided according to the site infected, namely, scalp (tinea capitis), feet (tinea pedis, commonly called “athletes’ foot”), groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”), beard (tinea barbae), hands (tinea manuum, toe nails or finger nails (tinea unguium, also called onychomycosis), face, non-bearded area (tinea faciei) and other parts of the body, such as arms, abdomen, or legs (tinea corporis). Dermatophytosis is common world-wide and is caused by species of three genera of dermatophytes, namely Microsporum, Trichophyton, and Epidermophyton. This study presents an update of ecology of different species of dermatophytes and epidemiology of infections caused by them in the Caribbean. Possibility of herbal therapy of these infections as an alternative treatment is also dealt with. Methods: A thorough search of literature was made using PubMed, MEDLINE, Biomed Lib, Med Facts, and different sets of key words, viz. dermatophytes, tineas in Caribbean, occurrence in animals, soil etc. Results: It was revealed that incidence of dermatophytic infections and their epidemiologic characteristics depend on social, geographic, and environmental factors and may change with passage of time. For instance, prior to year 2000, the major cause of tinea capitis in North America for 100 years was Microsporum canis followed by M. audouinii; Since 1950 Trichophyton tonsurans has advanced from Mexico and the Caribbean to be currently a major cause of tinea capitis in North America. The two dermatophytes Microsporum gypseum and M. fulvum, and several Chrysosporium species have been frequently isolated form soils in different countries in the Caribbean. Conclusions: There is almost complete lack of information on human infections due to dermatophytes in several Caribbean countries. The preponderant occurrence of M. fulvum in Anguilla soils with comparatively rare isolation of M. gypseum is a significant observation. The need for further epidemiological studies on dermatophyosis in the Caribbean countries cannot be overemphasized.

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Terbinafine (TRF) has been used in the treatment of fungal infections for more than 20 years. Recently, TRF-resistant Trichophyton interdigitale and T. rubrum strains have been isolated from human patients worldwide. However, an epidemiological study of TRF-resistant strains in Japanese patients has not been investigated. In the present study, antifungal susceptibility testing was performed on clinical isolates from Japanese patients to assess TRF-resistance patterns of T. interdigitale and T. rubrum strains. We also sequenced the squalene epoxidase (SQLE) encoding gene of TRF-resistant T. rubrum strains. Two hundred and ten T. interdigitale and T. rubrum clinical isolates were obtained from 210 human cases of tinea pedis, tinea corporis, tinea unguium, tinea cruris, tinea manuum, tinea faciei and tinea capitis in Tokyo, Saitama, Chiba, Hyogo and Kumamoto, Japan, in 2020. Five T. rubrum isolates (N74, N79, N99, H30 and K2) grew on Sabouraud's dextrose agar (SDA) containing 1 mg/L of TRF. All five strains exhibited TRF minimum inhibitory concentrations (MICs) ≥32 mg/L but remained susceptible to azoles. We determined SQLE sequences in these TRF-resistant T. rubrum strains and found that all strains harbored missense mutations (L393F) in the SQLE-encoding gene.

An unusual case of a 37-year-old woman with bullous tinea manuum caused by an infection with Trichophyton mentagrophytes is described. The patient presented with a pruritic erythematous vesicular rash on the right palm and interdigital web spaces between the first and second digits. The preliminary diagnosis was acute contact dermatitis, which was treated with oral and topical corticosteroids. The rash failed to respond to treatment, resulting in tinea incognito. At 2-week follow-up, a potassium hydroxide (KOH) preparation performed in clinic was positive for T mentagrophytes. The suspected source of infection was a domestic 4-toed, white-bellied African pygmy hedgehog (Atelerix albiventris). There was remarkable improvement of the lesion after 2 weeks with appropriate topical and systemic antifungal agents. This case illustrates that popular exotic pets such as the hedgehog can increase the risk for zoophilic dermatophytic infection, which can present as bullous lesions with little or no scale and can be confused with acute contact dermatitis. It is important for the clinician to recognize this presentation and provide close follow-up for lesions not responding to treatment.

Background and Purpose: Dermatophytes as the causative agents of dermatophytosis (ringworm) are widely spread around the world. Accurate identification of dermatophytes in one area can be particularly important for epidemiological studies. Regarding this, the aim of the present study was to describe the species spectrum of dermatophytes, isolated from patients in Mashhad city, Iran, using the molecular-based method. Materials and Methods: This study was conducted on 79 dermatophyte isolates obtained from the human skin, hair, and nail specimens. Species identification was performed by the polymerase chain reaction-restriction fragment length polymorphism analysis of ribosomal DNA internal transcribed spacer regions using MvaI restriction enzyme. Results: The identified species included Trichophyton mentagrophytes/T. interdigitale species complex (n=37, 46.8%), Epidermophyton floccosum (n=12, 15.2%), T. rubrum (n=8, 10.1%), Microsporum canis (n=8, 10.1%), T. violaceum (n=5, 6.3%), T. tonsurans (n=4, 5.1%), Nannizzia gypsea (n=3, 3.8%), T. benhamiae (n=1, 1.3%), and T. verrucosum (n=1, 1.3%). The clinical forms of infection were tinea corporis (n=26, 32.8%), tinea cruris (n=22, 27.8%), tinea capitis (n=10, 12.6%), tinea unguium (n=7, 9%), tinea manuum (n=6, 8%), tinea pedis (n=5, 6.3%), and tinea faciei (n=3, 3.5%). Conclusion: As the findings indicated, T. mentagrophytes/T. interdigitale species complex had the highest prevalence, and T. benhamiae appeared to be a new emerging agent of dermatophytosis in Mashhad, northeastern Iran.

