Takuro Katoh

Epidemiological survey of foot diseases in Japan: Results of 30 000 foot checks by dermatologists

There has been no epidemiological survey of foot diseases in Japan. In this study we determined the prevalence of foot diseases, especially tinea pedis (TP) and tinea unguium (TU) in Japan. We conducted a randomized survey of outpatients who visited a dermatologist during the third week of May in 1999, 2000 and 2006. The most frequently reported condition was “fungal infection” in 8737 (40.0%) of 21 820 patients in 1999/2000, and 3848 (49.4%) of 7783 patients in 2006. The patients who visited a dermatologist for reasons other than superficial fungal infection but were diagnosed with TP or TU comprised 18.6% of the study population in 2000 and 24.1% in 2006. Of the patients with TP or TU, 63.2% used topical medication only. This survey showed that often patients are not aware of fungal infections and that their treatment is sometimes insufficient. Dermatologists should actively examine and treat patients with TP and TU.

Allergic photocontact dermatitis due to suprofen : photopatch testing and cross-reaction study

We report 5 cases of Photocontact dermatitis due to suprofen, a nonsteroidal anti‐inflammatory drug introduced to the Japanese market in 1989, and available as a 1% ointment. The patients developed pruritic eczematous lesions after applying the ointment for from 2 weeks to 3 months. All 5 patients reacted positively to photopatch testing with ultraviolet A (UVA) and suprofen down to 0.1–0.01% pet., and 3 patients showed positive reactions with ultraviolet B (UVB)and suprofen down to 1.0–0.1% Moreover, all patients showed a cross‐reaction with tiaprofenic acid, which has a very similar chemical structure to suprofen. However, there was no cross‐reaction between suprofen and ketoprofen. Prescribers should be aware of the existence of photocontact sensitivity due to these drugs.

Adhesion of dermatophytes to healthy feet and its simple treatment

At several public baths, we isolated dermatophytes from the soles of healthy volunteers by a new direct isolation method (foot‐press culture method). We confirmed that a public bath is one of major sources of infection of dermatophytes. We showed that simple treatments such as (i) wiping the sole with a towel; (ii) washing with soap; (iii) 100 steps on another mat; and (iv) holding the foot up for an hour, significantly reduced the fungi on the soles of six healthy volunteers. These treatments may be effective for prevention of tinea pedis.

Demonstration of dermatophyte dissemination from the infected soles using the foot-press method

Summary. We have designed a new direct isolation method, the foot‐press method, to survey dissemination of dermatophytes from the infected soles. A total of 56 untreated patients with tinea pedis were examined. The infected soles of 42 patients were pressed onto actidione‐chlor‐amphenicol‐5‐fluorocytosine (5FC)‐gentamicin sulphate Sabouraud glucose medium prepared in a large culture dish; the culture media were then incubated at 25 °C. Dermatophytes were isolated in 30 out of the 42 patients, while no dermatophytes could be grown from 10 healthy controls. The number of isolated colonies from each patient ranged from 1 to 97 (mean±SD, 11±20). The isolation frequencies were higher in the patients of hyperkeratotic type and in those with tinea unguium, while causative organisms and the extent of the lesions did not affect the results of the foot‐press method significantly. In order to reveal the morphology of disseminated dermatophytes, 1 times 1 cm pieces of culture media were cut out from culture dishes after pressing infected soles and were examined microscopically. Dermatophyte‐like spores or hyphae, most of which were detached from cornified cells, could be seen in 10 out of 14 patients. Subsequently performed slide cultures isolated dermatophytes from approximately 70% of the pieces on which dermatophyte‐like fungi were observed.

Local Hyperthermia in the Treatment of Sporotrichosis. Die lokale Hyperthermie in der Sporotrichose‐Behandlung

Summary:  21 patients with sporotrichosis underwent treatment of local hyperthermia using a pocket warmer. The treatment was performed 1–3 times a day, totalling 40–60 minutes per day, until the lesions healed with scarformation. As a result, “complete cure” was observed in 18 patients, “relapse” in 1 and “improvement” in 2. In the 18 patients with complete cure, the period of treatment was 5–13 weeks (mean ± SD: 8.5 ± 2.5 weeks), and was not affected by sex, age, sites of lesions or clinical types. Because heat resistant strains were not detected by thermotolerance tests of isolates, the reason for failure was suspected to be mainly due to the misuse of the pocket warmer. It was, therefore, thought that the application technique of a pocket warmer was the most important factor in the success of the local hyperthermic therapy.

Isolations of dermatophyte from clinically normal scalps in M. canis infections using the hairbrush method.

