Analysis of Adult Patients with Tinea Capitis in Southeastern Korea

BACKGROUND: Tinea capitis is a cutaneous infection of dermatophytes and predominant in children. Although tinea capitis in Korea is controlled by oral antifungal medications and concerted public health initiatives, it's still a health issue.OBJECTIVE: To investigate changes in the epidemiological and mycological characteristics of adult patients with tinea capitis in southeastern Korea.METHODS: Using medical records from Kyungpook National University Hospital and Catholic Skin Clinic from 1989 to 2018, we retrospectively investigated the epidemiological and mycological characteristics of 266 adult patients (aged over 20) with tinea capitis.RESULTS: Among total 266 patients, 239 were KOH-positive. The annual incidence of tinea capitis ranged from 3 to 18 between 1989 and 2018. Of the total, 54 (20.30%) were male and 212 (79.70%) were female. Eighty patients (30.08%) were in their seventies, the most commonly affected age group. Of the remaining, 58 (21.80%) were in their sixties, and 41 (15.41%) in eighties. Among all, 77 (28.95%) visited the hospital in summer, 72 (27.07%) in spring, 64 (24.06%) in winter, and 53 (19.92%) in fall. Dermatophytes were cultured from 171 patients. Microsporum canis was the most common dermatophyte (42.48%), while Trichophyton rubrum was the second (15.79%). Of the 266 patients, 186 (69.92%) lived in urban areas and 80 (30.08%) in rural areas.CONCLUSION: The epidemiological and mycological characteristics of adult patients with tinea capitis were different from those of children in terms of annual incidence, sex distribution, and isolated dermatophytes. These results provide useful information for the treatment and prevention of tinea capitis.

Eruptive Keratoacanthoma en Plaque Confirmed by Complete Spontaneous Regression: A Case Report and Review of the Literature / 대한피부과학회지

Here we present a case of an unusual variant of keratoacanthoma, eruptive keratoacanthoma en plaque, occurring on the upper lip of a 58-year-old man. The lesion was a flesh-colored nodular plaque measuring 1.5×1.0 cm that rapidly grew within 2 months. After two biopsies, the cutaneous lesion grew more rapidly for 1 month, covering the entire cutaneous surface of the upper lip and measuring 6.0×2.0 cm. Thereafter, it disappeared without any treatment within 3 months, resulting in mild scarring with a cobblestone-like surface similar to the stereotypical involuting course of ordinary keratoacanthoma. In addition to the clinical features, the present case displayed essential diagnostic features of eruptive keratoacanthoma by showing typical spontaneous involution not reported in previous reports. Furthermore, it also revealed histopathology suggestive of squamous cell carcinoma, at least focally in addition to that of keratoacanthoma, which may evoke the potential for a misdiagnosis of malignancy.

Epidemiological and Mycological Characteristics of Teenagers with Tinea Capitis in Southeastern Korea: Trichophyton tonsurans as the Main Causative Fungus in Recent 10 Years / 대한의진균학회지

BACKGROUND@#Tinea capitis is a contagious fungal infection that occurs predominantly in childhood. Although its incidence has declined, its epidemiological and mycological characteristics are continue to evolve.@*OBJECTIVE@#To assess changes in the epidemiological and mycological characteristics of tinea capitis in teenage patients in Southeastern Korea.@*METHODS@#We retrospectively investigated epidemiological and mycological characteristics of 202 teenage patients with tinea capitis who visited Kyungpook National University Hospital and the Catholic Skin Disease Clinic from 1989–2018.@*RESULTS@#Of 202 patients, 177 patients showed KOH-positivity. Dermatophytes were cultured from 157 patients. The annual incidence of tinea capitis ranged from 0 to 30 between 1989 and 2018. Of 202 patients, 153 patients (75.74%) were male and 49 patients (24.26%) were female. The ratio of male to female was 1:0.32. For seasonal distribution, 78 patients (38.61%) visited our hospital in winter, 59 patients (29.21%) visited in spring, 35 patients (17.33%) visited in fall, and 30 patients (14.85%) visited in summer. Microsporum canis was the most common dermatophyte (44.06%) isolated from tinea capitis. Trichophyton tonsurans was the second most common dermatophyte (26.73%). For inhabitancy distribution, 151 patients (74.75%) lived in urban areas and 51 (25.25%) lived in rural areas.@*CONCLUSION@#The epidemiological characteristics of teenage patients with tinea capitis were distinct from those of adults in annual incidence, sexual distribution and isolated dermatophytes. Trichophyton tonsurans was the main causative organism of tinea capitis in recent 10 years. These results are useful for the targeted treatment and prevention of tinea capitis.