The current study is the identification and isolation dermatophyte species in clinical isolates by both Sabouraud’s Dextrose Agar (SDA) and on Dermatophyte Test Medium (DTM). Clinical specimens of hair, nails and skin scales were collected from patients with dermatophytosis and submitted to direct microscopic examination after immersion in 20% of potassium hydroxide solution. The clinical specimens were cultured on SDA containing chloramphenicol and cycloheximide, and on DTM. Tinea corporis showed the highest prevalent dermatophyte infection among patients (26.7%), followed by Tinea pedis (23.3%), whereas Tinea manuum exhibited the lowest fungal infection (6.7 %). Rural areas revealed the highest prevalence of dermatophyte infection (70.0 %) in comparison to 30.0% in urban areas. Based on the conventional laboratory methods, 30 clinical isolates of dermatophytes showed positive cultures which belong to three genera (Trichophyton, Microsporum and Epidermophyton). Trichophyton mentagrophytes was the most common species (21.7%) isolated among 30 positive dermatophytes, followed by Epidermophyton flocosum (17.4%), then Trichophyton bullosum and Trichophyton tonsurans (13.0%).

Summary Objective Dermatophytosis is one of the most common mycotic infections, which considered as a public health problem in the major of countries. This study evaluated the molecular epidemiology of dermatophytosis in patients referred to Farshchian hospital in Hamadan city with PCR-RFLP method. Materials and methods Four hundred and five specimens from clinically suspected patients of dermatophytosis were collected and analyzed by direct microscopic and culture. The isolates were identified by PCR-RFLP method using the MvaI restriction enzyme. Results Of the 405 specimens, 88 specimens were positive in direct examination and culture. Among the patients, 64.8% were males and35.2% females. Tinea pedis (31.8%) was the most common type of dermatophytosis followed by tinea corporis (22.7%), tinea cruris (20.5%), tinea capitis (10.2%), tinea manuum (5.7%), tinea faciei (4.6%) and tinea unguium (4.6%). Trichophyton interdigitale (36.4%) was the most common isolate followed by Trichophyton rubrum (27.3%), Epidermophyton floccosum (17%), Trichophyton tonsurans (11.4%), Microsporum canis (4.5%), Microsporum gypseum (2.3%) and Trichophyton benhamiae (1.1%). Conclusion Our finding showed that the anthropophilic dermatophyte species causing dermatophytosis are increasing, and molecular methods are reliable assays for accurse identification of dermatophyte species in epidemiological studies.

The zoophylic dermatophytes, as Trichophyton erinacei, frequently cause very inflammatory tineas in the human host. This dermatophyte is carried by some pets, particularly by the terrestrial hedgehog. Herein, we present the case of a 22-year-old male student with an exudative erythematous scaly plaque on his right fifth finger for 1 month. He had a pet African hedgehog (Atelerix albiventris). KOH examination demonstrated hyphae compatible with dermatophytes. The culture revealed a white, radiated dusty colony. PCR sequencing of the region ITS1-5.8S-ITS2 identified T. erinacei. The final diagnosis was inflammatory tinea manuum due to T. erinacei. Clinical and mycological cure was achieved after treatment with oral terbinafine 250 mg/day × 1 month.

Mycoses are common in HIV/AIDS patients, vary from superficial mycoses to deep mycoses. Although most of the superficial mycoses are mild, deep mycoses are fatal. Specific mucocutaneous manifestations of fungal infection may provide important diagnostic clues for HIV infection and evaluate individual immune status. In this chapter, authors present a variety of fungal infection cases in HIV/AIDS patients, such as candidiasis, cryptococcosis, talaromycosis, histoplasmosis, tinea corporis, tinea cruris, tinea manuum, tinea pedis, and onychomycosis. The purpose is to review the manifestations of mycoses in HIV/AIDS patients with typical or atypical mucocutaneous lesions and with misdiagnosed cases, providing references for diagnosis and differential diagnosis of relevant diseases.

Trichophyton erinacei is a member of the Trichophyton mentagrophytes complex, a zoonotic dermatophyte that is very rarely isolated as a human pathogen. It often causes a localized itchy rash at the size of contact, such as the extremities, and is typically reported in the context of hedgehog exposure.1, 2, 3, 4, 5, 6, 7, 8 Epidemiologically, T erinacei was first recognized in New Zealand then in Europe, Africa, and Australia. Case reports existed in East Asia since the early 2000s in Japan,7 Korea,1 and Taiwan.5 We report the first case, to our knowledge, of T erinacei arising in Southeast Asia in the context of hedgehog exposure.

We report here the results of the 2016 epidemiological survey of dermatomycosis in Japan. In total, 6,776 cases were analyzed as follows: dermatophytosis, 5,772 cases (85.2%); candidiasis, 757 cases (11.2%); Malassezia infection, 235 cases (3.5%); and other fungal infections, 11 cases (0.2%). In dermatophytosis, tinea pedis was the most frequent (3,314 cases: male, 1,705; female, 1,609), followed by tinea unguium (1,634 cases: male, 766; female, 868), tinea corporis (423 cases: male, 241; female, 182); tinea cruris (316 cases: male, 242; female, 74); tinea manuum (58 cases: male, 29; female, 29); tinea capitus, Celsus' kerion (26 cases: male, 19; female, 7); and tinea barbae (1 case: male, 1). The most frequent pathogen was Trichophyton rubrum. In candidiasis, candidal intertrigo was the most frequent (181 cases: male, 98; female, 83), followed by oral candidiasis (165 cases: male, 84; female, 81), genital candidiasis (119 cases: male, 45; female, 74), diaper candidiasis (113 cases: male, 49; female, 64), erosio interdigitalis (63 cases: male, 13; female, 50), onychomycosis (41 cases: male, 17; female, 24), onychia et paronychia (28 cases: male, 2; female, 26), and angular cheilitis (23 cases: male, 6; female, 17). Although the number of cases varied depending on the role of each cooperating medical institution in the area and on population composition, no significant differences in the frequencies of clinical types were observed.

