Most Effective Ringworm Treatment
While immunological mechanisms provide potential methods of defense, the persistence of infection in many apparently healthy individuals suggests that these are either ineffective or inoperative in some patients. It has been shown that some patients with persistent dermatophytosis have defective lymphocyte blastogenesis to T-cell mitogens and dermatophyte antigen and that this can be reversed either by substituting heterologous (foetal calf) for autologous serum or after successful antifungal treatment (Mayou et al., 1987). This suggests that an inhibitory factor(s) is present in serum. If this parallels the situation described in mice referred to previously then dermatophyte antigen is a potential candidate as a blocking agent (Calderon, 1989). Dermatophyte antigen has been identified in such infected serum The possibility that there is interference with the process of immunological activation in the skin is supported by immunohistochemical studies of biopsies from chronically...
Tinea capitis primarily affects school-aged children, appearing as one or more round patches of alopecia. Hair shafts broken off at the scalp may appear as black dots. Sometimes tinea capitis appears as non-specific dandruff, or gray patches of hair, or areas of scales, pustules and erythema. A localized, boggy, indurated granuloma called a kerion may develop. B. Tinea capitis should be treated with oral therapy. Griseofulvin (Fulvicin PG, Gris-PEG, Grisactin Ultra). Itraconazole (Sporanox) and terbinafine (Lamisil) are effective options. III. Tinea barbae. Tinea barbae affects the beard area of men who work with animals. It is often accompanied by bacterial folliculitis and inflammation secondary to ingrown hairs. Oral therapy with griseofulvin, itraconazole (Sporanox) or terbinafine (Lamisil) is preferred over topical therapy because the involved hair follicles do not respond well to topical therapy.
Tinea cruris ( jock itch ) usually involves the medial aspect of the upper thighs (groin). Unlike yeast infections, tinea cruris generally does not involve the scrotum or the penis. This dermatophyte infection occurs more often in men than in women and rarely affects children. Erythematous, pruritic plaques often develop bilaterally. B. Topical therapy is sufficient in most patients with tinea cruris. If the infection spreads to the lower thighs or buttocks, oral therapy with itraconazole or terbinafine is recommended.
The majority of patients with dermatophytosis are not immunosuppressed and have no underlying disease. Previous studies have occasionally revealed a number of underlying diseases in patients with dermatophytosis, notably hereditary palmoplantar keratoderma (Elmros & Liden, 1983) and Raynaud's phenomenon (Hay, 1982). But the former is likely to reflect a major change in the local environment in which dermatophytes grow and the latter vascular disease. In fact it is possible to see patients with dermatophytosis on one foot where there is poor vascular perfusion detectable clinically but not on the other normally perfused foot (Hay, 1982). Atopy is an underlying disease syndrome which has been consistently connected with dermatophytosis. A high proportion of chronically infected individuals, over 40 in some surveys, have hay fever, asthma, or atopic eczema either on personal or family history (Hay, 1982 Jones et al., 1973). In addition a high proportion of individuals seen in...
Tinea pedis ( athlete's foot ) is the most common dermatophyte infection. Tinea pedis infection is usually related to sweating, warmth, and oclusive footwear. The infection often presents as white, macerated areas in the third or fourth toe webs or as chronic dry, scaly hyperkeratosis of the soles and heels. B. Occasionally, tinea pedis may produce acute, highly inflamed, sterile vesicles at distant sites (arms, chest, sides of fingers). Referred to as the dermatophytid or id reaction, these vesicles probably represent an immunologic response to the fungus they subside when the primary infection is controlled. The id reaction can be the only manifestation of an asymptomatic web space infection. C. Tinea pedis is often treated with topical therapy. Oral itraconazole and terbinafine are more efficacious in the treatment of hyperkeratotic tinea pedis. Once-weekly dosing with fluconazole is another option, especially in noncompliant patients. VII. Tinea manuum is a fungal infection of...
What do you and Athletes Foot have in common You'll recall from Chapter 1 that Tinea pedis is the scientific name for athlete's foot and that it is caused by the Trichophyton fungus. Both of you are alive. Sometimes it's hard to imagine that microorganisms are alive because we can't see them with our naked eye although they make their presence known to us in annoying ways.
