Systematic review of topical treatments for fungal infections of the skin and nails of the feet

OBJECTIVE: To identify and synthesise the evidence for efficacy and cost effectiveness of topical treatments for superficial fungal infections of the skin and nails of the feet. DESIGN: Systematic review. INTERVENTIONS: Topical treatments for superficial fungal infections. MAIN OUTCOME MEASURES: Cure confirmed by culture and microscopy for skin and by culture for nails in patients with clinically diagnosed fungal infections. RESULTS: Of 126 trials identified in 121 papers, 72 (57.1%) met the inclusion criteria. Placebo controlled trials yielded pooled relative risks of failure to cure skin infections: allylamines (0.30, 95% confidence interval 0.24 to 0.38); azoles (0.54, 0.42 to 0.68); undecenoic acid (0.28, 0.11 to 0.74); and tolnaftate (0.46, 0.17 to 1.22). Although meta-analysis of 11 trials comparing allylamines and azoles showed a relative risk of failure to cure of 0.88 (0.78 to 0.99) in favour of allylamines, there was evidence of language bias. Seven reports in English favoured allylamines (0.79, 0.69 to 0.91), but four reports in foreign languages showed no difference between the two drugs (1.01, 0.90 to 1.13). Neither trial of nail infections showed significant differences between alternative topical treatments. CONCLUSIONS: Allylamines, azoles, and undecenoic acid were efficacious in placebo controlled trials. There are sufficient comparative trials to judge relative efficacy only between allylamines and azoles. Allylamines cure slightly more infections than azoles but are much more expensive than azoles. The most cost effective strategy is first to treat with azoles or undecenoic acid and to use allylamines only if that fails

Epidemiology of Skin Infections in Men's Wrestling: Analysis of 2009–2010 Through 2013–2014 National Collegiate Athletic Association Surveillance Data

CONTEXT: Our knowledge of the current epidemiology of skin infections among wrestlers is limited. OBJECTIVE: To analyze and report the epidemiology of skin infections among National Collegiate Athletic Association (NCAA) men's wrestling student-athletes during the 2009-2010 through 2013-2014 academic years. DESIGN: Descriptive epidemiology study. SETTING: Aggregate skin infection and exposure data collected by the NCAA Injury Surveillance Program. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's wrestling student-athletes. MAIN OUTCOME MEASURE(S): All viral, bacterial, or fungal skin infections reported by athletic trainers at 17 NCAA programs were analyzed, providing 35 team-seasons of data. Skin infection rates per 10 000 athlete-exposures (AEs), rate ratios, skin infection proportions, and skin infection proportion ratios were calculated. RESULTS: The athletic trainers reported 112 skin infections contracted by 87 student-athletes across 78 720 AEs. The overall skin infection rate was 14.23/10 000 AEs (95% confidence interval [CI] = 11.59, 16.86). Of the skin infections identified, 22.3% (n = 25) were recurrent skin infections. Most skin infections (65.2%) were attributable to 5 team-seasons (range, 11-19 infections). Most skin infections occurred during the regular season (n = 76, 67.9%), were identified during practice (n = 100, 89.3%), and resulted in ≥24 hours' time loss (n = 83, 74.1%). The rate for viral skin infections was 1.72 times the rate for bacterial skin infections (95% CI = 1.09, 2.72) and 2.08 times the rate for fungal skin infections (95% CI = 1.28, 3.39). Fungal skin infections more often resulted in time loss <24 hours compared with all other skin infections (75.0% versus 12.5%; infection proportion ratio = 6.00; 95% CI = 3.30, 10.92). CONCLUSIONS: Our findings highlight the contagiousness of skin infections and suggest that skin infection rates may be attributable to high incidences among particular teams

Reflectance confocal microscopy for the diagnosis of skin infections and infestations

Reflectance confocal microscopy (RCM) is a noninvasive real-time imaging technique that has been widely used for the diagnosis of skin cancer. More recently, it has been reported as a useful tool for the diagnosis and management of several inflammatory and infectious skin disorders. This article provides an overview of the current available applications of RCM use in cutaneous infections and infestations. PubMed was used to search the following terms in various combinations: reflectance confocal microscopy, skin, hair, nail, infection, parasitosis, mycosis, virus, bacteria. All papers were accordingly reviewed. In most cutaneous infections or infestations, the main alterations are found in the epidermis and upper dermis, where the accuracy of confocal microscopy is nearly similar to that of histopathology. The high resolution of this technique allows the visualization of most skin parasites, fungi, and a few bacteria. Although viruses cannot be identified because of their small size, viral cytopathic effects can be observed on keratinocytes. In addition, RCM can be used to monitor the response to treatment, thereby reducing unnecessary treatments

Complicated skin, skin structure and soft tissue infections - are we threatened by multi-resistant pathogens?

