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.

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.

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.

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.