We report a case of neonatal cutaneous candidiasis on the right forearm in a 24-day-old infant. She showed well-defined 1.0 x 0.8 cm & 0.5 x 0.4 cm-sized erythematous patches with pustules and vesicles on the right forearm. The diagnosis was confirmed by 15% KOH preparation of the lesion, fungal culture and germ tube test. The 15% KOH preparation of the lesion showed numerous pseudohyphae and blastospores and fungal culture from the lesions on Sabouraud's dextrose agar containing antibacterial antibiotics showed white creamy colonies. The germ tube test revealed germ tube formation of Candida albicans. Skin biopsy was not available because of parents were not wanted. She had been treated with topical lanoconazole and lesions were improved, and recurrence is not observed.
Agar ; Anti-Bacterial Agents ; Biopsy ; Candida albicans ; Candidiasis, Cutaneous* ; Diagnosis ; Forearm* ; Glucose ; Humans ; Infant ; Parents ; Recurrence ; Skin

Phialemonium and Myrothecium species are rare agents of human deep mycosis infection and those have been increasingly documented as emerging agents of opportunistic infection in immunocompromised patients. We discribed a 69-year-old Korean male, previously diagnosed as lung cancer, presented with 2 x 2 cm sized normal skin to erythematous nodules on the both lower legs for 10 years. Biopsy specimen showed brownish septated hyphae in the dermis and subcutaneous tissue from the left lower leg and colorless spores from the right leg (H& E). Each identifications were confirmed by polymerase chain reaction of ITS2 using universal fungal primers as Phialemonium dimorphosporum on the left lower leg and Myrothecium species on the right lower leg. The patient was treated with surgical excision and fluconazole.
Aged ; Biopsy ; Dermis ; Fluconazole ; Humans ; Hyphae ; Immunocompromised Host ; Leg ; Lung Neoplasms* ; Lung* ; Male ; Opportunistic Infections ; Polymerase Chain Reaction ; Skin ; Spores ; Subcutaneous Tissue

"Black dot" tinea capitis is a clinical form of tinea capitis, which is a dermatophytosis of the scalp and associated hair. It is caused by the anthropophilic endothrix organisms. We report a case of black dot tinea capitis caused by Trichophyton (T.) tonsurans in an 18-year-old woman who is a judoist in the college. She had suffered from a diffuse hair loss involving nearly entire scalp hair for 1 year. The scalp lesion showed diffuse multiple black dots with minimal inflammatory sign or scales. KOH examination revealed arthroconidia of endothrix pattern. On mycological studies, T. tonsusrans was identified. She was treated with oral itraconazole pulse therapy (2 cycles) and ketoconazole shampoo.
Adolescent ; Female ; Hair ; Humans ; Itraconazole ; Ketoconazole ; Scalp ; Tinea Capitis* ; Tinea* ; Trichophyton* ; Weights and Measures

BACKGROUND: Dematophytes are classified into geophilic, zoophilic and anthrophilic fungi, based on their ecological traits. Zoophilic dermatophytosis primarily is responsible for infection in animals, and the inflammatory reaction often tends to be more severe than skin lesions inflicted by anthrophilic species. For the clinical manifestation of superficial dermatophytosis caused by these zoophilic dermatophyte are highly variable, a through review of history about the contact with these animals is often solicited. OBJECTIVE: The purpose of this study is to evaluate clinical and epidemiological zoophilic dermatophytosis associated with animal contact, in an effort to elucidate the link between the causative organism and the route of infection. METHOD: We performed clinical and mycological study on 63 cases of dermatophytosis associated with prior animal contact at the department of dermatology, Konkuk University Hospital from September 2004 to August 2005. RESULT: The ratio of male to female patient was 1: 1.17 and showed more prevalence in female. The age distribution of patients was highest in the age group of 10 years (22.2%). The exposed area (71.4%) was more frequently affected than unexposed area (28.6%) and the most common site was face and forearm. Single lesions were 41 cases (65.1%). Dogs, cats, and rabbits were the most common culprits in animal contact-associated dermatophytosis, each comprising 19, 15, and 10 respectively, of total cases. Hamsters, Guinea pigs, miniature pigs, and miscellaneous (cattles and birds) were among other causative animals. Twenty nine patients with dermatophytosis had accompanying diseases. In the age group of under 10 years old, 6 patients were being treated with atopic dermatitis; in the age group of under 40 yrs, 15 were being treated with diabetes, and 3 with pulmonary tuberculosis, and 1 with rheumatoid arthritis. These evidences support the fact that underlying conditions renders patients susceptible to opportunistic infections. In all age groups, M. canis and T. mentagraphytes var. mentagraphytes were the most predominant species, with most of them in the age groups of teens and twenties. In patients who had contact with dogs, M. canis was recovered in 8 cases, T. mentagraphytes var. mentagraphytes in 7 and M. gypseum in 3. In those patients who had contact with cats, M. canis was found in 6, and T. mentagraphytes var. mentagraphytes in 3, M. gypseum in 2, and T. verrucosum in 1 case. In those who had contact with hamsters, 2 cases each of M. canis, T. mentagraphytes var. mentagraphytes, and M. gypseum were recovered. CONCLUSION: As evidenced above, contact with specific animals play an important role in the pathogenesis of dermatomycosis. As the leisure and recreational activities of people become more diverse and more extensive, and as the influx of exotic domestic animals increases, and frequent contact with people from abroad makes the manifestation of this disease more complex, it would be wise for us to strive to come up with an effective strategy for prevention and epidemiological studies.
Adolescent ; Age Distribution ; Animals* ; Animals, Domestic ; Arthritis, Rheumatoid ; Arthrodermataceae ; Cats ; Child ; Cricetinae ; Dermatitis, Atopic ; Dermatology ; Dermatomycoses ; Dogs ; Epidemiologic Studies ; Female ; Forearm ; Fungi ; Guinea Pigs ; Humans ; Leisure Activities ; Male ; Opportunistic Infections ; Prevalence ; Rabbits ; Skin ; Swine ; Tinea* ; Tuberculosis, Pulmonary