Similar to tumorigenesis in other tissues, development of meningiomas is likely to result from complex interactions between genes and environment. The etiological role of environmental factors in meningioma development has been suggested for ionizing radiation, diet, smoking, head trauma, and occupational exposures to carcinogenic substances. Of these factors, the evidence is convincing only for an association between ionizing radiation and meningiomas. Elevated risk of meningioma development was shown in studies involving patients who received a low-dose radiation therapy for childhood tinea capitis. Meningiomas were also found to occur years after any type of therapeutic cranial irradiation. Moreover, an increased incidence of meningiomas has been recently reported in survivors of atomic bomb explosions. Radiation-induced meningiomas are often aggressive or malignant. They are also
Fungi may infect the skin, hair, nails, and tissues of the body. For example, fungi on the skin can cause ringworm. Ringworm, as shown in Figure 26-9, can occur almost anywhere on the skin. Athlete's foot, another form of ringworm, occurs on the foot and between the toes. Ringworm is a fungal infection of the skin. The dried skin that falls off a lesion is contaminated with fungal spores. These spores can infect other people and spread the infection. Ringworm is a fungal infection of the skin. The dried skin that falls off a lesion is contaminated with fungal spores. These spores can infect other people and spread the infection.
Side effects of terbinafine (Lamisil) include skin rashes and gastrointestinal upset. It has also been associated with Stevens-Johnson syndrome, blood dyscrasias, hepatotoxicity and ocular disturbances, as well as elevated liver enzyme levels in 0.5 . Some patients have noted losing their sense of taste for up to six weeks.
One of the important nonstochastic late effects of ionizing radiation is damage to the lens of the eye (49). The lens is an onion-structured epithelial tissue located inside a fibrous capsule that is situated immediately behind the pupil. The epithelial cells constitute the outer anterior layer. They divide near the equator of the lens. The replicated cells are displaced inward where they flatten and become transparent fibers. There is no mechanism for removing damaged cells. When the proliferating cells are damaged by radiation, they migrate as opaque granules to the posterior surface of the lens. If the amount of damage is mild as with scattered radiation to the eyeball from tinea capitis radiation, where the dose was about 50 rads, the only observed effect was scattered posterior granules. These had no effect on eyesight. Furthermore, the damage was not progressive (50, 51).
Figure 22.27 Dermatophytosis (a) Tinea pedis, usually caused by species of Trichophyton. (b) Large boat-shaped spores of Microsporum gypseum, a cause of scalp ringworm in children. Figure 22.27 Dermatophytosis (a) Tinea pedis, usually caused by species of Trichophyton. (b) Large boat-shaped spores of Microsporum gypseum, a cause of scalp ringworm in children.
Candida albicans is a ubiquitous agent of diaper dermatitis, which may be precipitated by moisture, occlusion, fecal contact and urinary pH. Its classical presentation is that of an erythema bordered by a collarette of scale with satellite papules and pustules. Concomitant dermatophytosis may occasionally be present. Treatment consists of the correction of physiological factors and topical antifungal treatment 28 .
Tolnaftate (Tinactin, others) is a nonprescription an-tifungal agent effective in the topical treatment of der-matophyte infections and tinea. The mechanism of action is unknown. Other older, less effective topical antifungal agents still available include undecylenic acid (Desenex, others). Used in the treatment of topical dermatophytes, undecylenic acid is fungistatic, requires prolonged administration, and is associated with a high relapse rate. Desenex, containing 5 undecylenic acid and 20 zinc undecylenate, is effective in the prevention of recurrent tinea pedis.
Certain species of molds can invade hair, nails, and the keratinized portion of the skin. The resulting mycoses have colorful names such as jock itch, athlete's foot, and ringworm, and more traditional latinized names that describe their location tinea capitis scalp, tinea barbae beard, tinea axillaris armpit, tinea corporis body, tinea cruris groin, and tinea pedis feet, to list a few. Tinea just means worm, which probably reflects early ideas about the cause.
Ravuconazole is an oral derivative of fluconazole (Figure 4.5) with expanded spectrum of in vitro activity. Its inhibitory potency and binding affinity to yeast P-450 dependent 14a-demethylase is similar to that of itraconazole. Ravuconazole is active against Candida spp., A. fumigatus, C. neoformans, most hyaline hyphomycetes (except Fusarium spp. and P. boydii), dermatophytes, and dematiaceous fungi (Cuenca-Estrella et al., 2006 Espinel-Ingroff, 2003 Yamazumi et al., 2000 Pfaller et al., 1998a). After 8 h of oral administration of 10 mg kg body Other azoles Systematic modifications of the piperazine moiety resulted in the discovery of several novel triazoles like SYN-2869 (Figure 4.6). SY-2869 is orally active against isolates of Candida spp., Aspergillus spp., C. neoformans, and several dematiaceous molds (Johnson et al., 1999). SYN-2869 derivatives, SYN-2836 (has a P-trifluoromethyl moiety at the benzyl group) and 3'-fluoro-substituted analogs of SYN-2836 (SYN-2903) and SYN-2869...