Trichophyton is a species of fungus that commonly infects hedgehogs. As the popularity of keeping hedgehogs as pets increases, there have been reports of Trichophyton species infection in humans. Diagnosis and appropriate treatment of Trichophyton infection can be delayed owing to physicians’ low index of suspicion and unfamiliarity with the physical manifestations. We describe a case of a 27-year-old healthy man who developed tinea manuum after handling a pet hedgehog. Presenting symptoms included a worsening bullous eruption and severe pain. Both fungal and histopathological study confirmed Trichophyton infection. He was treated with oral and topical antifungal medication. All symptoms resolved 2 weeks after initiation of treatment.

Cutaneous infections with Trichophyton species of Arthroderma (A.) benhamiae are increasingly being detected in Germany. This dermatophyte typically causes tinea corporis, tinea faciei or tinea capitis with in part heavy clinical manifestation like kerion celsi. In special cases diagnosis and therapy can be difficult. In this article, four clinical cases are presented, whereby attention is given to special clinical situations and therapeutic aspects with regard to Trichophyton species of A. benhamiae: Case 1: Kerion celsi by in a 6-year-old boy; Case 2: Deep trichophytia at the mons pubis in a 32-year-old man working in a pet shop and his 27-year-old female partner; Case 3: Tinea manuum in a 7-year-old girl; Case 4: Tinea corporis in an 8‑year-old girl.

Background: Superficial mycosis is among the most frequent forms of human infection affecting more than 20-25% of world’s population. Current study aims at assessing the clinical profile of dermatophytic infection and to identify the fungal species responsible. Methods: A prospective study conducted on 100 patients with clinically suspected dermatophytosis presenting to Skin OPD in a tertiary hospital in north Karnataka. A detailed clinical history, general physical examination and systemic examination routine lab investigations were done. Sample collection for mycological examinations was done for direct microscopy in 10% KOH (40% KOH for nail) and fungal culture an SDA with 0.5% chloramphenicol and 0.5% cyclohexidine was done in every case.Results: A total of 100 patients were included in the study. Male:female ratio was approximately 3:2. Maximum numbers of cases were in the age groups of 16-30 years (46 cases). 46% patients had multiple site involvement followed by tinea corporis in 20 (20%), tinea cruris in 18 (18%), tinea unguium (8%), tinea manuum (3%), tinea pedis (3%), tinea barbae (1%), and tinea faciei (1%). Potassium hydroxide examination was positive for fungal elements in 88(88%) patients and 35(35%). The most common species identified were. Trichophyton rubrum in 60% samples, followed by Trichophyton mentagrophytes in 20%.Conclusions: Present clinical and mycological study showed tinea corporis as the most common clinical pattern followed by tinea cruris and T. rubrum as the most common causative agent.

Background No reliable data are available in the province of Buenos Aires regarding the frequency of dermatophytoses and other fungal diseases. The distribution of the clinical forms and the species involved are also unknown. Aims To present the data collected by the laboratories participating in the Mycology Network of the province of Buenos Aires (MNPBA) from a retrospective epidemiological survey on dermatophytoses. Methods A descriptive and exploratory analysis was performed on the cases of dermatophytoses gathered between 2002 and 2007 by the Mycology Network of the province of Buenos Aires. Results Of the 3966 dermatophytosis cases reported by 41 laboratories in 31 municipalities, more than a half occurred in three highly populated urban municipalities. The male:female ratio was 1:1.5. The most frequent clinical form was tinea unguium, diagnosed in 904 cases (51.83%), followed by tinea capitis (19.32%), tinea corporis (15.19%), tinea pedis (6.77%), tinea cruris (3.73%), and tinea manuum (2.18%). The species involved was identified in 1368 (33.49%) cases. Trichophyton rubrum was the most common species, with a frequency of 42.03%. An association was found between urban municipalities and T. rubrum or the Trichophyton mentagrophytes complex. Conclusions Results from the MNPBA survey provide valuable information that should enable further interventions to be designed in order to prevent and control the disease., UIQA -Unidade de Investigação Química Ambiental, info:eu-repo/semantics/publishedVersion

Superficial fungal infections are common worldwide; however, the distribution of pathogenic species varies among geographical areas and changes over time. This study aimed to determine the epidemiologic profile of superficial fungal infections during 2004-2014 in Guangzhou, Southern China. Data regarding the superficial mycoses from outpatients and inpatients in our hospital were recorded and analyzed. From the 3367 patients that were enrolled in the study, 3385 samples were collected from skin, hair and nail lesions. Of the 697 positive cultures, dermatophytes were the most prevalent isolates (84.36 %), followed by yeasts (14.92 %) and non-dermatophyte molds (0.72 %). Trichophyton rubrum (56.24 %) was the most common dermatophyte isolated from cases of tinea unguium (83.92 %), tinea pedis (71.19 %), tinea cruris (91.66 %), tinea corporis (91.81 %) and tinea manuum (65.00 %). Trichophyton mentagrophytes (13.35 %) and Microsporum canis (10.19 %) were the predominant species associated with cases of tinea faciei (54.55 %) and tinea capitis (54.13 %), respectively. Yeasts and molds were identified primarily from other cases of superficial fungal infections. In conclusion, when compared to previous studies in the same area, the epidemiology of superficial mycoses in Guangdong did not significantly change from 2004 to 2014. The prevalence of causative agents and the spectrum of superficial fungal infections, particularly tinea caused by dermatophyte infection, are similar to reports from several specific regions in China and Europe, whereas increasing incidences of Trichophyton mentagrophytes and Microsporum canis occurred in Guangdong, China.