Tissue infections or skin, skin structure, and deep seated soft tissue infections are general terms for infections of the entire skin layer including the subcutaneous and muscle tissue layers and their respective fascia structures. Infections of the different mediastinal fascias (mediastinitis) and retroperitoneal fascia infections also belong to this category. Due to the variability of their clinical presentation, skin and soft tissue infections can be classified according to different features. The following aspects can be used for classification

The Prevalence of Dermatological Infection in Outpatient Dermatology Clinic of RSUD Wonosari in January-September 2016

Background: The Skin is a complex organ that protects humans from their surrounding environment, like an infectious pathogenic agent, sunlight exposure, temperature, or other exposures. Skin infections can be divided into bacterial, viral, or fungal infections where infestations of bugs or worms are included. In Indonesia, the exact number of skin infection incidents has not been established. And until now, there are no research reports about the case pattern of skin infections in the area of Kabupaten Gunung Kidul in 2016. Objective: This research aimed to describe the overview of skin infection cases in Outpatient Dermatology Clinic of RSUD Wonosari, Gunung Kidul fromJanuary 2016 until September 2016. Methods: This research was conducted retrospectively based on medical records of all cases of skin infections in Outpatient Dermatology Clinic of RSUD Wonosari during the period of January 2016 - September 2016. Results: All new cases of skin infections in outpatient dermatology clinic of RSUD Wonosari within the period of January 2016 - September 2016 amounted to 303 cases. The cases consisted of 127 cases of fungal infection (42%) with a variety of cases of dermatophytosis, PVC, and candidiasis; 55 cases of bacterial infections (18%) with a variety of cases of impetigo, folliculitis, leprosy, ektima, erysipelas, furuncles, and abscesses; 40 cases of viral infections (13%) with variaty of cases of HFMD cases, Moluscum contagiosum, zooster, warts, varicella; and 81 cases of parasitic infections (27%) with a variety of cases of scabies, creeping eruption, and pediculosis capitis. Conclusion: Skin diseases caused by infections was still a dominant skin disease in the outpatient Dermatology clinic of RSUD Wonosari, with the number of cases 18.35% of all cases of skin and venereal diseases. The most common cause is infection by fungi (7.69%), followed by parasitic infections, scabies (4.91%), bacterial infections (3.33%), and viral infections (2.42%)

Granulomatous skin infections

Granulomatous skin disorders are a heterogeneous group of disorders characterized by granuloma formation on histopathology. They may be triggered by various stimuli, including infectious and non-infectious stimuli (foreign bodies, malignancy, metabolites, and chemicals), of different etiological origins. Although pathophysiological mechanisms are still poorly understood, infectious granuloma formation may occur if the patient’s immune system could not eliminate an agent. Clinically, localized or disseminated infectious granuloma formation can be related to the infectious agent’s pathogenicity or the patient’s immunity. Typical infectious agents causing infectious granulomatous reactions are mycobacteria, fungal infections, or parasites, such as leishmaniasis. This review aims to summarize granulomatous skin diseases encountered more frequently in our clinical experience because of infectious causes

Cytokines Gene Expression on Macrophages Exposed to Triatoma Salivary Gland Extracts

Triatoma sanguisuga and Triatoma Indictiva are vectors of Chagas disease. These two vectors goes to the host and bites down to feed on blood, which is necessary for the egg laying process. The disease however is not spread through their bite, but through their feces. When they become full of blood, they defecate and that is where the parasite is. The parasite is then introduced into the skin when the host scratches at the bite and feces enter the skin. An estimated 8 million people worldwide are infected with T Cruzi, and the United States has the 7th highest prevalence of Chagas infections. The Macrophages produces cytokines including TNF (Tumoral Necrosis Factor), IL-10 and IL-18 in responses to danger or infections, the function include tissue inflammation and destruction

Polyhexamethylene Biguanide and Nadifloxacin Self-Assembled Nanoparticles: Antimicrobial Effects against Intracellular Methicillin-Resistant Staphylococcus aureus

The treatment of skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA) remains a challenge, partly due to localization of the bacteria inside the host’s cells, where antimicrobial penetration and efficacy is limited. We formulated the cationic polymer polyhexamethylene biguanide (PHMB) with the topical antibiotic nadifloxacin and tested the activities against intracellular MRSA in infected keratinocytes. The PHMB/nadifloxacin nanoparticles displayed a size of 291.3 ± 89.6 nm, polydispersity index of 0.35 ± 0.04, zeta potential of +20.2 ± 4.8 mV, and drug encapsulation efficiency of 58.25 ± 3.4%. The nanoparticles killed intracellular MRSA, and relative to free polymer or drugs used separately or together, the nanoparticles displayed reduced toxicity and improved host cell recovery. Together, these findings show that PHMB/nadifloxacin nanoparticles are effective against intracellular bacteria and could be further developed for the treatment of skin and soft tissue infections

Bacterial skin infections in childhood

Bacterial skin infections are among the most common clinical conditions found in pediatric dermatological practice. Bacterial diseases of the skin - pyoderma - are all inflammatory processes caused by bacteria (staphylococci, streptococci, corynebacteria, propionibacteria, Escherichia coli, Pseudomonas aeruginosa, proteus, etc.). Actually, these are diseases caused by purulent bacteria - pyococci - mostly staphylococci and streptococci. Bacterial infections of the skin and skin structures, commonly found in children, include impetigo, ecthyma, folliculitis, furuncles, carbuncles, inflammation of epidermal appendages, streptococcal perianal dermatitis and others. Skin infections are primary and secondary, depending on the mode of action. Pyoderma can be acute, subacute, recurrent, and with obvious clinical signs of inflammation. Another division of skin bacterial infections defines them as uncomplicated (superficial) and complicated (deep). Various factors, such as poverty, malnutrition, poor hygiene, lower socio-economic status, climate change, immunocompromised conditions, comorbidity, and increasing resistance to pathogens, are the cause of increased incidence of bacterial skin infections