Rare cause of foreign body in urinary bladder

Foreign body in urinary bladder is not an uncommon entity. Mostly it happens due to iatrogenic reasons or for sexual gratification. Here we are reporting a common foreign body in urinary bladder with a rare cause which is not reported in literature earlier. A 50-year-old married man referred from village with history of inserting electric wire in urethra and X-ray pelvis showing coiled metallic foreign body in the bladder region. There was dysuria, burning and sometimes hematuria. All other investigations were normal. On examination his both groins and perianal region were involved with Tinea cruris. Patient told that he had intense itching which was not benefitted by skin treatment. He himself started doing some manipulation in urethra with a piece of wire to get some relief in itching. The metallic wire was removed by cystoscopy under spinal anaesthesia and C-arm guidance. Post-operative course was uneventful, and patient was sent to dermatologist for treatment of Tinea cruris. After 1 month there were no urinary symptoms and patient had improvement in Tinea symptoms. We recommend that whenever anyone comes across a case of foreign body in urinary bladder, detailed history should be taken, and local examination should be done to find any organic cause for the same and treated to prevent recurrence and stigma to the patient.

A pharmacoepidemiology study of local fungal infections in skin and venereal diseases outpatient department of a rural tertiary care hospital

Background: Fungal infections of the skin were the 4th most common skin disease in 2010 affecting 984 million people. An estimated 20-25% of the world抯 population has some form of fungal infection. Dermatophytes are fungi that cause superficial infections of the skin, commonly referred to as tinea infections.Methods: This was a prospective and an observational study conducted from February 2018 to January 2019 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended dermatology OPD. Factors considered were sociodemographic parameters, the disease encountered and number of patients in each group and number of patients who received antifungal therapy (oral and topical) etc.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. There were a greater number of males (57.4%) than females (42.6%). The average number of antifungal drugs prescribed per prescription was 2.33. Majority of the patients were prescribed itraconazole (82.30%) followed by terbinafine (9.70%) and fluconazole (8.0%).Conclusions: The most common oral antifungal drug used was itraconazole. Ketoconazole and Terbinafine were the most commonly used topical agents respectively.

Dermoscopy - a simple and rapid in vivo diagnostic technique for tinea incognito

Abstract Tinea incognito resulting from corticosteroid abuse is becoming very common in the tropics. Its diagnosis is tricky owing to its confusing morphology, as well as practical and technical issues associated with mycological tests. Dermoscopy has now evolved as a novel diagnostic tool for diagnosing tinea incognito in such challenging situations, since the typical hair changes such as Morse-code hairs, deformable hairs, translucent hairs, comma and cork screw hairs, and perifollicular scaling may be seen despite steroid use, irrespective of mycological results.

Comparative evaluation of efficacy of terbinafine and itraconazole in treatment of tinea cruris

Background: In a hot and humid country like India, the prevalence of superficial mycotic infections is on the rise due to contributing environmental and demographic factors. In this study, we sought to assess the efficacies of two oral antifungal drugs, Itraconazole (a traditional azole) and Terbinafine (the only orally available allylamine). The two drugs were analyzed to see whether they differed significantly in their cure rates of tinea cruris. Since data, that compares only systemically administered Itraconazole and Terbinafine in the treatment of tinea cruris, is limited, this study becomes imperative.Methods: 60 patients, all clinically confirmed cases of tinea cruris and belonging to the age group of 18-65 years, were recruited for this prospective study. Patients were then randomly divided into groups A and B and followed-up for a month. Group A received cap. Itraconazole 100 mg, twice a day, for 15 days while group B received tab. Terbinafine 250 mg, once a day, for 4 weeks. Both groups were given topical 2% Sertaconazole that had to be continued for 8 weeks. During the 4 visits, scores for the 3 parameters (erythema, pruritis and scaling) were calculated and recorded for statistical analysis.Results: Authors observed that majority of the patients were exposed to hot and humid environment that contributed to sweating and poor personal hygiene. The changes in scores of erythema, pruritis and scaling from the baseline visit for both, Itraconazole and Terbinafine, were statistically significant at week 4 with P < 0.05 for all parameters. But the difference between the scores of the two drugs was not found to be statistically significant.Conclusions: Although the sample size of this study was small and the data was limited, findings of this study supported that both Itraconazole and Terbinafine were highly effective in the treatment of tinea cruris.