A Case of Phaeohyphomycosis on the Wrist: Identification of Exophiala spinifera in Korea

No abstract available.

Tinea Faciei in a Mother and Daughter Caused by Arthroderma benhamiae

No abstract available.

Low But Continuous Occurrence of Microsporum gypseum Infection in the Study on 198 Cases in South Korea from 1979 to 2016

BACKGROUND: Microsporum gypseum has been isolated from South Korea since 1966. However, the incidence of M. gypseum infection is very low. OBJECTIVE: The aim of this study is to add massive data on M. gypseum to the literature and to provide useful information on clinical and mycological characteristics of M. gypseum. METHODS: We retrospectively analyzed data of 198 cases infected with M. gypseum from 1979 to 2016. The identification of M. gypseum was done with mycological examination using 15% KOH preparation and potato corn meal tween 80 agar culture media. RESULTS: The incidence of M. gypseum infection was very low in South Korea, showing a tendency to decrease. Out of 198 cases, men were 94 cases (47.5%) and women were 104 cases (52.5%). Mean age of all patients was 29.83 years old: 24.97 years old in men and 34.22 years old in women. M. gypseum infection occurred most frequently in September (16.7%) and August (16.2%). The most common clinical type of M. gypseum infection was tinea corporis (38.4%). CONCLUSION: M. gypseum infection shows very low incidence but still remains around us until recent years. We should keep in mind the characteristics of M. gypseum.

The Incidences of Dermatophytosis and Cutaneous Candidiasis Infection in Southeastern Koreabetween 2013 and 2016 / 대한의진균학회지

BACKGROUND@#Superficial fungal infections, including dermatophyte infection and cutaneous candidiasis, are common and affect more than 25% of the population worldwide.@*OBJECTIVE@#The aim of this study was to investigate the recent clinical and mycological characteristics of dermatophytosis and cutaneous candidiasis in southeastern Korea.@*METHODS@#Of 20,413 patients with dermatophyte infection, cutaneous candidiasis, or suspected fungal infection, 8,106 who were culture positive for infection were retrospectively evaluated using their medical records.@*RESULTS@#The annual incidence rate of fungal infection tended to be constant. Such infections were more common in men than in women. Fungal infections most commonly occurred in patients in their 50s and in August. The most common clinical type of superficial fungal infections was tinea pedis. The most common causative fungus of superficial fungal infections was Trichophyton rubrum.@*CONCLUSION@#This study provides useful information on the clinical and mycological characteristics of fungal infections in southeastern Korea in recent years.

Changes in the Clinical and Epidemiological Characteristics of Trichophyton verrucosum Infection / 대한의진균학회지

BACKGROUND@#Trichophyton verrucosum (T. verrucosum) is a zoophilic dermatophyte that causes ringworm in cattle and is prevalent worldwide. This dermatophyte may be responsible for various conditions, especially inflammatory skin lesions.@*OBJECTIVE@#In this study, we aimed to investigate the changes in the clinical and epidemiological characteristics of T. verrucosum infections in southeastern Korea.@*METHODS@#A total of 34 patients who visited the Catholic Skin Clinic and the Kyungpook National University Hospital in Daegu, Korea from 2005 to 2017 were diagnosed with T. verrucosum infection. The diagnosis was confirmed using fungal culture. The data were based on a retrospective survey of the medical records.@*RESULTS@#The annual incidence of T. verrucosum infection was very low. There was no difference in the sexual incidence. T. verrucosum infection was most common among subjects in their fifties and sixties. The highest incidence was during the month of September. The arm was most frequently involved, followed by the face. This infection was predominant in patients living in rural areas.@*CONCLUSION@#These clinicoepidemiological findings provide useful information for understanding the changes in the infection caused by T. verrucosum. In particular, it was interesting to note that the incidence was very low, majority of the affected subjects were in their fifties and sixties, and the most commonly affected site was the arm.