BACKGROUND: Pitted keratolysis (PK) is a bacterial infection of the stratum corneum. The infection is characterized by 1 to 7 mm discrete and coalescing craterlike pits on the plantar surfaces of the feet and toes, especially the weight-bearing areas. Topically applied antibiotics such as clindamycin, benzoyl peroxide erythromycin, and clotrimazole are curative. OBJECTIVE: We performed this study to compare treatment efficacy of benzoyl peroxide (BP) and clindamycin phosphate (CP) in PK. METHOD: The clinical study was made in 44 patients with PK. Among 44 patients, 17 patients were treated by BP topical application alone, 15 patients treated by CP. And the others by combined topical application of BP and CP. RESULT: There were no significant differences in the treatment efficacy between BP and CP, and between monotherapy and combination therapy, neither. 1) Gender ratio showed extreme male predominance (M: F = 43: 1), and the mean age of onset was 22 years old. 2) Mean disease duration was 2.8 months and mean period for complete cure was 2.6 weeks. And there was no significant relation between disease duration and mean period for complete cure. 3) Hyperhidrosis (18.1%) was the most commonly associated condition with PK. The followings were Tinea pedis (13.6%), T. cruris (6.8%), erythrasma (6.8%), cellulitis (6.8%), osmidrosis (6.8%), wart (6.8%), and corn (6.8%) in the order of frequency. 4) There was no statistically significant difference in the treatment efficacy between BP and CP (p> 0.05). 5) Among 44 patients, irritation was observed in 4 cases (9.1%). Two cases were related with BP, and the others with CP. But these adverse effects were trivial and disappeared soon. 6) Four cases (9.1%) showed recurrence within 3 month-follow up. And they were all related with hyperhidrosis. There was no statistically significant difference in the recurrence rate between BP and CP, although patients treated with CP showed slightly higher recurrence rate (p> 0.05). CONCLUSION: Our study shows that no significant difference in the treatment efficacy between benzoyl peroxide and clindamycin phosphate, and between monotherapy and combined therapy, neither. Therefore, combination therapy should be spared for only intractable PK.
Age of Onset ; Anti-Bacterial Agents ; Bacterial Infections ; Benzoyl Peroxide* ; Cellulitis ; Clindamycin* ; Clotrimazole ; Erythrasma ; Erythromycin ; Foot ; Humans ; Hyperhidrosis ; Male ; Recurrence ; Tinea Pedis ; Toes ; Treatment Outcome ; Warts ; Weight-Bearing ; Young Adult ; Zea mays

Current antifungal agents, such as amphotericin B, fluconazole and itraconazole, have limitations in clinical use because of toxicity, low efficacy, and drug resistance. Newer systemic antifungal agents are available for better efficacy and lower toxicity. They include antifungal agents of a new class and a new generation of an existing class. Caspofungin, the first available echinocandin, inhibits cell wall synthesis and has broad antifungal spectrums. Caspofungin shows better antifungal activity against fluconazole resistant Candida and Aspergillus. Caspofungin was very effective in salvage therapy for amphotericinrefractory or intolerant aspergillosis. Voriconazole, the first available second-generation triazole, is a derivative of fluconazole. Voriconazole is more active against Aspergillus than other antifungal agents and shows lower MIC (minimal inhibitory concentrations) against Candida. The clinical efficacy of voriconazole in the treatment of invasive aspergillosis is superior to amphotericin B. Voriconazole has some limitations, including visual adverse events, liver enzyme elevation as well as a number of drug interactions. Caspofungin and voriconazole should be judiciously used in clinical practices based on clinical efficacy, adverse events, and costs.
Amphotericin B ; Antifungal Agents* ; Aspergillosis ; Aspergillus ; Candida ; Cell Wall ; Drug Interactions ; Drug Resistance ; Fluconazole ; Itraconazole ; Liver ; Salvage Therapy