A randomized, double-blind trial of amorolfine 0.25% cream and sertaconazole 2% cream in limited dermatophytosis

Background: Dermatophytosis is becoming increasingly unresponsive to conventional antifungals. Newer topical antifungals may be more effective in these patients. Aims: To evaluate and compare the efficacy and safety of amorolfine 0.25% cream and sertaconazole 2% cream in limited tinea cruris/corporis. Methods: A single-center, randomized (1:1), double-blind, parallel group, active-controlled trial (CTRI/2014/12/005246) was performed. Sixty-six untreated adults with acutely symptomatic tinea cruris/corporis were included in the study. All patients had limited cutaneous involvement and were KOH mount positive. Group A received amorolfine 0.25% cream, and group B received sertaconazole 2% cream twice daily application to the lesions for 4 weeks. After the baseline visit, four follow-up visits were carried out. The outcome measures for effectiveness were clinical and mycological cure. Safety parameters studied were treatment-emergent adverse events and changes in routine laboratory parameters. Results: Both sertaconazole and amorolfine significantly reduced symptoms (P < 0.001) in both groups. However, improvement in symptoms (pruritus, burning sensation, erythema, scaling and crusting) was significantly greater in the sertaconazole group at every follow-up visit. Sertaconazole cream was also more effective than amorolfine cream in reducing the number of lesions (P = 0.002 at 12 weeks) and improving the Dermatology Life Quality Index (P < 0.001) at all the follow-up visits. Adverse events were similar in the two groups (P = 0.117). Fungal cultures became negative in 92.3% of the sertaconazole group as compared to 80% in the amorolfine group (P = 0.010). Limitations: Antifungal susceptibility testing could not be done. Conclusion: Sertaconazole 2% is superior to amorolfine 0.25%, both in terms of effectiveness and tolerability. Improvement can be appreciated from second week onwards.

Comparative Efficacy of Terbinafine and Itraconazole on Fluconazole Resistant Tinea Corporis and Tinea Cruris Handling

Objectives: The study aimed at comparing the therapeuticefficacy of Terbinafine and Itraconazole in terms of clinical curein the treatment of Fluconazole resistant Tinea corporis andTinea cruris.Materials and Methods: A clinical trial with 154 patients’having Tinea corporis and Tinea cruris was performed. All thepatients were treated with fluconazole. The resistant patientswere randomly divided into two groups. The first group wastreated with Terbinafine 250mg daily for 4 weeks, whereassecond group was treated by Itraconazole for 4 weeks. Theparticipants were followed up till the end of treatment and onemonth after treatment.Results: At the end of the trial, terbinafine group developed78.84% clinical response, while Itraconazole treated groupdeveloped only 39.13%.Conclusion: Based on the marked observed difference, it maybe concluded that Terbinafine is more effective in treatingfluconazole resistant Tinea corporis and Tinea cruris.

Relapse of Cutaneous Fungal Infection in Healthy Individuals - A Rising Concern.

Background: Superficial fungal infections are among the most common skin diseases, affecting millions of people throughout the world. These infections, which occur in both healthy and immunocompromised persons, are caused by dermatophytes, yeasts and nondermatophyte molds. Effective treatment can reduce the duration of symptoms in patients with superficial fungal infections. Unfortunately, there is a strong tendency for fungal infections to recur in many people even after effective clearing with medication. Aims and Objectives: To study the relapse of cutaneous fungal infection in healthy people. Materials and Methods: 160 patients with a history of relapse of fungal infections who came to the out-patient department of this tertiary care hospital within 6 months period were studied in detail regarding patient characteristics, demographic details and line of management. Results: Relapse of cutaneous fungal infection occurs most commonly in adults greater than 30 years (75%). There was a definite family history of fungal infections (15.6%) in patients coming with history of relapse. Tinea cruris (34.38%) was the most common site to come with history of relapse followed by onychomycosis (15.6%). Relapse occurred in 38.75% of the cases treated with terbinafine as this was the most common drug used. Conclusion: Regardless of the drug taken there were cases of relapse in cases of cutaneous fungal infection even in healthy individuals.

Capacidade funcional de pacientes com úlceras venosas no município de Petrópolis-RJ / Functional capacity of patients with venous ulcers in the city of Petrópolis-RJ

