Intertrigo

BackgroundIn geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics.MethodsA cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated.ResultsThe prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo.ConclusionsEvery sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population.Trial registrationThis study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.

BackgroundDermatophytosis still remains a major public health concern worldwide, particularly in developing countries. This study was undertaken to determine the etiological and epidemiological factors of dermatophyte infections in Tehran, Iran.MethodsA total of 1530 patients clinically suspected of cutaneous fungal infections were examined in two hospitals over a period of 10 years (2010-2020). Samples were analyzed using direct microscopic examination and culture. Data regarding age, gender, and clinical manifestations were also recorded.ResultsOut of 1530 cases examined, dermatophytes were detected in 493 (32.2%) patients. Of these patients, 288 (58.4%) were males and 205 (41.6%) were females. The most affected age group was the 25-44 years old (31.6%). Tinea corporis (n=134) was the most prevalent type of ringworm, followed by tinea cruris (n=131), tinea pedis (n=90), tinea manuum (n=65), tinea unguium (n=29), tinea faciei (n=20), tinea capitis (n=18), and tinea barbae (n=2). Both tinea cruris (PP=0.002) had a significant association with male gender. As for etiological agents, Trichophyton mentagrophytes (29.0%) was the most frequent isolate, followed by Trichophyton tonsurans (25.8%), Trichophyton rubrum (25.3%), Epidermophyton floccosum (6.9%), Trichophyton verrucosum (4.9%), Microsporum audouinii (4.5%), Microsporum canis (2.0%), and Trichophyton violaceum (1.6%).ConclusionDermatophytes are still the prevailing causes of fungal infection of the skin, hair, and nails in Iran. Further studies with larger samples sizes and inclusion of diverse locations would yield more accurate results.

Syphilis is known as the great imitator with various clinical presentations which often lead to confusion and misdiagnosis. A 28-year-old male presented with non-pruritic and painless erythematous patches around the anus and scrotum. Initial differential diagnosis with tinea cruris. Fungal examination was negative. Serological tests for syphilis were positive and anti-HIV screening was reactive. A diagnosis of secondary syphilis was established and the patient was given intramuscular injection of 2.4 million unit of benzathine penicillin. The skin lesions improved significantly 1 week after treatment, confirming a diagnosis of secondary syphilis with HIV. Annular skin lesions in secondary syphilis are uncommon and often misleading. This case emphasizes the importance of considering secondary syphilis in the differential diagnosis of annular lesions.

Infected interdigital intertrigo is an exudative, macerating, mixed infection of the toe webs in which gram-negative bacteria (Pseudomonas aeruginosa and Enterobacterales) seem prevalent, but in which gram-positive pathogens (Staphylococcus [S.] aureus, streptococci, enterococci) and fungi (dermatophytes, yeasts) also occur. The former German term "gram-negative foot infection" misleadingly implied a soft-tissue infection of the foot caused by gram-negative bacteria. The updated term "infected interdigital intertrigo" is an internationally used designation, as is the term "gram-negative toe web infection". This superficial infection may yet progress to soft tissue infection (phlegmon, cellulitis) of the foot but in immunocompetent patients is usually caused by S. aureus. Complicated courses, as well as the development of interdigital intertrigo itself, are facilitated by diabetes mellitus, polyneuropathy, and peripheral arterial disease. Diagnosis is made clinically, based on painful macerated erosions or ulcers with yellow-green exudate, putrid odor and edema. Superficial swabs are not always diagnostically required or relevant. Management focuses on local therapy with anti-inflammatory, antiseptic, antimycotic agents, dry wound care and reduction of edema. Systemic antibiotics are indicated only in cases of associated soft-tissue infection, which in immunocompetent patients present as uncomplicated cellulitis and therefore require coverage limited to S. aureus. Early vascular evaluation, imaging and surgical assessment in cases of deep infection or necrosis are essential.