Dermatophytoses are among the most frequently diagnosed skin infections worldwide. However, the distribution of pathogenic species and the predominating anatomical sites of infection vary with geographical location and change over time. The aim of this study was to determine the epidemiological and aetiological factors of dermatophytoses in Crete, Greece over the last 5-year period (2011-2015) and their incidence in relation to the gender and the age of the patients. We compared our findings with those previously reported from the same area and from other parts of the world. A total of 2,910 clinical specimens (skin scrapings, nail clippings, and hair specimens) obtained from 2,751 patients with signs of dermatomycoses were examined using direct microscopy and culture. Overall, 294 specimens (10.1%) were proved mycologically positive for dermatophytes. The age of the patients ranged from 2 to 86 years (mean age, 37 years). Tinea corporis was the predominant clinical type of infection, followed by tinea unguium, tinea pedis, tinea capitis, tinea faciei, tinea cruris and tinea manuum. Among dermatophytes, eight species were isolated: Microsporum canis (35.8%), Trichophyton rubrum (35.1%), Trichophyton mentagrophytes (23.3%), Epidermophyton floccosum (2.5%), Microsporum gypseum (1.8%), Trichophyton violaceum (0.7%), Trichophyton verrucosum (0.4%), and Trichophyton tonsurans (0.4%). In our area, the most common dermatophyte was M. canis followed by T. rubrum. Increased migration, mass tourism, and climate changes will contribute to further changes in the epidemiology of dermatophytoses in our area. Continuing studies are necessary for determining the new epidemiological trends and to implement the appropriate control measures.

This chapter deals with superficial fungal infections from the scope of gender dermatology. Onychomycosis occurs in both sexes, but it is more common in males. While generally more effective than topical treatment for onychomycosis, systemic treatment should be avoided in pregnancy and its use is limited due to drug-drug interactions and potential side effects. Tinea pedis is three times more frequent in males due to habitual and occupational differences. Tinea cruris is almost exclusively found in males because of the humidity created by the scrotum. Tinea capitis is seen in children without gender differences and warrants systemic treatment. Tinea manuum is a rare fungal infection of the palms that tends to be unilateral and warrants systemic treatment. Dermatophytosis of the body has different clinical types that are described in the chapter. The chapter also discusses different clinical types of cutaneous and genital candidiasis which is the leading cause of fungal infections worldwide. The chapter concludes with pityriasis versicolor and mycological laboratory analysis.

Background and Purpose: It is important to follow annually the probable changes in distribution pattern of dermatophytosis and its etiological agents in different communities. In this study, we determined the prevalence of dermatophytosis and its causative agents in Damascus, Syria, between 2008 and 2016. Materials and Methods: A total of 4080 outpatients who visited the dermatological clinics in Damascus, were evaluated. The specimens were collected from clinically suspected tinea. The patients were referred to our laboratory for direct examination by 30 %KOH. Some of the specimens were cultured on Sabouraud Dextrose Agar for fungal identification. Results: Out of the 4080 cases, 1138 cases were positive in direct examination(%27.89) , including Tinea pedis (%46.98), followed by tinea capitis(%39.79) , tinea corporis (%25.38), toenail onychomycosi (%20.33), tinea manuum (%16.06), and fingernail onychomycosis .(%15.22) Tinea pedis and toenail onychomycosis were more common in summer %41.19) and %25.78 respectively .(Trichophytic rubrum was the most prevalent fungal pathogen, especially in toenail onychomycosis. Conclusion: Dermatophytosis is highly prevalent in Syria. This study provides valuable data for differential diagnosis of dermatophytosis

We report an observation of extensive and atypical dermatophytosis to Trichophyton rubrum coexisting with fingernails and tinea manuum candidiasis in a 13-year-old girl presenting inflammatory cutaneous lesions, involvement of scalp, as well as total dystrophic onychomycosis of feet associated with a perionyxis of hands. The results of the mycological examination of specimen showed fungal elements of septate hyphae and pilar parasitism. The fungal culture allowed the diagnosis of certainty of the dermatophytosis to T. rubrum. The therapeutic success of this infection was obtained thanks to the administration of antifungals by oral route.

We report a case of a 34-year-old Polish Caucasian male who was diagnosed with tinea manuum caused by Trichophyton rubrum var. raubitschekii. It would be the first described case of a dermatophytosis caused by this fungus in Poland and one of a few cases in Central Europe described so far. Admittedly, it would be the first case in Central Europe with no evidence pointing to African origin. The clinical condition improved after administering itraconazole (daily dose 100 mg orally) supplemented with a topical treatment, while the patient was totally cured after 2 months. The histopathological examination turned out to be highly useful in the diagnostic process. The genetic analysis of the urease gene pointed to a urease-positive T. rubrum rather than T. rubrum var. raubitschekii.

Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%.Microsporum audouiniiwas the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

Tinea manuum is a common superficial fungal infection which is usually coexistent with tinea pedis; there are few studies available on the epidemiology of tinea manuum at present. This study aims to investigate the epidemiology of tinea manuum and its correlation with tinea pedis in south China. A total of 280 patients with tinea manuum were recruited. The epidemiological and clinical data were analyzed, and causative agents were isolated and identified mycologically. Totally, 84.3 % patients with tinea manuum had co-occurrence of tinea pedis, among which 88.4 % patients had experience of scratching their feet. There was a significant relationship between the touch habits and the hand infection (χ(2) = 65.451, P = 0.000). More than 90 % patients had quite the same species of isolates from multiple infected sites in one patient. Therefore, it seems that transmission of dermatophytes from the feet to hand by scratching might be a most common way. As for tinea manuum, whether "unilateral" or "bilateral" is just the result that pathogens spread from feet to hand(s), which is only a special clinical presentation of tinea.

Superficial fungal infections due to dermatophytes are common over the world and their frequency is constantly increasing. The aim of our study was to discuss fungal infections with frequency of occurrence, clinical stages and aetiology in patients admitted to dermatological ward and microbiological laboratory of the specialist hospital in Krakow. Investigations performed between 1995 and 2010 included the group of 5333 individuals. Dermatophyte infections, confirmed by culture, were revealed in 1007 subjects (18.9%), i.e. in 553 males and 454 females. The most frequent clinical forms of infections were tinea unguium and tinea pedis, caused mainly by Trichophyton rubrum and by Trichophyton mentagrophytes. Tinea corporis, tinea manuum, tinea capitis and tinea cruris constituted a small percentage of infections and the main aetiological factors of these dermatomycoses were also T. rubrum and T. mentagrophytes. Between 1995 and 2000 there were stated small differences in the number of isolated strains of dermatophytes in comparison with the number of examined patients. Since 2006 there has been observed a decrease in number of patients in our hospital with suspected fungal infections, but per cent of positive cultures has remained unchanged in comparison with earlier period.

Infections caused by Trichophyton rubrum are very common in dermatological disease. It most often appears as superficial cutaneous mycosis, such as tinea manuum, tinea pedis, and tinea corporis. However, deep infection caused by T. rubrum was rarely reported. We describe a case of mixed type of deep infection caused by T. rubrum in a 45-year-old man with no significant immunodeficiency. This patient had a history of onychomycosis on the toenails without regular treatment for nearly 6 years. And, he had erythema, papule, and nodules on the submandibular area, neck, and chest for almost 1 year. After treated with intravenous infusion of cefotiam for 2 weeks, the lesion aggravated. The fungal direct microscopic examination of pyogenic fluid was positive, and the fungal cultures that produced reddish-brown and yellow pigment showed cottony, wooly, and white colony. After the DNA sequencing, it was identified as T. rubrum. We gave the patient oral terbinafine 250 mg per day and bifonazole cream for external use. Six months later, the patient’s skin lesion was disappeared, and healthy nail growth was seen in two-thirds of nail bed. The terbinafine is effective against deep infection caused by T. rubrum.

Tinea manuum is a dermatophytosis which is often mistaken for other keratodermas, especially palmar psoriasis and chronic hand eczema. We report the use of dermoscopy as a diagnostic aid in a case of tinea manuum. The dermoscopic clue turned out to be the presence of whitish scaling located mainly in the furrows. This aspect has never been seen in other keratodermas and therefore can be considered as a useful finding to assist in the recognition of tinea manuum.

Characterization of clinically important dermatophytes in North of Iran using PCR-RFLP on ITS region. Didehdar M1, Shokohi T2, Khansarinejad B3, Ali Asghar Sefidgar S4, Abastabar M5, Haghani I5, Amirrajab N5, Mondanizadeh M6. Abstract OBJECTIVE: Dermatophytosis is considered as one of the major public health problems in the world. Accurate identification of the dermatophytes species is important for recognition of the environment and animal sources of infection. In this survey, 1500 clinical specimens taken from outpatients suspected of dermatophytosis and they were examined by direct microscopy and culture. MATERIALS AND METHODS: In total, three hundred and twelve dermatophytes were isolates recovered in culture, they were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method based on the ribosomal DNA internal transcribed spacer (ITS) regions. RESULTS: Tinea pedis was the most common clinical form (32.1%) followed by tinea cruris (24.4%), tinea manuum (16.4%), tinea unguium (8.3%), tinea corporis (7.3%), tinea faciei (6.4%), and tinea capitis (5.1%). Trichophyton interdigitale was the most frequent isolate (38.2%), followed by Trichophyton rubrum (29.8%), Epidermophyton floccosum (16.6%), Trichophyton tonsurans (14.8%) and Microsporum canis (0.6%). The frequency of dermatophytosis was higher in males than in females and in the age-group of 21-30 years. CONCLUSION: Our finding indicated that the incidence of dermatophytosis caused by anthropophilic dermatophytes in Mazandaran province is increasing. Also, this study provides valuable data for the prevention and control of dermatophytosis in the southern coast of the Caspian Sea. KEYWORDS: Dermatophytes; Identification moleculaire; Molecular identification; Nord de l’Iran; North of Iran