O objetivo do estudo foi avaliar a capacidade funcional de pacientes com úlceras venosas. Trata-se de um estudo observacional com enfoque transversal e com abordagem quantitativa. Os participantes foram pacientes adultos e idosos com úlceras venosas, atendidos em dois Ambulatórios. No processo de seleção, foi adotada amostragem por conveniência. Para coleta de dados, foram utilizados os seguintes instrumentos: Protocolo I Adaptado­Perfil dos clientes com úlcera; Escala de LAWTON AIVDs; Escala KATZ AVDs e Escala do Índice de Tinetti. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Na análise, foi utilizada a estatística descritiva, composta pelo Teste de χ2 ou exato de Fisher para dados categóricos e o teste Mann-Whitney para dados numéricos, a fim de verificar se existe diferença significativa entre as variáveis e os escores das escalas de cada grupo estudado. O teste Mann-Whitney e o coeficiente de correlação de Spearman foram utilizados para examinar se existe correlação significativa, e a intensidade da correlação entre as variáveis (faixa etária, Medicação em uso, IMC, Número de lesões, Tempo das lesões (anos) e Tratamento utilizado) e os escores (total) das escalas Katz, Lawton e Tinetti de cada grupo. Os resultados referentes às características demográficas e socioeconômicas demonstraram que houve predominância do sexo feminino (57,4%), faixa etária a partir dos 60 anos (57,4%), renda familiar de 1 a 2 salários mínimos (75,9%). As características clínicas evidenciaram fatores de risco, como longos períodos em pé ou sentado (79,6%), história familiar de doença venosa (53,7%), Flebite (37,0%). As características gerais apontam a existência de obesidade I (42,6%), pressão arterial normal no momento (38,9%) e glicemia capilar normal (55,6%). Verificamos, através das características gerais das lesões a existência da lesão no MIE (38,9%) e no MID (38,9%), presença de apenas uma lesão (68,5%), de uma a duas recidivas (50%) e lesão há mais de 10 anos (50%). Na avaliação funcional, foi identificado, através da escala de Lawtom, dependência parcial (90,7%); na escala de Katz, foi identificado independência para todas as atividades (66,7%); e na escala de Tinetti, foi evidenciado baixo risco de queda (44,4%). Conclusão: O estudo mostrou que existem limitações em pacientes com úlceras venosas, tanto adultos como idosos de ambos os sexos, porém o sexo feminino é o mais afetado, assim como está mais presente nos idosos. Em relação à capacidade funcional, foi evidenciado que, nas atividades de vida diária, ela se mantém mais preservada do que nas demais atividades; nas atividades instrumentais de vida diária e atividades referentes ao equilíbrio e marcha, houve um percentual a ser considerado de dependência parcial e risco de quedas, sinalizando a necessidade de investimento do poder publico e atenção dos profissionais para essas questões

The aim of the present study was to evaluate the functional capacity of patients with venous ulcers. This is an observational study with cross-cutting and quantitative approaches. Participants were adults and elderly patients with venous ulcers treated at two ambulatories. In the process of selection, convenience sampling was adopted. For data collection, the following instruments were used: Protocol I Adapted-profile clients with ulcer; LAWTON IADL scale; Scale KATZ ADL scale and the Tinetti Index. The study was approved by the Research Ethics Committee. In the analysis, descriptive statistics were used, made by Fisher χ2 or exact test for categorical data, and the Mann-Whitney test for numerical data in order to verify a significant difference between the variables and the scores of the scales of each group. The Mann-Whitney test and Spearman correlation coefficient were used to examine whether there is a significant correlation, and the intensity of the correlation between variables (age, medication in use, BMI, number of lesions, time of injuries (years) treatment used) and scores (total) of Katz scales, Lawton and Tinetti of each group. The results of the demographic and socioeconomic characteristics highlighted that there was a predominance of women (57,4%), aged from 60 (57,4%) and with a family income of 1 to 2 minimum wages (75,9%). The clinical features showed risk factors, such as long periods of standing or sitting (79,6%), family history of venous disease (53,7%) and phlebitis (37,0%). The overall characteristics suggest the existence of obesity I (42,6%), normal blood pressure at the moment(38,9%) and a normal blood glucose (55,6%). Through the overall characteristics of the lesions, were verified the presence of injury MIE (38,9%) and MID (38,9%), presence of only one lesion (68,5%), one or two recurrences (50%) and injury for more than 10 years (50%). In the functional assessment, was identified: by Lawtom scale, partial dependence (90,7%); by the Katz scale, independence has been identified for all activities (66,7%); and Tinetti scale evidenced low risk of falling (44,4%). Conclusion: The study showed that there are limitations in patients with venous ulcers, both adults and elderly of both sexes, but women are the most affected, most of them elderly. Regarding to functional capacity, it was enhanced that, in the activities of daily living, it remains more preserved than in other activities; in instrumental activities of daily living and activities related to balance and gait, there was a percentage to be considered partial dependence and risk of falls, signaling the need for government investment and professionals' attention to these issues