Hedgehogs are nocturnal spiny mammals in a rodent family. Recently in Korea, the more hedgehogs are raised in the house as pets, the more people are acquired various infections from them. Herein, we report a case of Trichophyton(T.) mentagrophytes var. erinacei infection transmitted from the patient's pet hedgehog. The patient was a 37-year-old man who raised a hedgehog for 6 months. He presented with scaly, erythematous papules and plaques on the left hand and right elbow for 3 months. Potassium hydroxide (KOH) examination, fungus culture and PCR for the fungal strain showed T. mentagrophytes var. erinacei. Treatment was performed systemically and topically with antifungal agents and skin lesions were improved without recurrence. Up to date, there have been only three case-reports of T. mentagrophytes var. erinacei infection transmitted from pet hedgehogs in the English literature. Here we report a rare and interesting case.
Adult ; Antifungal Agents ; Elbow ; Fungi ; Hand ; Hedgehogs ; Humans ; Hydroxides ; Korea ; Mammals ; Polymerase Chain Reaction ; Potassium ; Potassium Compounds ; Recurrence ; Rodentia ; Skin ; Sprains and Strains ; Trichophyton

White superficial onychomycosis (WSO) is defined as fungal infection of the nail plate from dorsal surface of the nail plate. In English literatures, prevalence of WSO in the general population is about 1% to 2%, and the most common causative organism of WSO in adults is Trichophyton mentagrophytes except AIDS patients. On the other hand, the prevalence in children is 0.3%. A 6-year-old boy presented with whitish patches on his ten toe nails which had developed 4 years previously. He had cerebral palsy with spastic tetraplegia and epilepsy, and had admitted eight times for systemic infections, such as pneumonia and pharyngitis. Trichophyton rubrum was revealed as a causative organism by slide culture and PCR test. The nails showed improvement after two months of topical treatment with amorolfine nail lacquer. Herein we report a case of childhood multiple WSO caused by Trichophyton rubrum.
Adult ; Cerebral Palsy ; Child ; Epilepsy ; European Continental Ancestry Group ; Hand ; Humans ; Lacquer ; Morpholines ; Nails ; Onychomycosis ; Pharyngitis ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Quadriplegia ; Toes ; Trichophyton

Candida albicans is a dimorphic yeast which is responsible for 70 percent to 80 percent of all candidial infection, and is the most common cause of superficial and systemic candidiasis. Invasive candidiasis occurs under certain circumstances such as immunosuppression, prolonged hospitalization, and previous antibiotics use. We report a case of candidiasis with a unusual presentation of subcutaneous abscess. A 54 year-old woman came to our clinic with painful erythematous swelling plaques and nodules on the face and arms. She was hospitalized with generalized edema and weakness of both leg. She had a history of herbal medication for 1 year and was finally diagnosed with iatrogenic Cushing syndrome in department of the endocrinology. Biopsy of the lesion revealed chronic inflammation in dermis and subcutis and budding yeasts with pseudohyphae were shown in Gomoris Methenamine silver stain. And Candida albicans was identified by fungus culture.
Abscess ; Anti-Bacterial Agents ; Arm ; Biopsy ; Candida albicans ; Candidiasis ; Candidiasis, Invasive ; Cushing Syndrome ; Dermis ; Edema ; Endocrinology ; Female ; Fungi ; Hospitalization ; Humans ; Immunosuppression ; Inflammation ; Leg ; Methenamine ; Porphyrins ; Saccharomycetales ; Yeasts

BACKGROUND: Treatment of toenail onychomycosis requires long term oral medication of antifungal agent. So many factors such as preferred treatment option can affect the compliance and cure rate. OBJECTIVES: The objective of the present study was to identify most preferred treatment options for toenail onychomycosis patients. METHODS: This study was undertaken on 190 patients treated toenail onychomycosis, who visited Hanyang University Guri hospital, Konkuk University hospital and Asan Medical center during the period between March 2008 to April 2008. RESULTS: 1. Mean age of patients was 53.5+/-15.5 years old, 108 patients (56.8%) were female and 82 patients (43.2%) were male. 2. Mean duration of disease was 7 years 11 months (7.9+/-8.8 years). 3. The motives of treatment for toenail onychomycosis were 'ugly appearance' (39.8%) and 'pruritus' (33.9%). 4. Seventy six percent of patients had history of treatment for toenail onychomycosis. Most of them (43%) visited dermatologist's office and 14% of them used folk remedy. 5. Continuous therapy was the most common method (47%) in previous treatment. And it was the most common treatment option irrespective of age, disease duration and gender. 6. The most preferred treatment option was also continuous therapy (57%). And 69% of patients who received continuous therapy preferred it, but it was only 48% in pulse therapy group and 38% in weekly pulse therapy group. 7. Sixty six percent of the toenail onychomycosis patients had associated disease. CONCLUSIONS: Continuous therapy was the most convenient method for toenail onychomycosis patients who visited general hospital.
Compliance ; Female ; Hospitals, General ; Humans ; Nails ; Onychomycosis