Palmoplantar hyperkeratosis with their many variants of infestations are often resistant to therapy. This holds true for the hereditary forms as well as for the symptomatic forms. All possible therapeutic options should therefore be exploited through targeted diagnosis of the cornification disorders. This includes intensive examination of the cornification disorder for fungal infections since tinea manuum et pedum might themselves lead to hyperkeratosis. Diagnosis of the mycotic infestation of the hyperkeratosis is not easy as anti-hyperkeratotic local therapy with high doses of urea and salicylic acid preparations itself act fungistatic leading to false negative cytological, histological and cultural results. The samples taken at the hands and feet should include a wide area because the fungal structures might be loosely distributed over palms and soles in contrast to onychomycosis. Samples should also be taken from deep horny layers. Due to local fungistatic pretreatments, the fungal hyphae and spores are dystrophic and considerably smaller in the cytological and histological picture, with the result that these fine fungal elements might be detected only by thorough examination of the specimens. The known dyes PAS or fluorescence techniques should be applied. If fungal structures are detected in the hyperkeratosis, only intensive local and oral therapies over several months lead to an improvement in the clinical symptoms. According to our own experience, the fungal infections intensify the considerable cornifications of hyperkeratosis in almost 30 % of cases. In isolated cases, only a few residues of the previously considerable and for the patients distressing cornifications remain after intensive anti-mycotic therapy. Mycotic analyses of palmoplantar hyperkeratosis is mandatory as anti-mycotic therapy is a simple and often successful option for the treatment of these distressing and painful disorder. A mycotic cofactor leading to the cornification should be considered especially if the patient also exhibits onychomycosis.

PubMedID: 20730602 In modern taxonomy, Trichophyton rubrum with the 'raubitschekii' morphotype differs from the common strains of T. rubrum morphologically, physiologically, and clinically, despite genetic homogeneity. In this paper, we report the first autochthonous Turkish cases in a 24-year-old woman and her 26-year-old fiancé with tinea cruris and tinea manuum, respectively. The isolates were proven to be T. rubrum with the 'raubitschekii' morphotype by their morphological and physiological characteristics including the following: (1) granular colony surface, (2) profuse macroconidia and microconidia, (3) strongly positive urease activity after 3 days, (4) non-perforating hair, (5) restricted growth and producing no alkaline reaction on bromocresol purple-milk solids-glucose agar, and (6) restricted growth and producing no conidia on 3-9% NaCl-supplemented Sabouraud agar. The internal transcribed spacer (ITS) regions of both isolates were sequenced, and the assembled DNA sequences were examined using the Basic BLAST (nucleotide-nucleotide) software of the National Center for Biotechnology Information web database. Actually, the lack of epidemiological data on this variety is notable, and the actual prevalence is unknown. Otherwise, routine methods misidentified the strains as T. rubrum or unrecognized cases were underreported. © 2010 Springer Science+Business Media B.V.

Summary Background. Two feet–one hand syndrome (bilateral plantar tinea pedis with coexistent unilateral tinea manuum) is commonly seen in dermatology clinics, but the cause of the unilateral hand involvement remains unresolved. Aims. To investigate the unilateral hand involvement in this syndrome. Methods. This was a case–control study. The experimental group comprised 113 patients with bilateral tinea pedis and unilateral tinea manuum and the control group comprised 44 patients with tinea pedis only, without tinea manuum. Clinical data were recorded and pathogens were identified by fungal examination. The predominant pathogen, Trichophyton rubrum, was genotyped by PCR amplification of tandem repeat elements from the ribosomal DNA nontranscribed spacer region. Results. Scratching habits were significantly different between the groups, and there was a significant relationship between tinea manuum and the hand reportedly used to scratch the feet. In analysis of isolates from the feet and the involved hand, 94.5% of pairs were of the same species, and 80% of pairs had the same genotypes. Conclusions. Contact between hands and feet probably results in the transmission of dermatophytes from the feet to the scratching hand.

Summary Outbreaks of Trichophyton tonsurans infection constitute one of the serious problems among combat sports practitioners in Japan. To facilitate the diagnosis of individuals at risk, we undertook a study to determine which body sites are most commonly infected. We reviewed medical data, hairbrush culture results and questionnaire information from patients with T. tonsurans infection who were admitted to the dermatology clinic of Juntendo University hospital from 2000 to 2004. The study included 92 patients (87 males), aged 6–38 years (mean age: 18.4 years old). Eighty-nine patients were judo practitioners and three were wrestlers. Twenty-eight patients (30.4%) were asymptomatic carriers. In 64 patients, 51 patients (55.4%) with tinea corporis, 27 patients (29.3%) with tinea capitis, and/or one patient (1.1%) with tinea manuum were seen. Tinea corporis was observed on the forehead, auricles, nape of the neck, bilateral shoulders, left side of the upper chest, both elbows, back of the left hand to the wrist and both knees. Tinea capitis was most common in the occipitonuchal region at the hairline and in the temporal and frontal regions, at both auricles. Initial screening of these sites might facilitate the identification of the infection especially in judo practitioners.

Hedgehogs have recently become popular exotic pets in Korea. Several diseases may be acquired from these animals including dermatophytosis, Salmonella infections, contact urticaria and possibly Mycobacterium infections. We describe here a 15-year-old girl who developed tinea manuum after keeping a hedgehog for 4 months. Diagnosis was confirmed by histopathologic and mycological examination. The causative agent was identified as Trichophyton mentagrophytes var. erinacei, a zoophilic dermatophyte.

