Hiroyuki Tanuma

Case Report. A case of chromoblastomycosis effectively treated with terbinafine. Characteristics of chromoblastomycosis in the Kitasato region, Japan

A 38‐year‐old male with history of trauma in the left gluteal region 20 years ago presented with a dark red skin eruption at the traumatized area. It gradually grew to form an erythematous plaque with a well‐defined border. Clinical findings and mycological cultures resulted in the diagnosis of chromoblastomycosis due to Fonsecaea pedrosoi. After initial administration of 5‐fluorocytosine and local heat an almost complete cure was achieved with terbinafine combined with local heat therapy. A review is given on the chromoblastomycosis cases observed in the Kitasato region in Japan.

Increase in aspergillosis and severe mycotic infection in patients with leukemia and MDS : Comparison of the data from the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997

To study the relationship between the changes in visceral mycoses rates and recently advanced medical care in hematological settings, data on visceral mycosis cases with leukemia and myelodysplastic syndrome (MDS) that had been reported in the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997 were analyzed. The frequency rate of visceral mycoses with leukemia and MDS was 27.9% (435/1557) in 1989, 23.0% (319/1388) in 1993 and 22.3% (246/1105) in 1997. In comparing the rate of mycoses in recipients of organ or bone marrow transplantation with that of non‐recipients, that of recipients was approximately 10% higher. The predominant causative agents were Candida and Aspergillus, at approximately the same rate as in 1989. The rate of candidosis decreased to one‐half that of aspergillosis by 1993. Furthermore, severe mycotic infections clearly increased from 58.9% in 1989 to 75.6% in 1997. Among a total of 1000 cases with mycotic infection in those 3 years, acute lymphatic leukemia and acute myeloid leukemia were the major diseases (40.6% and 34.8%, respectively), followed by MDS (26.1%). The reasons for increased rates of aspergillosis and of severe mycotic infection can be surmised to be: (i) candidosis had become controllable by prophylaxis and by empiric therapy for mycoses with effective antifungal drugs; (ii) the marketed antifungal drugs were not sufficiently effective against severe infections or Aspergillus infections; and (iii) the number of patients surviving in an immunocompromised state had increased due to developments in chemotherapy and progress in medical care.

Efficacy of oral fluconazole in tinea pedis of the hyperkeratotic type. Stratum corneum levels

Summary. In this study, in addition to studying the efficacy and safety of the once‐daily administration of 100‐mg capsules of fluconazole over an 8‐week administration period with six patients with hyperkeratotic‐type tinea pedis, we also measured the serum and horny layer concentrations of fluconazole to study the mobility into the horny layer in diseased areas of the sole skin. The final overall efficacy and overall safety were both 100% (six out of six), and no side‐effects, including abnormal‐laboratory changes, were observed in any of the patients. The drug mobility study revealed that in the horny layer of the skin a steady state was reached after 4 weeks of administration, with the mean concentration being 12.8μgg‐1. This concentration was a high concentration that was no less than 13 times the geometric mean MIC (0.972 μg ml‐1) for fresh clinical isolates of Trichophyton rubrum. Based on the above results, fluconazole is considered to be highly useful for treating various kinds of dermato‐mycosis, including hyperkeratotic‐type tinea pedis.

Clinical and pharmacokinetic investigations of oral itraconazole in the treatment of onychomycosis

A clinical study was carried out in 19 patients with onychomycosis in whom itraconazole was orally administered in a single daily dose of 100 mg. A follow‐up period was instituted subsequent to the administration period so that the course of the nail lesions could be monitored. The concentrations of the drug in the plasma and in the nails were also determined. In patients in whom itraconazole was administered for 12–16 weeks, the decrease in the turbidity and thickening of the nails was maintained even after the administration period was completed. The efficacy rating in the overall evaluation at 12 weeks was 84.2% (16/19). In the evaluation performed at 24 weeks, the rating was 94.7% (18/19). These data indicate that the effect of itraconazole was maintained even after completion of the administration period. The retention of the drug in the nail after completion of the administration period was investigated in terms of the mean concentration of the drug in the nail with the passage of time in patients administered itraconazole for 10–16 weeks. It was found that a certain level of itraconazole was retained in the nail until at least the 24th week. Adverse reactions seen in this study consisted of diarrhoea and drug eruption, one case each, and elevations of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase in one case.

Usefulness of 1% terbinafine HCl (Lamisil) cream for hyperkeratotic-type tinea pedis and its transfer into the horny layer.

The usefulness of 1% terbinafine HCl (Lamisil®) cream for hyperkeratotic‐type tinea pedis and its transfer into the horny layer were evaluated. Of the 36 patients enrolled in the study, 35 were retained for analysis and one was excluded due to inappropriate drug application. Hyperkeratotic‐type tinea pedis was classified into three types: true hyperkeratotic‐type, partial hyperkeratotic‐type, and quasi‐hyperkeratotic type.

Pathogenesis and treatment of hyperkeratotic tinea pedis in Japan

In this paper, we describe the major characteristics of hyperkeratotic tinea pedis and review therapeutic results obtained in the Department of Dermatology of Kitasato University Hospital and those reported in the literature in Japan and abroad.

Local cytokine expression in steroid-modified tinea faciei.

In tinea faciei, a dermatophyte infection of the face, early stage lesions show erythema with crust and/or vesicles, a condition often misdiagnosed as dermatitis. Steroid application retards the healing in some cases and may induce penetration of the dermatophyte hyphae into hair and hair follicles. In the present study, we examined local immunity mediated by cytokines derived from lesional T lymphocytes in late stage of this disease. Interferon‐gamma (IFN‐γ) and macrophage migration inhibitory factor (MIF) were highly expressed, but neither interleukin‐4 (IL‐4) nor interleukin‐5 (IL‐5) could be detected by RT‐PCR using cryosections. These data suggested that IFN‐γ and MIF may be important in the delayed‐type hypersensitivity (DTH) response against the fungus in the hair follicle in late stages.

A case of tinea barbae successfully treated with terbinafine.

Summary. Terbinafine was remarkably effective in tinea barbae due to Trichophyton rubrum on the cheek in front of the right ear in a 75‐year‐old man. This patient also showed tinea pedis and unguium, but these were due to Trichophyton mentagrophytes and were unrelated to the tinea in the cheek. This patient showed an atypical clinical picture slightly different from that during the initial visit, requiring histological differentiation from trichophytic granuloma.