Dermatomycoses are common diseases in dermatological clinics. An epidemiological survey in Japan revealed that dermatophytosis was the most prevalent cutaneous fungal infection (89.1%), followed by candidiasis (8.4%) and the Malassezia infections(2.4%). Among dermatophytoses, tinea pedis was the most frequent, then in decreasing order, tinea unguium, tinea corporis, tinea cruris, tinea manuum, and tinea capitis including kerion. Among all dermatophyte infections, Trichophyton rubrum was the most frequently isolated. Among cutaneous candidiasis, intertrigo was the most frequent clinical form, followed by erosio interdigitalis and diaper candidiasis. Dermatomycoses may provoke several inflammatory reactions, but the organisms causing them are located in the keratin layer of the epidermis. Therefore, topical application is the first line therapy for the most dermatomycoses.

Itraconazole is an antifungal drug from the triazole group with distinct in vitro activity against dermatophytes, yeasts and some molds. Itraconazole has a primarily fungistatic activity. Itraconazole accumulates in the stratum corneum and in nail material due to its high affinity to keratin, as well as in sebum and vaginal mucosa. Together with terbinafine and fluconazole, itraconazole belongs to the modern highly effective systemic antifungal drugs with a favorable risk-benefit ratio and for this reason is a preferred therapy option for fungal infections of skin, nails and mucous membranes. Compared to terbinafine in the treatment of fingernail and toenail fungal infections, itraconazole offers the advantage of a broad antifungal spectrum and better effectiveness against onychomycosis caused by yeasts yet appears inferior with regard to the more common dermatophyte infections. Itraconazole constitutes an important therapy option, along with fluconazole, terbinafine, ketoconazole and griseofulvin, for the treatment of dermatophyte infections of glabrous skin (tinea pedis, tinea manuum, tinea corporis and tinea cruris) in adults following unsuccessful topical therapy. In the oral therapy of tinea capitis, itraconazole plays an especially important role, in particular for disease caused by Microsporum canis (for children, however, only off-label use is feasible currently). In the treatment of oropharyngeal candidiasis, candidiasis of the skin and vulvovaginal candidiasis, itraconazole and fluconazole are the preferred treatment options in cases in which topical therapy has proven unsuccessful.

Treatment of dermatophyte infection involves primarily oral and/or topical formulations of azoles or allylamines, particularly itraconazole and terbinafine. Topical medications applied once or twice daily are the primary treatment indicated for tinea corporis/cruris, and tinea pedis/manuum. Use of oral antifungals may be practical where the tinea involvement is extensive or chronic, or where application of a topical is not feasible. For tinea unguium (onychomycosis) and tinea capitis, oral therapies are the primary treatments provided. Recently, topical amorolfine and ciclopirox formulations have been approved for use in milder onychomycosis cases, and their role in the treatment of the different clinical forms of onychomycosis is currently being defined. Relapse of infection remains a problem, particularly with tinea pedis/unguium. Appropriate follow-up duration and education of patients on proper foot hygiene are also important components in providing effective therapy.

Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species and resistance to treatment are the characteristics of onychomycosis in HIV.To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically.A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e, 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study.Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp, Scytalidium hyalinum, Penicillium spp. and Gymnoascus dankaliensis on 1 each.Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Dermatophytoses are of worldwide distribution. Epidemiological studies concerning dermatophyte infections have been performed in many countries and differences in the incidence and the aetiological agents have been reported in different geographical locations. This study was undertaken to investigate the prevailing species of dermatophytes in the island of Crete, Greece, and their pattern of infection during a 7-year period (1997-2003). A total of 5544 samples obtained from 3751 patients with clinically suspected dermatomycoses were examined mycologically in the laboratory of Clinical Microbiology at the University Hospital of Crete, Greece. Skin, hair and nail specimens were subjected to direct microscopy and culture. Dermatophytes were isolated from 520 patients (13.9%). Trichophyton rubrum was the most frequently isolated dermatophyte accounting for 48% of the infections, followed by Microsporum canis (17.9%), Trichophyton mentagrophytes var. interdigitale (14.2%) and Epidermophyton floccosum (6%). Tinea unguium, tinea pedis, tinea corporis, tinea capitis, tinea cruris, tinea manuum and tinea facei were the clinical types of dermatophytoses in decreasing order of frequency. Trichophyton rubrum is the predominant dermatophyte in our area. As the epidemiology of dermatophytoses is changing over time it is important to review periodically the incidence of dermatophytes and their distribution.

Our objective in this study was to obtain information on the prevalence of fungi responsible for superficial mycoses in the region of Tripoli, Libya.Skin scrapings collected from 2224 patients attending the Dermatology Clinic at Tripoli Medical Center with suspected clinical symptoms of fungal involvement were investigated in a 28-month study period, from August 1997 to December 1999. Direct microscopy was carried out with a 20% KOH preparation, and cultures were performed in petri dishes on Sabouraud dextrose agar (SDA) with cycloheximide 0.5 mg/mL and chloramphenicol 0.05 mg/mL, and SDA with chloramphenicol 0.05 mg/mL. Olive oil (2%) was added to the SDA without cycloheximide when pityriasis versicolor was suspected.Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%), and the causal agents were isolated in 1160 cases (52.2%). Dermatophytes, Malassezia furfur (tinea versicolor) and Candida albicans were the major etiological agents isolated. Tinea corporis accounted for 45.9% (85% occurred in children below 15 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases), and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, and was responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked second in frequency with 27.8% (322 cases), followed by Trichophyton rubrum 13.8% (160 cases), and Candida albicans 10% (116 cases). Other species found were Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases), and Trichophyton mentagrophytes 3.1% (36 cases).Dermatophytes, in particular Trichophyton violaceum, Trichophyton rubrum and Microsporum canis, are an important cause of tinea corporis in Libya. Malassezia furfur and Candida albicans are the most commonly encountered fungi in superficial mycoses.

To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis.Prospective study based on a specially designed questionnaire completed by dermatologists.A total of 2761 patients with toenail onychomycosis.The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture.In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus.The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.

The skin mycoses, perticularly dermatophytoses, in Lanzhou district, Northwestern China, was investigated during July 2002-June 2003. The specimens from patients suspected of having dermatomycoses were examined microscopically in KOH preparations and cultured on Sabouraud dextrose agar (SDA). Among 1443 suspected cases, 594 were KOH positive and 221 cultures of fungi were isolated. The most frequently isolated fungi were Trichophyton rubrum (43.9%) Trichophyton mentagrophytes (29.4%) and Candida species (14.0%). The frequency of tinea pedis, onychomycosis and tinea manuum were 38.7, 27.8 and 13.5%, respectively. In Lanzhou district, tinea pedis is the most commonly seen dermatophytoses, and T. rubrum is the most frequent etiologic agent.