Summary: One hundred and fourteen evaluable patients with tinea pedis or tinea manuum have been analysed in this double-blind study between itraconazole and griseofulvin. All infections were confirmed by microscopic examination and/or culture. Daily double-blind medication consisted of either 100 mg itraconazole or 500 mg ultramicronised griseofulvin and was given for 30 consecutive days. All patients were examined clinically and mycologically at the start of treatment, at the end of treatment (day 30) and 2 weeks after the end of treatment (control day 45). The clinical outcome was virtually the same for both treatment groups at the end (75% response rate for itraconazole vs. 77% for griseofulvin) and 2 weeks after the end of treatment (83% response for itraconazole vs. 82% for griseofulvin). The most important difference between both treatments was the mycological outcome, for which itraconazole showed a cure rate of 85% compared to 48% for griseofulvin 2 weeks after end of therapy (p > 0.01, Fisher's exact test). This suggests that griseofulvin treated patients are more at risk for relapse than itraconazole patients. It is concluded that itraconazole 100 mg orally once daily for 30 days is mycologically more effective than griseofulvin 500 mg once daily for 30 days in the treatment of tinea pedis and/or tinea manuum. Furthermore, the best results are obtained 2 weeks after the end of treatment. Clinically both treatments are equally effective. The difference in clinical and mycological results with griseofulvin may be explained by the known anti-inflammatory effect of griseofulvin. Both drugs were well tolerated and appeared to be safe for use. Zusammenfassung: In dem vorliegenden Doppelblind-Vergleich zwischen Itraconazol und Griseofulvin wurden die auswertbaren Daten von 114 Patienten mit Tinea pedis oder Tinea manuum analysiert. Alle Infektionen waren durch mikroskopische Prufung und/oder Kultur belegt. Die tagliche Doppelblind-Medikation bestand aus entweder 100 mg Itraconazol oder 500 mg ultramikronisiertem Griseofulvin und wurde 30 Tage lang verabreicht. Alle Patienten wurden klinisch und mykologisch bei Beginn der Behandlung, bei Behandlungsende (Tag 30) und 2 Wochen nach Behandlungsende (Kontrolltag 45) untersucht. Das klinische Ergebnis war fur beide Behandlungsgruppen bei Behandlungsende (75% Ansprechquote fur Itraconazol vs. 77% fur Griseofulvin) und 2 Wochen nach Behandlungsende (83% fur Itraconazol vs. 82% fur Griseofulvin) praktisch gleich. Der wesentlichste Unterschied zwischen beiden Behandlungen war das mykologische Ergebnis. Hier ergab Itraconazol 2 Wochen nach Behandlungsende eine Heilungsquote von 85% gegenuber 48% mit Griseofulvin (p 0.01, Fisher-Test). Dies last vermuten, das Griseofulvin-Patienten ein hoheres Ruckfallrisiko als Itraconazol-Patienten haben. Die Schlusfolgerung lautet, das Itraconazol 100 mg einmal taglich p.o. uber 30 Tage mykologisch wirksamer ist als Griseofulvin 500 mg einmal taglich uber 30 Tage bei der Behandlung von Tinea pedis und/oder Tinea manuum. Dabei wurden die besten Resultate 2 Wochen nach Behandlungsende beobachtet. Klinisch waren beide Behandlungsmethoden gleich wirksam. Die Differenz zwischen dem klinischen und dem mykologischen Ergebnis mit Griseofulvin kann durch dessen bekannten antiinflammatorischen Effekt erklart werden. Beide Arzneimittel waren gut vertraglich und anwendungssicher.

Over 4000 cases of fungal nail, sole and palm infection recorded during a three-year study period were investigated to determine the prevalence and significance of etiologic agents other than dermatophytes and yeasts. Littman's oxgall agar, which permitted isolation of cycloheximide-sensitive species but restricted overgrowth by fast growing contaminants, was used to promote isolation of these disease agents. Non-dermatophytic filamentous fungi made up 2.3% of the confirmed etiologic agents obtained overall, and constituted 3.3% of the agents obtained from nail infections. The most common species were Scopulariopsis brevicaulis, Hendersonula toruloidea, and Aspergillus sydowii. Scytalidium hyalinum was recorded for the first time from Canada, and an instance of nail infection by Gymnascella dankaliensis was recorded. Only H. toruloidea and Sc. hyalinum caused palm and sole infections.

Summary. In the period between April 1984 and April 1988 a total of 4,294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 768 (17.9%) were suspected as tinea corporis (427 cases) and tinea cruris (341 cases). Twenty two different nationalities were represented. Both sexes were involved and the age range was 19 days to 70 years. Of the 768 patients examined, 738 (96.1%) had their diagnosis confirmed by direct microscopy and in 631 of these positive cases the etiology was determined. Of the 408 patients who had suffered from tinea corporis, 323 isolates were obtained from 313 culturally positive cases. Microsporum canis was the main etiologic agent followed by Trichophyton violaceum, T. mentagro-phytes, T. rubrum and Epidermophyton floccosum. Of the 330 patients who had suffered from tinea cruris, 388 isolates were obtained from 318 culturally positive cases and E. floccosum was the main etiologic agent. Next in frequencies were T. rubrum and T. mentagrophytes while Candida albicans was isolated from 45 of 70 patients with mixed isolates. Treatment with topical antifungal agents was effective in most of the cases. Oral griseofulvin in addition to the topical application was found necessary in extensive widespread cases. Zusammenfassung. Zwischen April 1984 und April 1988 wurden im Dammam-Zentralhospital in der saudiarabischen Ostprovinz insgesamt 4 294 Dermatomykose-Verdachtsfalle mykologisch unter-sucht. Von diesen imponierten 768 Falle (17,9%) entweder als Tinea corporis (427 Falle) oder Tinea cruris (341 Falle). Die Patienten gehorten 22 Na-tionalitaten an. Beide Geschlechter im Alter von 19 Tagen bis 70 Jahren waren vertreten. In dem un-tersuchten Kollektiv wurde bei 738 Patienten (96,1 %) die Diagnose direktmikroskopisch besta-tigt, und bei 631 dieser Falle konnte die Pilzatiologie belegt werden. Von 408 Patienten mit Tinea corporis waren 313 kulturell positiv mit 323 Isolaten. Als Haupterreger erwies sich Microsporum canis, gefolgt von Trichophyton violaceum, T. mentagro-phytes, T. rubrum und Epidermophyton floccosum. Bei 330 Patienten mit Tinea cruris waren 318 kulturell positiv mit 388 Isolaten; E. floccosum war der haufigste Erreger, gefolgt von T. rubrum und T. mentagrophytes. Candida albicans wurde bei 45 von 70 Patienten mit Mischisolaten nachgewiesen. In den meisten Fallen war die Behandlung mit to-pischen Antimykotika wirksam. Die orale Gabe von Griseofulvin zusatzlich zur topischen Behandlung erwies sich haufig als notwendig.

