Charussri Leeyaphan

Clinical characteristics of hypertrophic herpes simplex genitalis and treatment outcomes of imiquimod: a retrospective observational study.

OBJECTIVE Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection. METHODS The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively. RESULTS Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy. CONCLUSIONS Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.

Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men.

A high microbial cure rate was shown with 100 mg doxycycline twice daily for 21 days.

An unusual case of eumycetoma caused by Exophiala jeanselmei after a sea urchin injury

Penvadee Pattanaprichakul, Sumanas Bunyaratavej, Charussri Leeyaphan, Panitta Sitthinamsuwan, Montarop Sudhadham, Chanai Muanprasart, Peiying Feng, Hamid Badali and G. Sybren de Hoog Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Thailand, Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Department of Biology, Faculty of Science and Technology, Suansunandha Rajabhat University, Bangkok, Thailand, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, Department of Medical Mycology and Parasitology ⁄ Invasive Fungi Research Centre (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran and CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands

Distinct characteristics of Scytalidium dimidiatum and non‐dermatophyte onychomycosis as compared with dermatophyte onychomycosis

Studies of demographic data, predisposing factors and clinical manifestations of non‐dermatophyte mold (NDM) infection particularly in Scytalidium spp. have been limited. This study aimed to compare these data between dermatophytes (DMP) and NDM onychomycosis with statistical analysis. This was a retrospective chart review of outpatients with onychomycosis in the Nail Clinic of Department of Dermatology between January 2011 and December 2013. A total of 237 patients who had presented with onychomycosis were included. One hundred and eighty patients (75.9%) were infected with DMP: Trichophyton mentagrophytes, 46.8%; and Trichophyton rubrum, 28.3%. Of patients who had NDM onychomycosis, 17.3% were Scytalidium dimidiatum and 6.8% were Fusarium spp. Comparing the DMP and NDM groups, family history of superficial fungal infection was significantly demonstrated in the DMP group. Approximately 50% of patients in both groups had feet infections. However, no patients with NDM onychomycosis had fungal glabrous skin infection at other sites beyond the feet that was statistically different from cases with DMP onychomycosis. In conclusion, The distinct characteristic of patients with NDM onychomycosis was absence of fungal glabrous skin infection in areas other than the feet. This was statistically different from DMP.

Efficacy of 5% amorolfine nail lacquer in Neoscytalidium dimidiatum onychomycosis

Abstract Background: Amorolfine nail lacquer was mentioned as an effective treatment for non-dermatophyte nail infection. Onychomycosis that caused by Neoscytalidium dimidiatum is considered recalcitrant onychomycosis. Objective: This study aimed to demonstrate efficacy and treatment outcomes of amorolfine nail lacquer in N. dimidiatum onychomycosis, compared with topical urea treatment. Methods: This was a retrospective study of patients daiagnosed as N. dimidiatum onychomycosis at dermatologic clinic between April 2010 and August 2014. Clinical manifestations and laboratory results were collected. The evaluation included 50% improvement, which meant 50% decrease in subungual hyperkeratosis thickness from original untreated nails. Mycological cure is defined by negative result of both KOH and fungal culture. Moreover, complete cure means infected nails return to its normal condition as well as KOH and fungal culture yield negative results. Results: Among 53 outpatients of N. dimidiatum infection, 28 (52.8%) were treated by amorolfine nail lacquer and other 26 (47.2%) by conventional topical urea cream with occlusion. Comparison between amorolfine and topical urea groups, mycological cure rate was significantly shown in amorolfine group (89.3% vs. 32%; p < 0.0001). Moreover, 50% clinical improvement and complete cure rate of amorolfine group were significantly higher than those of topical urea group (85.7% vs. 48%; p = 0.003 and 50% vs. 20%; p = 0.023, respectively). Median time to mycological cure and complete cure in amorolfine group was significantly shorter than that of topical urea group (p = 0.001 and p = 0.013, respectively). Conclusion: This study supported that amorolfine nail lacquer provided promising efficacy in the treatment of Neoscytalidium onychomycosis as a novel monotherapy regimen which were superior to topical urea cream with occlusion in every aspect.

Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases.

Abstract Background: Treatment for rectal lymphogranuloma venereum where doxycycline 100 mg twice daily for 21 days was used—either alone or together with azithromycin 1 g single dose—resulted in microbiological cure of 97%. These data support doxycycline 100 mg twice daily for 21 days as the preferred treatment for rectal lymphogranuloma venereum.