Another dimension of multifunctionality is exemplified by products that claim to be functional in multiple situations. For example, consider a product whose primary function is to fight skin fungus. Yet, such a product may claim to cure both athlete's foot and jock itch. The function is the same (both maladies are caused by a fungus), but the situation of use is different, thus essentially making the product multifunctional.
These extracellular endoparasites or ectoparasites are larger and higher in the scale of plant life than are the bacteria. They include the yeast and molds, and produce infections of the skin such as ringworm, and infections of the mucous membranes such as thrush. Some attack internal organs, especially the lungs and central nervous system, very often with disastrous results.
Unlike trauma, radiation as a cause of menin-gioma development has been well documented 1 . In such cases, the meningiomas must meet certain criteria to be considered radiation-induced, such as the tumor location in the field of radiation, pathology distinct from the original neoplasm or condition under treatment, and occurrence after an appropriately long latent period following the radiation exposure 1 . Meningiomas have been reported following low-dose radiation exposure for tinea capitis and following high-dose radiation treatment for other central nervous system (CNS) or head and neck neoplasms. The male female ratio seems to be more equal for radiation-induced menin-giomas, in contrast to the female predominance for sporadic intracranial meningiomas in the general population.
Tinea corporis ( ringworm ) often affects children and adults who live in hot, humid climates. The classic presentation of this infection is a lesion with central clearing surrounded by an advancing, red, scaly, elevated border. B. Since tinea corporis can be asymptomatic, it can spread rapidly among children in day-care settings. Unless only one or two lesions are present, tinea corporis should be treated orally. Terbinafine and itraconazole are equally effective in treating tinea corporis. These agents have a better cure rate than griseofulvin. An alternative is fluconazole (Diflucan), which is given
A number of topical imidazoles are available for the treatment of cutaneous and mucous membrane candidi-asis, ringworm, and tinea versicolor. Butoconazole (Femstat) is an effective topical agent for vaginal can-didiasis terconazole (Terazol) is effective in the treatment of vaginal candidiasis and econazole (Spectazole) is useful in the treatment of superficial fungal infections of the skin, achieving high tissue levels in the stratum corneum. Oxiconazole nitrate (Oxistat) and sulconazole nitrate (Exelderm) are topical imidazole derivatives available for the treatment of dermatophyte infections and pityriasis (tinea versicolor). Tioconazole (Vagistat) is available without a prescription for the treatment of dermatophyte infections and candidiasis.
The principle means of defense against dermatophytes identified at present involve both non-immunological processes such as the interaction between fungi and unsaturated transferrin, activation of epidermal peptides, the inhibitory effect of fatty acids in sebum, and immunological processes including fungal killing by polymorphonuclear leucocytes attracted into the area of infection as well as the activation of T lymphocytes. The first of these are nonspecific mechanisms of defense against dermatophytosis. with similar structures, such as undecylenic acid, have antifungal inhibitory activity. These are found in a high concentration in post pubertal sebum, a fact that may account for the rarity of tinea capitis after puberty. Unsaturated transferrin inhibits the growth of dermatophytes by a direct mechanism involving its binding to the fungal cell membrane (King et al., 1975). As might be expected there is a similar effect of lactoferrin in experimental infections, although there is...
The skin is the site of several common disorders that include acne vulgaris, psoriasis, eczema dermatitis, contact dermatitis, drug-induced dermatitis, and burns. Some disorders result from viral infections such as herpes simplex and herpes zoster. Some result from fungal infections such as tinea pedis (athlete's foot) and tinea capitis (ringworm).
Patients with persistent foot and groin infections due to T. rubrum are more likely to have positive immediate-type immune responses to intradermal tests with trichophytin (Jones et al., 1973). A similar finding has been recorded for chronic tinea imbricata infections, i.e. a different species affecting large areas of the trunk and limbs (Hay et al., 1983). This is supported by elevated levels of IGE specific to different dermatophytes in patients with dry type T. rubrum infections and tinea imbricata. Currently it is thought that this is most likely to reflect a Th2 switch occurring in the development of dermatophytosis. This interpretation is supported by a study which has shown that high IgE levels are accompanied by raised specific IgG4. In the same study, a higher level of delayed-type hypersensitivity to intradermal Once again there are some parallels here with the chronic infection, CMC. For although this is beyond the scope of a review of defense against dermatophytosis there...