Summary. A total of 4 294 clinically suspected cases of dermatomycoses belonging to 26 different nationalities were examined between April 1984 and April 1988. Fungi were demonstrated in routine potassium hydroxide/dimethyl sulfoxide mount in 3 814 cases (88.8%) and the etiology was determined by culture in 2 458 cases (57.2%). Tinea ver-sicolor was the predominant fungal infection (30.9% of all infections). Onychomycosis and pa-ronychia ranked second in prevalence (16.8%). Candidal onychomycosis was the most common type of infection. Scalp ringworm among children ranked third (15.3%), Microsporum canis was the main etiologic agent. Tinea pedis and tinea man-uum ranked fourth in prevalence (13.2%). Tinea corporis represented 10.7% of infections and M. canis was the main agent. Tinea cruris accounted for 8.7% of infections and Epidermophyton floc-cosum was the most common agent. Cutaneous can-didosis constituted 4.3% of infections. White piedra was seen in 6 cases (0.16%). Yeasts were proved not to be unimportant as a cause of disease of skin and nail in our study. Zusammenfassung. Zwischen April 1984 und April 1988 wurden im Dammam-Zentralhospital in der saudi-arabischen Ostprovinz insgesamt 4 294 Dermatomykose-Verdachtsfalle untersucht, die 26 unterschiedlichen Nationalitaten angehorten. In 3 814 Fallen (88,8%) wurden Pilze mikroskopisch in KOH-DMSO-Praparaten nachgewiesen und die Pilzatiologie kulturell in 2 458 Fallen (57,2%) be-legt. Tinea versicolor stellt die vorherrschende Pilz-infektion dar (30,9 % aller Infektionen). An zweiter Stelle standen Onychomykose und Paronychie (16,8%). Die Candida-bedingte Onychomykose war der haufigste Infektionstyp. An dritter Stelle lag Tinea capitis bei Kindern (15,3 %); hier war Microsporum canis der Haupterreger. Tinea pedis und Tinea manuum lagen an vierter Stelle (13,2 %). Bei Tinea corporis (10,7 %) war M. canis der Haupterreger. Tinea cruris (8,7 %) wurde uber-wiegend durch Epidermophyton floccosum verur-sacht. Die kutane Candidose machte 4,3 % der Infektionen aus. Weise Piedra wurde sechsmal (0,16%) gesehen. Ferner erwiesen sich in unserer Studie Hefen zu einem nicht unbedeutenden Anteil als Erreger von Haut- und Nagelkrankheiten.

Itraconazole is an antifungal drug from the triazole group with distinct in vitro activity against dermatophytes, yeasts and some molds. Itraconazole has a primarily fungistatic activity. Itraconazole accumulates in the stratum corneum and in nail material due to its high affinity to keratin, as well as in sebum and vaginal mucosa. Together with terbinafine and fluconazole, itraconazole belongs to the modern highly effective systemic antifungal drugs with a favorable risk-benefit ratio and for this reason is a preferred therapy option for fungal infections of skin, nails and mucous membranes. Compared to terbinafine in the treatment of fingernail and toenail fungal infections, itraconazole offers the advantage of a broad antifungal spectrum and better effectiveness against onychomycosis caused by yeasts yet appears inferior with regard to the more common dermatophyte infections. Itraconazole constitutes an important therapy option, along with fluconazole, terbinafine, ketoconazole and griseofulvin, for the treatment of dermatophyte infections of glabrous skin (tinea pedis, tinea manuum, tinea corporis and tinea cruris) in adults following unsuccessful topical therapy. In the oral therapy of tinea capitis, itraconazole plays an especially important role, in particular for disease caused by Microsporum canis (for children, however, only off-label use is feasible currently). In the treatment of oropharyngeal candidiasis, candidiasis of the skin and vulvovaginal candidiasis, itraconazole and fluconazole are the preferred treatment options in cases in which topical therapy has proven unsuccessful.

A multicentre, randomized, double-blind, parallel-group trial was conducted to compare the efficacy and safety of two dosages of itraconazole in the treatment of tinea pedis or manuum. Of the 135 patients recruited, 66 received itraconazole 400 mg daily for 1 week and 69 received itraconazole 100 mg daily for 4 weeks. In the evaluable patients observed-case analysis, mycological cure was seen in 63% of patients in the 400 mg/1 week group and in 75% in the 100 mg/4 weeks group at the end of a 6-week follow-up period (not significantly equivalent). In the evaluable patients worst-case analysis and the intention-to-treat analysis, mycological cure rates in the two groups were borderline significantly equivalent at the end of follow-up (range 51-57%). Clinical response was seen in 81% of evaluable patients in the 400 mg/1 week group and in 75% in the 100 mg/4 weeks group at the end of follow-up; equivalence testing showed the 400 mg/1 week regimen to be at least equivalent to the 100 mg/4 week regimen. Similar results were found in the intention-to-treat analysis, and tolerability ratings for the two treatment regimens were significantly equivalent. This trial has shown that itraconazole 400 mg/1 week and itraconazole 100 mg/4 weeks are both effective regimens for the treatment of tinea pedis or manuum. The two treatment schedules were equally well tolerated and safe.