El objetivo del estudio fue evaluar la capacidad funcional de los pacientes con úlceras venosas. Se trata de un estudio observacional con enfoque transversal y un enfoque cuantitativo. Los participantes eran adultos y pacientes de edad avanzada tratados con úlceras venosas en dos clínicas ambulatorias. En el proceso de selección, se adoptó un muestreo de conveniencia. Para la recogida de datos, se utilizaron los siguientes instrumentos: los clientes Protocolo I-perfil Adaptado con úlcera; AIVD de Lawton; Escala Escala KATZ ADL y el Índice de Tinetti. El estudio fue aprobado por el Comité de Ética de la Investigación. En el análisis, se utilizó estadística descriptiva, realizado por Fisher χ2 o la prueba exacta para los datos categóricos y la prueba de Mann-Whitney para datos numéricos con el fin de verificar que no existe una diferencia significativa entre las variables y las puntuaciones de las escalas de cada grupo estudiado. La prueba de Mann-Whitney y el coeficiente de correlación de Spearman se utilizaron para examinar si existe una correlación significativa, y la intensidad de la correlación entre las variables (edad, los medicamentos en uso, índice de masa corporal, número de lesiones, el tiempo de las lesiones (años) tratamiento utilizado) y anota (total) de las escalas de Katz, Lawton y Tinetti de cada grupo. Los resultados de las características demográficas y socioeconómicas mostraron que hubo un predominio del sexo femenino (57,4%), con edades comprendidas entre 60 (57,4%), los ingresos familiares de entre 1 y 2 salarios mínimos (75,9%). Las características clínicas mostraron factores de riesgo, tales como largos períodos de pie o sentado (79,6%), antecedentes familiares de enfermedad venosa (53,7%), flebitis (37,0%). Las características generales sugieren la existencia de la obesidad I (42,6%), la presión normal de la sangre cuando (38,9%) y una glucosa en la sangre normal (55,6%). A cuadros a través de las características generales de las lesiones, la presencia de lesión MIE (38,9%) y MID (38,9%), la presencia de una sola lesión (68,5%) de un dos recurrencias (50 %) y la lesión por más de 10 años (50%). La evaluación funcional, fue identificado por Lawtom escala, la dependencia parcial (90,7%); la escala de Katz, la independencia ha sido identificado para todas las actividades (66,7%); y la escala de Tinetti, se evidencia un bajo riesgo de caídas (44,4%). Conclusión: El estudio mostró que existen limitaciones en los pacientes con úlceras venosas, los adultos y los ancianos de ambos sexos, pero las mujeres son las más afectadas, como es más común en los ancianos. En cuanto a la capacidad funcional, se demostró que, en las actividades de la vida diaria, sigue siendo más conservado que en otras actividades; en las actividades instrumentales de la vida y las actividades relacionadas con el equilibrio y la marcha diaria, hubo un porcentaje que se considera la dependencia parcial y el riesgo de caídas, lo que indica la necesidad de inversión del poder público y de los profesionales de la atención a estas cuestiones

Estilo de vida da pessoa com úlcera venosa: implicações no cuidado com a saúde / Lifestyle of the person with venous ulcer: implications for health care

Ainda nos dias atuais úlcera venosa é considerada como um problema de saúde pública causando prejuízos na vida do indivíduo que a possui e para a economia do país. Contudo, é notória a preocupação por parte da comunidade científica quanto ao estímulo às pesquisas com especialidades focadas para o desenvolvimento de produtos cada vez mais eficazes vislumbrando o processo de cicatrização e a cura. Independente da faixa etária acometida, a ferida pode gerar situações limitantes como odor, dor, a falta de mobilidade, interferindo assim no desenvolvimento de suas atividades diárias, podendo levar à exclusão social e a solidão. Assim, definimos como objeto de estudo: O estilo de vida de pessoas com úlcera venosa e suas implicações no cuidado em saúde. Como problema de pesquisa, apresentamos o seguinte questionamento: de que maneira o estilo de vida interfere no cuidado com a saúde da pessoa com úlcera venosa? Como questões de pesquisa: o estilo de vida adotado pelo indivíduo pode ser um fator que contribui para o desenvolvimento de úlcera venosa? Quais as formas do cuidado com saúde realizada pela pessoa com úlcera venosa? A pessoa com úlcera venosa necessita de cuidados apropriados e de forma resolutiva, com vista ao restabelecimento da saúde e o retorno as suas atividades cotidianas, pois o desenvolvimento da ferida pode trazer implicações aos usuários em relação ao tempo de cicatrização, refletindo em sua qualidade de vida além dos gastos aos cofres públicos. Como objetivos da pesquisa: Descrever as características socioculturais da pessoa com úlcera venosa e discutir a repercussão da úlcera venosa no do estilo de vida da pessoa com a ferida. Trata-se de uma pesquisa quantitativa, um estudo observacional do tipo transversal com análise descritiva. Trinta e cinco pessoas participaram da pesquisa respondendo um formulário com perguntas fechadas apresentando os seguintes: dados sócio demográficos, doenças pregressas, exame físico, crenças e religiosidade, residência (condições de moradia), integridade tissular/avaliação da ferida, palpação do pulso pedioso, como são realizados os curativos pelos sujeitos, aspectos relacionas, auto imagem corporal; todos com úlcera venosa, com idade entre 21 e 84 anos, moradores do município de Niterói- RJ, atendidos nas salas de curativos de duas Policlínicas de Saúde deste município. A escolha dos participantes ocorreu de forma probabilística casual, sem distinção de sexo. Os dados foram analisados através do programa estatístico R. Trata-se de um sistema o qual foi desenvolvido a partir da linguagem S (que também é usada numa versão comercial (o S-Plus). Com posse dos resultados obtidos, foi observado que 80% dos participantes apresentam úlcera venosa somente e 20% úlcera mista (arterial e venosa). Com relação às atividades laborais, 48,5% afirmam que estão aptos para realização do seu labor e 51,5% abandonaram seus empregos após o desenvolvimento da ferida. O estilo de vida adotado pode ser um fator colaborador para a manutenção de uma vida saudável, pois a maioria dos sujeitos compreende a sua importância. Todavia, a desgastante jornada de trabalho vivenciada pelos indivíduos, pouco favorece para a realização de atividade física e para adoção de uma dieta balanceada. O presente estudo buscou compreender o estilo de vida e suas implicações no cuidado em saúde da pessoa com úlcera venosa, com o intuito de contribuir para a ampliação de estudos focados nesta temática colaborando para formação e informação de enfermeiros, proporcionando o aprimoramento de seus conhecimentos, promovendo assim uma assistência holística e integral

