Dermatology for Skin of Color A. PAUL KELLY Frofetor of Matsine, Divison of Dematlogy Chass Dew Unser af ene and Sree ‘Chef Enea Dinteon of Demasogy Tove ing/Dicu dial Caner Tae Angee, Cenin ‘Cia ier of Mine Bhsion ol Demataogy The David Caen Shoo of Mado at UCLA Tos Angee, Calorie SUSAN C. TAYLOR Founding Decor Division of Desatelogy Se LakeeRocurls Hom Cones ‘New York New York Asstaot Cina Poiesor of Dematsogy Calegs of ssn and Surgeons Columbus Unersty Medal Ceer ER medical NewYork Chicago. San Fanciseo Usbon London Madrid Mexico City ‘won ‘New Deli Sanjuan Scout Singapore Sidney Torontoepi © 20 he Nel Compa nc Age ord Lepper nd he Uns Sc Capri Atf 7 out tip ‘nna epi elm an fr oty mew inane nana pr wes wan ae ‘Stucco ato es bn ne asa ore i encampment sen ee Ny nc ten peed stale ci ese oe salable ot pec any duce oe pains at pmo a compan ing og To cn rome plows emacs bcloismesw hea ‘hee copra wo ed Te MG sl Cagis (i an eo areal gh an ihe wo Lat he we at ‘ster cows peed ware Copmtt are! ib an tc io eave oe pa he mor outa cmp dae ee ‘eget: wesc tne seks he pn Unt Senin por bt tee pete Na lipoma Yum th eo our on ssl peso ay ta a eh ype Yar ret we ah ‘temic ea ean whoo {ME WoRK 1s PAOVIDED “A ° MGHANULL AND TS LICENSORS MAKENO GUARANILES O8 WARRANTIES AS T THE ACCURACY ADEQLN. ‘taro pater ta cond be wo a myrrh opin wi Weir oa fe Nr cc ‘iat thate ane te yueramee ce foray lmuruay srr orem pi an woh ory ee ing em [McGretil no peri fr come lyon acne rnp he ek Uren cerca Meri ander carb a ‘Srny cy ide peri, tne spear la dae on tne enya woe fay fe ar ad he pntiy of ah ages Tn hal pp ay sioner Wate ei ce issnCHAPTER 57 Bacterial Infections Mice Tuchman Jefey ML Weinberg ey Ponts + ris i kin faker ay ccna wie ange of ees "ts cing ete gam pote or mst cae, es ects oat ier sg om ae hat oo Ine rer papain Sahocncis ues and Srepbzncss pogenes abe wo ‘aj paste ans ha ae ‘pleat os on cormon sn {pes se sions + an-eae inesons cto kine ‘na commence pate ah ates ae rmureampronise — + hie wpe ant team an ‘par tin eat bce ctr, cathe dao ‘eed wear an shu be aed by te abe sorsias fe ctu Individuls with skin of color may acointer wie ring esto [ptelor torceng etic pss pontive ‘oe parecpitire eepiaitna, to moet as tose fst do et tir og ‘aly fom hove thn corn general” population. This chapter ‘describes some ofthe mote common Infecions tha occur inthe population as wells prefered weatments Hi saa. rosirve mrecrions Sephyleed en tid Seep prmentin the bra man gorposr ‘ve ovganisms that are mos tea mp ‘aed in common skin and soft ese Infecos. Infections usualy begin and emai contained atthe ste of # minor ‘wound or akin abrasion, but once skin porction occa, cab of apsiomae Chie ech eels cal on ‘cad emlcartisfcveto, The ents fons isis eel Tbk 7 Jelly are diagnosed cimically and wrested empincaly ames7-1 omen Gram Pstve acter Inoctons Eytvasra rosy cya vec allt Dses, ner cance Farry alate ros Bling dt cis ‘avons ara ‘Suptycoal ale in ge Te shock sere Seto It antibiotics ae indeed tequted for these infections, one with activity inet gram-positive organism such a peniliniseressant pencil, 4 fephalospoia, a mace, or 2 Buse. ffunone i eleced! While erpitesl Seat battens an eat fat sep one che agate i sbi, Tretnent shoud be diated by the nubiotic eens of the cured gas, Enythrasma Eythasma isa chronic bacterial infec: tion eased by Cincher mins tom that affects the interiginoue seas Of the ane, goin, and tes eis often misdiagnored. ar a. fungal infection because ofthe ineriginous predic ‘on of both infections. CLMICAL DESCRIPTION The skin lesions of entrasma (Faure 57-1) ae typicaly ‘Sharply magnate reddish brown mac le smetiies wath bp White macertion, erosion or Barres, patted inthe webbing ofthe toc Fite comet aay be ounce eh seuhing secoodaty cencaten and lchenifestion TREATMENT For prophylactic measures, Eoertitng cotingi accuragel A absorban powder suchas Zeaso AF poveder can be used The westment of fhoice Is a 14-day course of ery ‘hromcin, 250 mg qu Secoodne wea ‘ments incude temacyclie and chlo ‘teephenia. Casthroyein also vay prove ta be fictive, i ioe ress orf erythromycin eaten, cookinatin of opie dnckamyee, ‘Whiteflds cient, sodium fondte iment, or ance oape may be recesay for both ueatmeat and pro- phylaxis Whitefil' otmene ‘hae been shown to have greater efficacy than ‘ejhromyein. for sinterdigial ImpetigarEcthyma Impetigo may be either bullous or ‘bullous in nature Bullous impetigo is caused by Saurus. In indus. fed counties, onbuloue impetigo is also primanly caused by stephylo oct wheres in developing nations, sonballous inpetiga aan lesen? “A FIGURE 87-1 Sinn entrasma pay pean etna aas sua eae, us ualdvHo ‘SNOWO3.MI LOVE aaFitzpatrick’s Dermatology in General Medicine Eighth Edition errors LOWELL A.GOLDSMITH, MD, MPH ‘STEPHEN | KATZ, MD, PHO [AMY S.PALLER, MO DAVID