Favus Diagnosed in Siblings in 1979 / 대한의진균학회지

Favus is a chronic dermatophyte infection of the scalp presented by thick yellow crusts within the hair follicles which leads to scarring alopecia. Favus is associated with poor hygiene and malnutrition so that it is seen almost exclusively in Africa, the Middle East and parts of South America with abruptly decreased incidence nowadays. The last report referring favus was published in 1996 in Korea, which might have historical significance. Herein, we report favus diagnosed in siblings in 1979.

Classification and Typing of Trichophyton mentagrophytes Isolated from a Korean Population / 대한의진균학회지

BACKGROUND: Trichophyton mentagrophytes complex is a heterogeneous group. A new classification, based on molecular biology, has replaced the one based on morphology, physiology, and mating behavior. OBJECTIVE: T. mentagrophytes isolates from Korean patients were classified using the new method and compared with the classic classification. METHODS: During 2010-2011, fungal isolates were collected at the Catholic skin clinic from 562 patients infected with T. mentagrophytes; clinical characteristics were reviewed. Patients were divided into four groups based on the morphological characteristics of the isolates. Thirty-four strains of T. mentagrophytes were randomly selected from the four groups for mycological and molecular biology analyses, including analyses of morphological characteristics, ribosomal DNA (rDNA) internal transcribed spacer (ITS) sequence, and rDNA nontranscribed spacer (NTS) typing. RESULTS: Among the 562 isolates, persicolor (41.6%) was the most common strain type, followed by the powdery (38.4%), downy (11.2%), and granular (8.7%) types. The granular type differed from the other three with respect to the isolation site, patient's age, seasonal variation, and microscopic characteristics. Among the selected 34 strains, the microscopic characteristics varied for each strain. The powdery, persicolor, and downy types had ITS sequences identical to those of the anthropophilic T. interdigitale/A. vanbreuseghemii. The ITS sequence of granular type was similar to that of zoophilic T. interdigitale/A. vanbreuseghemii. The granular type had different NTS types than the other types did. CONCLUSION: The T. mentagrophytes strains isolated were classified as T. interdigitale/A. vanbreuseghemii; the majority (91.7%) was anthropophilic and 8.3% were zoophilic and granular type.

A Case of Fonsecaea monophora Infection / 대한의진균학회지

No abstract available.

Skin Infection due to Trichophyton tonsurans Still Occurs in People in Korea but not as Outbreaks

Since 1995, Trichophyton tonsurans has been one of the causative agents of dermatophytosis in Korea. Herein we evaluate 77 patients infected with T. tonsurans who visited an outpatient clinic between 2004 and 2014. Infections due to T. tonsurans were diagnosed by mycological examination, which included direct microscopic examination using 15% KOH and culture in potato dextrose agar complemented with 0.5% chloramphenicol. The annual prevalence of infection due to T. tonsurans was the highest in 2014 (15 cases) but remained constant in non-gladiators between 2004 and 2014. The ratio of male to female patients was 1:0.3. The spring season presented the highest incidence compared with other seasons, with 27 cases. The incidence of infections due to T. tonsurans among gladiators was highest in spring compared with the other seasons whereas the incidence in non-gladiators was the highest in the winter. The body site most commonly affected was the face. Tinea corporis was the most common subtype of dermatophytosis caused by T. tonsurans. Herein, we demonstrate that the prevalence of infection with T. tonsurans remain constant throughout the study period in Korea.

The Epidemiology of Dermatophyte Infection in Southeastern Korea (1979~2013)

No abstract available.

Mycological and Molecular Analysis of Soil Keratinophilic Fungi Isolated in Summer Beaches of the Korean South Coast / 대한피부과학회지