Still nowadays Ulcus Cruris is considered as a public health problem causing damages in the life of the individual who has and for the country's economy. However, it is notorious the concern on the part of the scientific community regarding the stimulus to research with specialities focused to the development of increasingly effective products glimpsing the healing process and the cure. Regardless of the age group affected, the wound can generate limiting situations such as odor, pain, lack of mobility, thus interfering in the development of their daily activities, and can lead to social exclusion and loneliness. Thus, we define as object of study: the lifestyle of people with venous ulcer and its implications on health care. As a search problem, We present the following question: how lifestyle interferes with the person's health with Ulcus Cruris? As research issues: the lifestyle adopted by the individual may be a factor that contributes to the development of venous ulcer? What forms of health care held by the person with Ulcus Cruris? The person with Ulcus Cruris requires proper care and determined manner, with a view to the restoration of health and return their daily activities, because the development of the wound can bring users implications in relation to healing time, reflecting on their quality of life than spending to the public coffers. Research objectives: Describe the socio-cultural characteristics of the person with Ulcus Cruris and discuss the impact of the Ulcus Cruris in the lifestyle of the person with the wound. It is a quantitative research, an observational study of transverse type with descriptive analysis. Thirty-five people participated in the survey by answering a form with close-ended questions showing the following: socio demographic data, prior diseases, physical exam, beliefs and religiousness, residence (housing conditions), tissue integrity/evaluation of the wound, palpation of pulse pedioso, as are the bandages by subject, body image, auto-related aspects; all with Ulcus Cruris, aged 21 and 84 years, residents of the municipality of Niterói-RJ, served in the dressing rooms of two Polyclinics of Health of this municipality. The choice of participants of probabilistic form occurred irrespective of casual sex. Data were analyzed through the statistical program R. This system which was developed from the S language (which is also used in a commercial version (S-Plus). With the obtained results, it was observed that 80% of the participants present and only 20% venous ulcer Ulcer (arterial and venous) joint. With respect to industrial activities, 48.5% claim they are able to perform your labor and 51.5% abandoned their jobs after the development of the wound. The lifestyle adopted may be a contributor to the maintenance of a healthy life, because most guys understand its importance. However, the exhausting journey of work experienced by individuals, little favors for the realization of physical activity and a balanced diet. The present study sought to understand the lifestyle and its implications in the health care of the person with Ulcus Cruris, in order to contribute to the expansion of studies focused on this theme collaborating to training and information of nurses, providing improved their knowledge, thereby promoting a holistic and integral assistance

Clinical Efficacy of Topical Terbinafine Versus Topical Luliconazole in Treatment of Tinea Corporis/Tinea Cruris Patients.

