Dermatophytosis caused by Trichophyton raubitschekii. Report of the first case in São Paulo, Brazil.

The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.

Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes.

BACKGROUND: Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES: Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS: Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS: Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.

Open clinical study of the efficacy and safety of terbinafine cream 1% in children with tinea corporis and tinea cruris.

BACKGROUND: Topical application of antifungal agents is considered the treatment of choice for dermatomycoses. Most of the available drugs are fungistatic, requiring long term treatment to prevent relapses. Terbinafine is a synthetic antifungal agent that, because of its fungicidal action, provides high cure rates and low relapse rates after short periods of treatment. METHODS: Ninety-seven children ages 2 to 15 years with a suspected diagnosis of tinea corporis and/or tinea cruris were enrolled in this open trial. After mycologic assessment to confirm diagnosis (culture and direct microscopy) terbinafine 1% cream was applied once daily during 1 week. Clinical and mycologic assessments were made at the baseline visit and on Days 7, 14 and 21. Efficacy assessment was based on 88 children (9 patients excluded by protocol violation). RESULTS: Therapy was considered effective in 92.0% (81 of 88) of patients (complete clinical and mycologic cure or mycologic cure with minimum signs and symptoms or clinical improvement, > or = 50%). Tolerability was assessed in 97 patients on an intention-to-treat basis. Adverse reactions were itching 3% (3 of 97), itching associated with erythema exacerbation 1% (1 of 97) and contact dermatitis 1% (1 of 97). CONCLUSION: Terbinafine 1% cream appears to be an effective and well-tolerated treatment for tinea corporis and tinea cruris in children.

Subcutaneous phaeohyphomycosis caused by Phoma cava. Report of a case and review of the literature.

We report a case of subcutaneous phaeohyphomycosis observed in a male patient presenting pulmonary sarcoidosis and submitted to corticosteroid treatment. He presented nodular erythematous-violaceous skin lesions in the dorsum of the right hand. Histopathological examination of the biopsied lesion revealed dematiaceous hyphae and yeast-like cells, with a granulomatous tissual reaction. The isolated fungus was identified as Phoma cava. A review of the literature on fungal infection caused by different Phoma species, is presented. The patient healed after therapy with amphotericin B. followed by itraconazole.

Subcutaneous hyalohyphomycosis caused by Acremonium recifei: case report.

We present a case of subcutaneous hyalohyphomycosis due to Acremonium recifei, a species whose habitat is probably the soil, first identified in 1934 by Arêa Leão and Lobo in a case of podal eumycetoma with white-yellowish grains and initially named Cephalosporium recifei. A white immunocompetent female patient from the state of Bahia, Brazil, with a history of traumatic injury to the right hand is reported. The lesions was painless, with edema, inflammation and the presence of fistulae. Seropurulent secretion with the absence of grains was present. Histopathological examination of material stained with hematoxylin-eosin showed hyaline septate hyphae. A culture was positive for Acremonium recifei. Treatment with itraconazole, 200 mg/day, for two months led to a favorable course and cure of the process. We report for the first time in the literature a case of subcutaneous hyalohyphomycosis due to Acremonium recifei in a immunocompetent woman. Treatment with itraconazole 200 mg/day, for two months, resulted in cure.

Estudo clinico com o uso do itraconazol em Tinha crural, Tinha do corpo e Tinha do pe interdigital / Clinical study with itraconazole in the treatment of Tinea cruris, Tinea corporis and tinea pedis interdigital

Os autores estudaram 31 pacientes portadores de tinhas crural, do corpo e do pe interdigital, tratados com 100 mg de itraconazol, administrados junto com o almoco, durante 15 dias. Foram realizadas 3 avaliacoes clinicas e micologicas: no pre-tratamento, no final do tratamento e 2 semanas apos o tratamento. O itraconazol mostrou-se eficaz para o tratamento das dermatofitoses estudadas, na dose empregada, com 100 por cento de cura micologica. Em relacao a evolucao clinica, houve diminuicao estatistica significante (teste de Friedman-p < 0.001) dos sinais e sintomas avaliados. Nao foi observada ocorrencia de efeitos colaterais

[Clinical study of itraconazole for the treatment of Tinea cruris, Tinea corporis and Tinea pedis interdigital]. / Estudo clínico com o uso do itraconazol em tinha crural, tinha do corpo e tinha do pé interdigital.

The authors studied 31 patients with Tinea cruris, corporis or pedis interdigital. The patients were treated with 100 mg of itraconazole, once a day, during the lunch, for 15 days. Mycological and clinical evaluations were performed at the pre-treatment, by the end of treatment and 2 weeks after finishing the treatment. The results showed that itraconazole is effective for the treatment of dermatophytosis, at the studied posology, with 100% of mycological cure. Clinical evaluation showed a significant reduction (Friedman test--p less than 0.001) of signs and symptoms.

[Epidemiological study of tinea pedis in a population studied in Santa Casa de Sao Paulo]. / Estudo epidemiológico da tinha do pé em população estudada na Santa Casa de São Paulo.

The authors make an epidemiologic study of tinea pedis aiming at establishing its minimal frequency in the population studied, as well as recognizing the most frequent fungi and the clinical aspects they determine. We've tried to study the role of the dermatophytes in the normal microbiota of the feet. Finally we analyzed the influence of sex and seasonality factors on the incidence of tinea pedis.

[Behavior of the intradermal reaction with lepromin in sarcoidosis patients]. / Comportamento da intradermo-reação con lepromina em doentes de sarcoidose.

The Lepromin (Mitsuda) skin test was performed in 14 patients with sarcoidosis and in 40 controls. In the sarcoidosis patients results were negative in 85.8% and positive in 14.2%. In the control group, on the contrary, results were negative in 15.0% and positive in 85.0%. Thus it became evident that patients with sarcoidosis produce an impaired reaction to the characteristic granuloma formation of the Mitsuda test. This seems to be a paradoxical response, since sarcoidosis is an essentially granulomatous disease.

[Dermatitis herpetiformis and systemic lupus erythematosus]. / Dermatite herpetiforme e lupus eritematoso sistêmico.

A case of Dühring-Brocq with high titres of ANA is reported. It was not possible to demonstrate a SLE. The associations DH-SLE, blistering diseases-SLE, ANA-DH are reviewed.