Dermatophvtosis pedis (also called tinea pedis and athlete's foot) may be recognized by the presence of superficial fissures between and toes, and vesicles on the sides and beneath under the toes. If secondary bacterial infection occurs, pustules appear, and ulceration may result. (2) Dermatophvtosis (tinea) corporis, capitis, and cruris. These fungous infections are commonly called ringworm. Dermatophytosis (or tinea) cruris is also called jock itch. The diagnosis of ringworm is made by the presence of a few (usually not over two or three) circular, ring-like, red, scaling lesions, clearing at the center, with advancing vesicular margins. Tinea cruris is distinguished by its location on the upper surface of the thighs. Excessive perspiration and friction from clothing are important contributing factors. Therefore, an important part of the treatment consists of exposing the involved parts to the air as much as possible.
The allylamines (naftifine hydrochloride and terbinafine hydrochloride) are reversible noncompetitive inhibitors of the fungal enzyme squalene monooxygenase (squa-lene 2,3-epoxidase), which coverts squalene to lanos-terol. With a decrease in lanosterol production, ergos-terol production is also diminished, affecting fungal cell membrane synthesis and function. These agents generally exhibit fungicidal activity against dermatophytes and fungistatic activity against yeasts. Terbinafine hydrochloride (Lamisil) is available for topical and systemic use (oral tablet) in the treatment of dermatophyte skin and nail infections. Terbinafine also exhibits in vitro activity against filamentous and dimorphic fungi, but its clinical utility in treating infections with these organisms has not yet been established. It is used most commonly in the treatment of onychomyco-sis in this setting, terbinafine is superior to griseofulvin and at least equivalent to itraconazole. When given sys-temically,...
Most people colonized by these molds have no symptoms at all. Others complain of itching, a bad odor, or a rash. In ringworm, a rash occurs at the site of the infection and consists of a scaly area surrounded by redness at the outer margin, producing irregular rings or a lacy pattern on the skin. On the scalp, patchy areas of hair loss can occur, with a fine stubble of short hair left behind. Involved nails become thickened and brittle and may separate from the nailbed. Sometimes, a rash consisting of fine papules and vesicles develops distant from the infected area. This rash is referred to as a dermatophytid, or id reaction, a reflection of allergy to products of the infecting fungus.
The normal skin is generally resistant to invasion by dermatophytes. Some species, however are relatively virulent and can even cause epidemic disease, especially in children. In conditions of excessive moisture, dermatophytes can invade keratinized structures, including the epidermis down to the level of the keratin-producing cells. A keratinase enables them to dissolve keratin and use it as a nutrient. Hair is invaded at the level of the hair follicle because the follicle is relatively moist. Fungal products diffuse into the dermis and provoke an immune reaction, which probably explains why adults tend to be more resistant to infection than children. It also explains why some people develop the allergic id reactions.
In the treatment of ringworm of the beard, scalp, and other skin surfaces, 4 to 6 weeks of therapy is often required. Therapy failure may be to the result of an incorrect diagnosis superficial candidiasis, which may resemble a dermatophyte infection, does not respond to griseofulvin treatment. Onychomycosis responds very slowly to griseofulvin (1 year or more of treatment is commonly required) and cure rates are poor itracona-zole and terbinafine hydrochloride are more effective than griseofulvin for onychomycosis.
With distal involvement, the affected nail is hyperkeratotic, chalky and dull. The brownish-yellow debris that forms beneath the nail causes the nail to separate from its bed. Coexistent tinea manuum or tinea pedis is common. Topical Treatments for Tinea Pedis, Tinea Cruris and Tinea Corporis Miconazole 2 percent (Micatin, Monistat-Derm) Terbinafine 1 percent (Lamisil) Tinea capitis Tinea corporis cruris Tinea pedis Terbinafine (Lamisil)
Microscopy, a cleared area can be seen around the site of penetration in hair. The production of proteases, some of which are inducible in the presence of amino acid residues, is a key stage in the invasion of the skin by dermatophytes. In early studies at least three low-molecular weight proteases were isolated from T. mentagrophytes (Yu et al., 1971) a number of different proteases have also been extracted from T. rubrum. These range in size from 34, 77, and 105 kD. In addition, this dermatophyte produces a secreted metalloprotease with a molecular weight of approximately 200 kD which shows specificity for collagen and elastin. In Microsporum canis metalloproteases are produced by invading organisms at the site of hair shaft infection (Brouta et al., 2002). In addition it has been shown that the metalloproteases in M canis are members of the subtilisin family and to date three genes named sub1, 2, and 3 are linked to these. In an experimental murine model of dermatophytosis, after...
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