Aims: Tinea corporis & cruris of skin respond well to topical antifungal therapy, but there is a need to apply cream 2- 3 times daily for up to four weeks will impair compliance & lead to treatment failure. Luliconazole is one of those drugs offering good efficacy & tolerability with a short duration of treatment. Terbinafine, an allylamine antifungal agent, acts by selective inhibition of fungal squalene epoxidase. Luliconazole, an imidazole antifungal agent is considered to be more effective in inhibition of ergosterol biosynthesis and its reservoir property in stratum corneum is greater than that of terbinafine. As there are lack of studies between terbinafine & luliconazole, the present study was undertaken to compare the clinical efficacy in tinea corporis/tinea cruris patients. Study Design: Prospective parallel study. Place and Duration of Study: Study was conducted on 60 patients presenting to the Dermatology out-patient department of RL Jalapa Hospital, Kolar, from 1st December 30th April 2012. Methodology: Patients alternatively assigned to either terbinafine or luliconazole & advised to apply test drugs topically for 14 days. Clinical symptoms & signs were assessed using 4-point (pruritus, erythema, scaling) scale & 10% KOH mount at base line, end of treatment visit (15th day) & later 30th day. The data was analysed based on age, gender distribution, duration of lesion, clinical score & KOH mount. Results: Of the 60 patients recruited, all came for 1st follow up (14th day) & 51 patients for 2nd follow-up (30th day). Mean age of the patients was 33.80± 9.58 years in terbinafine & 33.90 ± 9.58 years luliconazole group. Majority of patients were in 12- 40 years aged in both group. Sixty patients and 51 patients were negative for KOH mount preparation on 15th & 30th day respectively. At the end of first follow-up, the clinical score was reduced from 3 to zero (P=0.0001) in both the treatment groups. Mycological cure was 100% in both the drug groups. There was no relapse in 51 patients who came for 2nd follow-up. Four in terbinafine and 5 in luliconazole group were lost to follow up. Conclusion: Only mild forms of tinea infections were included as compared to other studies where moderate to severe (pustules, incrustations, vesiculation). Hence the onset of illness, treatment duration and severity of illness were favorable in this study for two weeks. In both the treatment arms, clinical & mycological cure was comparable, hence once a day application for two weeks of terbinafine & luliconazole were equally effective for treatment of tinea corporis/cruris infection.

Isolation, Identification and Prevelance of Dermatophytes in Tertairy Care Hospital in Gulbarga District.

Dermatophytosis is one of the most commonly encountered cutaneous fungal infections worldwide. The higher prevalence in tropical and subtropical areas is supposedly due to the hot and humid climatic condition. Other factors like personal hygiene and habits, prevalence of virulent species in the soil are also known to influence the infection. A high prevalence of dermatophytoses has been reported from India. Hence, this study was undertaken to identify, speciate and study the sensitivity pattern of dermatophytosis from clinical samples received at Basveshwar Teaching & General Hospital, Gulbarga. A total of two hundred clinically diagnosed randomly selected patients of dermatophytosis attending the out patient department of Dermatology and Venereology, Basveshwar Teaching & General Hospital & M.R. Medical College, Gulbarga were studied. Skin, nail and hair specimens taken from the patients were processed by potassium hydroxide preparation (KOH) for direct microscopy and culture. Dermatophytosis was more common in the age group of 21-30 years (36%) and in males (73%). Fungi was demonstrated in 130 cases by KOH and in 96 cases by culture; 78 cases were positive by both direct examination and culture. Tinea corporis was the commonest clinical type encountered (54.5%) followed by tinea cruris (25.5%). Tricophyton rubrum (46.87%) was the commonest aetiological agent in majority of clinical types followed by Trichophyton mentagrophytes (36.46%), Microsporum gypseum (4.16%), Trichophyton tonsurans (1.04%) , Epidemophyton floccosum (8.33%). Microsporum audouinii (2.08%) and Trichophyton violecium (1.04%). Dermatophyte infections are very common in our country where hot and humid climate along with poor hygienic conditions play an important role in the growth of these fungi. By and large, Trichophyton species forms the commonest etiological agent of dermatophytosis. Tinea rubrum was the commonest isolate in tinea corporis, tinea cruris and Onychomycosis. Microporium audouinii was isolated from 1 case of tinea capitis.

A Case of Concomitant Tinea Infection Diagnosed with Molecular Biologic Technique / 대한의진균학회지

Trichophyton(T.) rubrum is known to be the most common causative agent of tinea cruris, tinea corporis, and tinea pedis, and hygiene, nutritional status, and high temperature/humidity are known to play an important role in pathogenesis. Although there has been a report on a case of co-infection in which tinea pedis subsequently developing tinea cruris with the foot lesion being a reservoir of the later lesion, there is of yet no report which confirmed co-infection of two different lesions through identification of definite causative organisms. This case concerns a 32 year-old patient who presented with erythematous annular scaly patches on the groin and axilla. Although no organism was identified on mycosel culture, DNA base sequence and RFLP analysis of the scales revealed T. rubrum in both of the lesions. Considering that this is a rare case of tinea cruris accompanied by tinea corporis in the axilla and groin confirmed by molecular biological techniques, the authors present it with review of literature.