The scalp hair of patients with dermatophytosis due toM. canis but without scalp lesions, and that of their family members without dermatophytosis were examined using the hairbrush method. The dermatophyte was detected in 93.8% of the scalps of those who lived in homes where cats were kept, and in 25% of those without cats. After the source of infection had been treated, the dermatophyte showed a gradually decreasing presence, finally disappearing altogether, so that no case of the disease on the scalp hair could be found.We inferred from the above findings inM. canis infections that, since the dermatophytes are seen in a high proportion of cases without scalp lesions, the dermatophytes, in many cases, exist only as saprophytes on the hair.

Isolation of dermatophytes from house dust on a medium containing gentamicin and flucytosine

Summary. Dermatophytes are usually isolated from house dust by using actidione‐chloramphenicol Sabouraud glucose medium (ACS medium). We have prepared a new medium, 5FC medium, by adding gentamicin sulphate (GS) and 5‐fluorocytosine (5FC) to ACS medium to achieve more efficient isolation of dermatophytes from house dust. 5FC medium was more effective in isolating dermatophytes than ACS medium or ACS medium supplemented with GS alone. Trichophyton rubrum could be grown from 13 out of 19 house dust samples from the homes of patients with tinea pedis (68.4%). and T. mentagrophytes could be grown from 17 out of 21 (81.0%). Two of 20 house dust samples from the home of a control family without dermatophytosis grew only one colony of dermatophytes in 5FC medium: the rest of the samples showed no growth. The number of colonies isolated on 5FC medium was much higher than on ACS medium (5.3 vs. 2.0 for T. rubrum and 17.2 vs. 2.1 for T. mentagrophytes). In addition, the size of the isolated colonies was much larger than that on ACS medium. Thus, 5FC medium can be regarded as a useful tool for isolating dermatophytes from various contaminated samples.

Taste Disorders in Healthy “Carriers” and “Non-Carriers” of Candida albicans and in Patients with Candidosis of the Tongue

Impairments in taste perception may be caused by a number of factors, including the presence of Candida albicans in the oral cavity. We attempted to establish whether the presence of Candida albicans on the tongue is a cause of taste disorders by studying taste disorders in patients with candidosis of the tongue and in healthy “carriers” and “non‐carriers” of C. albicans. Taste disorders and their severity were objectively assessed by the filter‐paper disk method in 18 patients with candidosis of the tongue and in 33 healthy “carriers” and 167 healthy “non‐carriers” of C. albicans. The gustatory function was re‐tested in 7 patients and 8 “carriers” after treatment with topical anti‐mycotic medication to detect any improvement. Patients with candidosis of the tongue and “carriers” of C. albicans demonstrated significantly higher incidences (p<0.001) of taste disorders than did “non‐carriers”. The mean taste threshold of each of the four individual taste qualities was significantly higher in patients with candidosis than in “non‐carriers”. The average taste threshold was significantly higher in “carriers” than in “non‐carriers”. Post‐treatment improvement or recovery from taste disorders was obtained in 5 out of 7 patients (71.4%) with candidosis and in 7 out of 8 “carriers” (87.5%) of C. albicans. This study clearly demonstrates that not only overt candidosis of the tongue but also commensal harboring of ***C. albicans is a cause of taste disorders.

A Case of Secondary Syphilis with a Solitary Pulmonary Lesion

This study describes a case of secondary syphilis with a papular eruption and penile ulceration. A chest roentgenogram showed a solitary lesion in the left middle lung field. Histological examination revealed epithelioid cell granuloma in both the penile ulcer and the lung lesion. After antisyphilitic treatment, the lung lesion shrunk remarkably and at the same time the skin eruption and the systemic symptoms also improved.

Preventive effects of various types of footwear and cleaning methods on dermatophyte adhesion

Tinea pedis is contagious and typically spreads from infected to non‐infected persons. The purpose of this study was to evaluate the efficacy of footwear in preventing tinea pedis adhesion. Using the stamp culture method, we investigated the effectiveness of preventing dermatophyte passage by the wearing of stockings made of nylon, socks made of cotton and tabi (Japanese socks), as well as the effect of removing dermatophytes from these items by washing with soap, cold water and cold water after turning inside‐out. For sandals, sneakers and boots, we also investigated the effect of dermatophyte removal by pouring cold water into the footwear, wiping with a wet towel, and pouring boiling water into the footwear. The wearing of socks or tabi was effective in preventing passage of dermatophytes. The stocking material proved to be too thin to prevent passage. On the inner side of socks (the side of the sole ), all treatments were effective at removing dermatophytes, but on the outer side of socks (the side touching the surface of the sandals ), the treatment of washing in cold water after turning inside‐out resulted in significantly more dermatophytes as compared with the other treatments. Pouring cold water, wiping with a wet towel and pouring boiling water were all effective for removing dermatophytes from sandals and sneakers. However, for boots, the treatment of pouring cold water was less effective. To prevent the adhesion of dermatophytes to sandals, wearing socks or tabi was effective, and the treatments of washing socks in cold water after turning inside‐out and of pouring cold water into the boots were less effective than the others.