Prevalence and Clinical Correlation of Superficial Fungal Foot Infection in Thai Naval Rating Cadets

Background Superficial fungal foot infection is one of the most important dermatological diseases currently affecting military personnel. Many Thai naval rating cadets are found to suffer from superficial fungal foot infections and their sequels. Objective To investigate prevalence, potent risk factors, responding pathogens and clinical correlation of superficial fungal foot infection in Thai naval rating cadets training in Naval rating school, Sattahip, Thailand. Materials and Methods This cross-sectional study was performed in August 2015. Validated structured questionnaire was used regarding information about behaviors and clinical symptoms. Quality of life was assessed by Dermatology Quality of Life Index (DLQI) questionnaire and clinical presentation demonstrated by Athletes foot severity score (AFSS). Laboratory investigations including direct microscopic examination and fungal culture were performed and recorded. All of the participants were informed and asked for their consent. Results A total of 788 Thai naval rating cadets with a mean age of 19 yr were enrolled. There were 406 (51.5%) participants suspected of fungal skin infection from questionnaire screening. After clinical examination, 303 participants (38.5%) were found to have foot lesions (AFSS ≥1). Superficial fungal foot infection was diagnosed with microscopic examination and fungal culture in 57 participants, giving a point prevalence of 7.2%. Tinea pedis was diagnosed in 54 participants with the leading causative organism being Trichophyton mentagrophytes (52.8%). Other 3 participants were diagnosed as cutaneous candidiasis. Wearing combat shoes more than 8 h was found to be a predisposing factor (p = 0.029), taking a shower less than two times a day (p = 0.008), and wearing sandals during shower (p = 0.055) was found to be protective against infection. Most fungal feet infection cases noticed their feet abnormalities (p < 0.001) including scales (p < 0.001), vesicles (p = 0.003) and maceration at interdigital web spaces (p < 0.001). Mean DLQI in superficial fungal foot infection cases was 3.35. Participants who had foot lesions (AFSS ≥1) were concerned of their foots unpleasant odor demonstrated significantly higher mean DLQI than those without odor (4.2 vs. 2.28; p < 0.001). Conclusion Superficial fungal foot infection is found as 7.2% of naval rating cadets. Wearing combat shoes more than 8 h was found to be a predisposing factor. In addition to skin manifestations including scales, vesicles, and maceration, superficial fungal foot infection also exhibited an unpleasant foot odor which affected quality of life. Self-foot-examination and life style modification should be promoted to prevent fungal infection.

A cohort study of risk factors, clinical presentations and outcomes for dermatophyte, non-dermatophyte and mixed toenail infections

To the Editor: Mixed infections of dermatophyte and nondermatophyte mold (NDM) onychomycosis have increased, with prevalence ranging 20%-40%. This study investigated the clinical manifestations, risk factors, and treatment outcomes of mixed infection onychomycosis compared with dermatophyte onychomycosis and NDM onychomycosis. This cohort study comprised patients presenting at a Thai tertiary hospital with toenail onychomycosis during 2008-2016. To diagnose mixed infections, the dermatophytes needed to be detected in a fungal culture and the patients needed to meet all the criteria for NDM onychomycosis proposed by Gupta et al. The following oral antifungal regimens were assigned according to the patient’s health insurance for dermatophyte onychomycosis: pulsed itraconazole, continuous terbinafine, or fluconazole. Patients with mixed infections were treated with oral antifungals ( for dermatophytes) until mycologic cure and with topical amorolfine nail lacquer alone

Clinical manifestations, risk factors and quality of life in patients with pitted keratolysis: a cross-sectional study in cadets

Pitted keratolysis (PK) is a common skin disorder that is associated with malodor.1,2 Predisposing factors for PK include hyperhidrosis3,4 and prolonged foot wear - especially in military personnel. The aim of this study was to investigate the clinical symptoms of PK, the impact of PK on patient quality of life, and the behavior risk factors for developing PK. This article is protected by copyright. All rights reserved.

Clinical and Laboratory Characteristics of a Tinea Capitis Outbreak Among Novice Buddhist Monks

Sixty novice Buddhist monks with tinea capitis confirmed according to clinical presentation and mycological laboratory finding were included in this study. Mixed‐type clinical presentation was observed in approximately half of all cases, together with scarring alopecia (95%) and superficial fungal skin infection at locations other than the scalp (43.3%). The major isolated organism was Trichophyton violaceum, and mixed‐organism infection was found in 27 cases (45%). Slow‐onset presentation and an extensive area of infection were significantly associated with mixed‐type clinical presentation.