Dermatitis cruris pustulosa et atrophicans.

Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, primarily affecting the lower limbs. It is characterized by symmetrical follicular pustules of both legs, with cutaneous edema, resulting in alopecia, atrophy and scarring. It was first described by Clarke, from West Nigeria, in 1952 and well illustrated in his book "Skin diseases in the African," under the initial label of "Nigerian shin disease." Subsequently, it was described in India as well, in 1964, and continues to be a problem in dermatology clinics across the country. It is predominantly a disease of men and has a high prevalence in some geographical regions; up to 3-4% in Madras, South India. Some unique features that distinguish DCPA from banal pustular folliculitis include its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the involved skin, with little postinflammatory hyper- or hypopigmentation. Further, even in the presence of extensive lesions, there are no systemic features. Coagulase-positive Staphylococcus aureus is known to have a role in the etiology of DCPA, but the exact etiopathogenesis still needs to be elucidated. Immunological postulates such as hypergammaglobulinemia have been put forward to explain the chronicity of the condition. A number of therapeutic agents have been tried in various studies, including cotrimoxazole, psoralen with ultraviolet A (PUVA) therapy, ciprofloxacin, pentoxifylline, rifampicin, dapsone, minocycline and mupirocin (topical) with variable success rates. Although a well-recognized entity in dermatology clinics in tropical countries, DCPA has received little attention in the dermatological literature and has only a few studies to its credit. Its unique clinical picture, unclear etiopathogenesis and resistance to therapy afford a vast scope for further investigation and study.

The antidermatophytic activity of Zingiber officinale (ginger): In vitro study of ginger rhizome extract in ethanol using various dermatophytes and Candida albicans, and double-blind, randomized controlled trial comparing commercially prepared ginger rhizome powder 25mg/g cream and ketoconazole (Nizoral) 20mg/g cream

BACKGROUND: In vitro studies reported the antifungal activity of Zingiber officinale (ginger) rhizome extract against certain dermatophytes and Candida albicans. However, no in vivo studies had been made.OBJECTIVES: (1) To determine in vitro the antifungal activity of commercially prepared ginger rhizome powder against common dermatophytes and Candida albicans.(2) To determine the Minimum Inhibitory Concentration (MIC) of commercially prepared ginger rhizome powder against Trichophyton rubrum and Candida albicans.(3) To compare the efficacy and safety of ginger 25 mg/g cream versus ketoconazole (Nizoral) 20mg/g cream on patients with tinea.METHODS: Patients (n=24) with tinea corporis or tinea cruris were randomly allocated to two groups. They were instructed to apply either ginger or ketoconazole cream twice daily on lesions for eight weeks. Follow-up consultations were done every two weeks for a total of eight weeks. Photographs, KOH and recording of parameters (erythema, papules, scaling and pruritus) per lesion were used as outcome measures. An investigator's global response assessment was done at the end to determine the improvement of each lesion.RESULTS: The disk diffusion method revealed that Trichophyton mentagrophytes,Trichophyton rubrum and Candida albicans were inhibited by the ginger powder at 2 mg/10?L. The MIC for C. albicans as 12.5 mg/ml and 25 mg/ml for T. rubrum. The age, gender distribution, and the severity index of the two treatment groups were comparable at baseline. There were significant improvements in erythema, papules, pruritus and scaling scores of patients in each group across different time points (Friedman's ANOVA p95% conversion rate to negative KOH at the fourth and eighth week of treatment for the ginger group respectively, while 100% conversion to negative KOH was noted at the second week of treatment for ketoconazole. One patient in the ginger group experienced increased erythema, pruritus and thickness of her lesions during the second week of treatment and the medication was discontinued.CONCLUSION: While ketaconazole 20mg/g cream treatment resulted in faster clearance of fungal lesions, ginger 25mg/g cream yielded progressive improvement of tinea corporis and tinea cruris when used over an eight week period. Ginger cream may be an affordable alternative antifungal treatment. Future studies using a higher concentration and larger sample size are recommended although a possible case of contact dermatitis is seen using 25mg/g ginger cream.