BACKGROUND: Some species of soil keratinophilic fungi (KPF) are known to be pathogens that may lead to cutaneous infection. People exposed to these species through direct contact with soil on beaches can contract KPF infection. However, there is little literature regarding pathogenic KPF isolated from beaches during summer time. OBJECTIVE: This study aims to evaluate the distribution of soil KPF isolated from beaches in Korea during summer. METHODS: One hundred eighty soil samples from six beaches in the southern coastline of Korea under three different climatic conditions were collected. The KPF species were isolated using the hair-baiting technique. Then, molecular identification was performed by sequencing the ribosomal RNA (rRNA) internal transcribed spacer (ITS) region to investigate the exact species of the isolated fungi. RESULTS: Among the one hundred eighty soil samples, twenty-nine strains (16.1%) of KPF were recovered. The isolation rate of KPF among the beaches varied from 0 to 34.5%. KPF was most frequently isolated in shaded dry areas (30%), followed by sunny dry areas (18.3%), and sunny wet areas (0%). Molecular identification of the fungi using rRNA ITS analysis helped in their classification. Microsporum gypseum/Arthroderma incurvatum (69.0%), Microsporum gypseum/Arthroderma gypseum (3.4%), Trichophyton ajelloi/Arthroderma uncinatum (13.8%), Microsporum cookei/Arthroderma cajetani (10.3%), and Chrysosporium indicum/Aphanoascus terreus (3.4%) were identified. Single nucleotide polymorphism (SNP) was observed at position 180 of the rRNA ITS2 in the 20 strains of Microsporum gypseum/Arthroderma incurvatum, and the species was divided into Types 1 (14 strains) and 2 (6 strains) depending on the base present at the SNP position. The geographic distribution of these two types differed. CONCLUSION: Our results show that the beach is a possible source of keratinophilic fungal infection in humans. People should be aware of pathogenic fungi on the soil of beaches during summer and take measures to prevent possible superficial fungal infections.

Increasing Prevalence of Trichophyton rubrum Identified through an Analysis of 115,846 Cases over the Last 37 Years

Trichophyton rubrum is the most common dermatophyte in the world with the highest prevalence in Korea. There are few reports about epidemiological and mycological characteristics of T. rubrum based on long-term, large-scale studies. The purpose of this study was to investigate the clinical and epidemiological characteristics of T. rubrum infections in Korea. We retrospectively investigated with patients' records about the epidemiological and mycological status of 115,846 cases with T. rubrum infection that was mycologically diagnosed at Catholic Skin Disease Clinic from 1979 to 2013. Direct microscopy in 15% KOH solution and culture was done in each case. The annual incidence of patients with T. rubrum infection had been increasing during the period; and of 131,122 patients with dermatophytosis, 115,846 patients (88.35%) had T. rubrum infection. Disease was most prevalent among patients in their twenties in the 1970s and 1980s; in their thirties in the 1990s; in their forties in the 2000s; and in their fifties in the 2010s. The sex ratio was 1.5:1. T. rubrum infection was most commonly seen in summer and was found predominantly in patients living in urban areas. Toe webs were most frequently involved, followed by toenails and groin. This epidemiologic findings provide useful information for prevention of T. rubrum infection and future dermatophytosis prospects.

The Clinical and Mycological Study of Tinea Faciei in Daegu / 대한의진균학회지

BACKGROUND: Tinea faciei is a superficial dermatophyte infection on non-bearded skin of face. It is often confused with other dermatoses. Tinea faciei accounts for 3~4% of cases of tinea corporis. There have been only a few reports on the clinical and mycological features of tinea faciei. OBJECTIVE: This study aims to evaluate the demographic, clinical, and mycological features of tinea faciei in Daegu, Korea. METHODS: The medical records of 56 cases with tinea faciei from the Daegu catholic university medical center and Catholic skin clinic from January 2013 to December 2014 were evaluated retrospectively. RESULTS: The incidence was highest at 6th decade age group. The most frequent occupation of patients was agro-livestock area. Among 56 cases, the lesions were round patches in 40 cases (71.5%), followed by ring-shaped patches in 8 cases (25.0%) and plaques in 2 cases (3.5%). The most commonly isolated organism was Trichophyton rubrum (79.2%). CONCLUSION: Tinea faciei could easily be misdiagnosed clinically due to its abnormal presentation. When facing erythematous patches on face, physician should be aware of tinea faciei and undergo careful history taking with mycological study.