The Frequency of Tinea Pedis in Patients with Tinea Cruris / 대한의진균학회지

BACKGROUND: There have been many studies about concurrent infection with tinea cruris and tinea pedis as a part of dermatophytosis in Korea. However, few studies have been reported about actual percentage regarding the frequency of tinea pedis in patients with tinea cruris and comparison of the causative organisms in the groin and foot. OBJECTIVE: The purpose of this study was to investigate the frequency of tinea pedis in patients with tinea cruris and the causative organisms in the groin and foot. METHODS: We examined clinical characteristics, frequency of tinea cruris, and causative organism on one hundred and eight nine cases with tinea cruris at the department of dermatology, Dongguk University Hospital from September 2000 to August 2005. RESULTS: The ratio of male to female patients was 10.8:1. Besides most of them were between the twenties and forties. Most (74.6%) of them involved both sites of the groin. Duration of tinea cruris was the most common within one year. The frequency of tinea pedis in patients with tinea cruris was 85.7%. Most of them (69.1%), duration of tinea pedis was longer than that of tinea cruris. One hundred and thirty nine dermatophytes were isolated from 189 patients with tinea cruris. They were Trichophyton(T.) rubrum (89.2%), T. mentagrophytes (7.2%), and Epidermophyton floccosum (3.6%). Of one hundred and sixty two patients with both tinea cruris and tinea pedis, 52 patients (32.1%) had same species and only four patients (2.5%) had different species in the groin and foot. CONCLUSION: Because of the high incidence of concurrent infection with tinea cruris and tinea pedis, we suggest the need of a careful mycological examination for foot in patients with tinea cruris.

Dermatophytosis among Filipinos: its incidence and flora in the outpatient dermatological clinic of the Philippine General Hospital

1. Mycologic laboratory studies consisting of KOH preparations for direct microscopic examination and cultural procedures for the isolation and identification of the causative pathogenic fungi were performed on 401 cases of suspected dermatophytosis in the Outpatient Skin Clinic of the Philippine General Hospital during the period August, 1948 to May, 19502. Ninety-one cases suspected of tinea pedis were studied. Twenty or 22% showed a positive KOH preparation for hyphal filaments. Eleven positive cultures were obtained, 10 of Trichophyton mentagrophytes and 1 of Trichophyton rubrum. This low figure of demonstration of the fungus is explained mainly by technical errors in the performance of the laboratory examination and the probable non-mycotic nature of a certain percentage of the cases3. Ninety-seven patients with involvement of the hands were seen and only one gave a positive KOH mount. Not a single culture showed growth of a dermatophyte4. Eighty-one cases with lesions on both feet and hands were examined. There were 15 cases with positive KOH of the feet and negative KOH of the hands. One case gave positive findings from both feet and hands. Only three positive cultures were obtained from the feet which proved to be Trichophyton mentagrophytes. None was isolated from the hand lesions5. There were 62 patients suspected of tinea corporis. Out of this total, 40 gave positive KOH mounts. Nineteen cultures were isolated, 13 of Trichophyton rubrum, 4 of Trichophyton mentagrophytes and one each of Trichophyton violaceum and Microsporum gypseum6. Fifty-six cases were diagnosed clinically as tinea cruris. Of these, 47 had a positive KOH mount. Twenty-two cultures were obtained with 19 of Trichophyton rubrum, 2 of Trichophyton mentagrophytes and one of Trichophyton violaceum. This preponderance of Trichophyton rubrum as the causative agent of tinea cruris in the series studied is in contrast to that recorded by most dermatologic textbooks which is Epidermophyton flocosum. The greater tendency of this form of tinea cruris caused by Trichophyton rubrum to spread to adjacent areas and to involve other sites was also observed7. The paucity of cases of tinea capitis, tinea unguium and tinea barbae in the clinical material studied is noted8. The results as obtained are compared with statistics reported by authors from other lands. (Summary)

Clinical and Mycologic Studies of Tinea Cruris / 대한피부과학회지

BACKGROUND: The incidence and causative dermatophytes of tinea cruris has been changed with time. Although clinical and mycologic studies of whole dermatophytosis have been reported many times, there have been only a few studies about tinea cruris reported. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of tinea cruuis. METHODS: We evaluated the clinical and mycologic aspects of tinea cruris in 598 patients with tinea cruris from January 1985 to December 1997 in Yeungnam University Hospital. RESULTS: The incidence of tinea cruris was 20.8% of 2,878 total dermatophytoses. The ratio of male to female patients was 23.9:1. And most of them were in their twenties and thirties. Most(82.1%) of them involved both sites of the groin. Concurrent dermatophytic infections of tinea cruris were noted in 29.4% of the cases and the most common one was tinea pedis(22.4%). Three hundred and thirty eight dermatophytes were isolated from 598 patients with tinea cruris. They were Trichophyton(T.) rubrum(95.3%), T. mentagrophytes(4.4%), Epidermophyton floccosum(1.2%), Microsporum canis(0.9%). CONCLUSION: Tinea cruris is a male predominant dermatophytosis, the most common causative organism is T. rubrum, and tinea pedis seems to be an important reservoir.