Decreasing Incidence of Trichophyton mentagrophytes in Korea: Analysis of 6,250 Cases during the Last 21-Year-Period (1992-2012)

Trichophyton mentagrophytes is the second common dermatophyte in Korea. However, few reports have been issued on the epidemiological and mycological characteristics of T. mentagrophytes in Korea based on long-term, large-scale study. The purpose of this study was to elucidate the epidemiological and mycological characteristics of T. mentagrophytes in Korea. During the 21-yr-period from 1992 to 2012, 6,250 patients with T. mentagrophytes were surveyed to determine annual incidence and the distribution of subjects by age, sex, season, involved sites, and place of residence. T. mentagrophytes infections were confirmed by fungal culture. In addition, the colony appearance of T. mentagrophytes was classified as granular, persicolor, powdery, or downy. Epidemiological analysis showed that annual incidence reached a peak in 2005, and then gradually decreased. T. mentagrophytes infection was most common in July, and was found predominantly in middle-aged adults, especially in those in their forties. Mycological analysis showed a powdery colony appearance was the most common, followed by persicolor and granular colonies. Toewebs were most frequently involved. This investigation on T. mentagrophytes provides insights into its incidence and characteristics.

Intra-familial Infection due to Trichophyton tonsurans in Korean General Population / 대한의진균학회지

Trichophyton (T.) tonsurans is a common anthropophilic species, which causes tinea capitis and tinea corporis particularily in Europe and America, but has not been prevalent in Korea. One case with mycoses infection of the scalp and the other with tinea corporis due to T. tonsurans were observed in Korean general population. We confirmed T. tonsurans infection on the basis of the direct microscopic examination and culture from scales and infected hairs of skin lesions. Systemic itraconazole and terbinafine therapy with topical ketoconazole cream led to clinical and mycological recovery in our cases. Infection of T. tonsurans appears to have spread gradually among the general population in Korea. Therefore, athletic and medical associations should make constant observation and take close consideration about T. tonsurans infection.

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis / 대한의진균학회지

BACKGROUND: Tinea manus is a common superficial dermatophyte infection that is usually coexistent with tinea pedis. Trichophytom rubrum is the most commonly isolated agent in tinea manus. Despite this condition, there have been only a few reports on the clinical and mycological features of tinea manus. OBJECTIVE: This study aims to evaluate the variables related with tinea manus and to determine the correlation with other superficial dermatophyte infection. METHODS: Clinical and mycological features of 54 cases with tinea manus from the department of dermatology in Daegu Catholic University Hospital and the Catholic Skin Clinic from January 2011 to December 2012 were evaluated retrospectively. RESULTS: The male to female ratio was 2:1. The age distribution ranged from 14 to 81 years old. The affected site was the palm in 31 cases (57.4%), the dorsum in 13 cases (24.1%), and both palm and sole in 10 cases (18.5%). Tinea manus was accompanied with other superficial dermatophyte infections, such as tinea pedis, tinea unguium, and tinea corporis in 42 cases (77.8%) and not in 12 cases (22.2%). Fungal culture result was positive in 8 cases of tinea manus only group and in 26 cases of tinea manus with other dermatophyte infection group. The most commonly isolated agent was Trichophyton rubrum in both groups. CONCLUSION: The patients with only tinea manus tend to predilect the dorsum of hand and were relatively more caused by other fungus than Trichophyton ruburum when compared with the patients with other dermatophytosis.

Contamination of Slippers in Operating Room by Dermatophytes and Effect of Antifungal Agent (Terbinafine) Disinfection / 대한의진균학회지

BACKGROUND: It is known that floor, clothes, shoes and slippers of common uses are the sources of infection by dermatophytes. However there hasn't been any report about the culture of dermatopytes from slippers in operating room. OBJECTIVE: The purpose of this study was to evaluate the contamination status of the slippers in operating room by dermatophytes and the effect of antifungal agent disinfection. METHODS: The samples were collected from 240 pairs of slippers that were used in common at operating room of Daegu Catholic University Medical Center with scrapping method. The collected samples were cultured on the media with chloramphenicol (500 mg/L) and cycloheximide (500 mg/L) to control the growth of nondermatophytic fungi. The same collection and culture was done again after the antifungal agent (terbinafine) disinfection. RESULTS: Dermatophytes were isolated from 22 (9.2%) pairs of slippers from a total of 240 pairs before the treatment, and 9 (3.8%) pairs after the treatment. There was significant difference in isolation rate between the slippers before the treatment and after the treatment (p=0.016). Trichophyton (T.) mentagrophytes and T. rubrum were isolated from the slippers and T. mentagrophytes (54.8%) was the most common isolated fungus. CONCLUSION: About ten percent of slippers in operation room were contaminated by dermatophytes. Regular antifungal agent disinfection on slippers in operating room will help to decrease in the prevalence of dermatophytes growth and prevent the nosocomial infection.