J. LEFFELL, MO KLAUS WOLFF, MO, FRCPCopii © 2012 by The McGraw-Hill Companies, Inc.All sighs reserved. Except as pemited under the Unied State ‘Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in 1 database or evieval sem without prior writen pension of the publisher ISBN: 978-0.07.171788-7 MAID: 0071717882 took also appears in the print version ofthis le: ISBN: 978-0-07-166904-7, MID: 0.07- 1660083, All wadenark are trademark oftheir respective owners. Rather tan put a wademark symbol afer every occurence of @ Caaerarked mae, we tse nts ina eit fashion on ar to he benefit of he tack owe, ihm son of itingatat fs ade Whare uch dnigiton ape in as book, ey tave been pnd with ital cpa McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use it corporate training programs. To contact a representative please e-nmil us at bulksales(@megraw-hill.com. ‘The material in TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. 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Your right to use the work may be terminated if you fil to comply with these terms, THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEE WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTA FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IME INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS 1 PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantce that the finctions contained in t work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, etror or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility forthe content of any information accessed through the work. Under no circumstances shall MeGiraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of Liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tortor otherwise.Figure 176-18 Pitted keratolysis. The web spaces between the toes are sharply eroded. Inerdigital tinea pedis and erythrasme say oceur concurrently DIFFERENTIAL DIAGNOSIS. Interdigital tinea pedis can present with erosive lesions in the web spaces. Erythrasma in the web spaces is usually hhyperkeratotic but can be erosive. LABORATORY FINDINGS. Gram staining of scrapings may detect the microorganism more readily than potassium hytiroxide examination. Histologically, the organisms are present in the walls and bases of the crateriform defects in the upper layer of the stratum comeum. The organisms appear as coceoid and filamentous forms with branches and septa TREATMENT. Prophylactic measures are aimed at keeping the feet as dry as possible. Inert antiseptic foot powders often help. Aluminum chloride 20% solution is an effective astringent. A benzoyl peroxide wash and 5% gel are effective therapy in most cases as well. Other commoniy used topical adjunctive agents include clindamycin and erythromycin solutions. Systemic use of these agents can be attempted in severe eases." INFECTIONS CAUSED BY CORYNEBACTERIUM ERYTHRASMA. Erythrasma is @ common superficial bacterial infection of the skin characterized by well-defined but irregular reddish-brown patches, occurring in the interriginous areas, or by fissuring and white maceration in the toe clefts. It is commonly misdiagnosed as tinea cruri for many months before proper diagnosis is made, Etiology and Epidemiology. Corynebacterium minuissimum, the ciologic agent of erythrasim, is a short, Gran-positive rod with subterminal granules ‘The infection is more common in tropical than in temperate climates. Ina study in a temperate climate, 20% of randomly selected subjects were found to have erythrasma by Wood's lamp examination. The generalized disease is mach more common inthe tropies, Erthrasna is more common in men and may occur in asymptomatic form in the genitocrurl area Clinical Findings History. 3052Symptoms vary froma completely asymptomatic form, through a genitocrural form with considerable pruritus, o a generalized {orm with scaly lamellated plaques on the trunk, inguinal area, and web spaces of the feet. When pruritic, irritation of lesions ‘may cause secondary changes of excoriations and lichenificaton, ‘Cutaneous Lesions. ‘The most common site of involvement is the web spaces of the feet, where erythrasma presents as a hyperkeratotic white ‘macerated plaque (Fig. 176-19), especially between the fourth and filh toes. Inthe genitocrural, axillary, and inikamammary regions, the lesions present as well-demareated, reddish-brown, superficial, finely scaly, and finely wrinkled patches (Fig. 176-20), In these sites, the patches have a relatively uniform appearance as compared with tivea corporis or cruris, which often have central clearing Figure 176-19 Exythrasma. Hyperkeratosis with a yellowish hue in the web space ofthe foot. The three lateral web spaces 0! both feet were involved, The potassium hydroxide preparation was negative; the Wood’s lamp examination showed a bright ccoral red fluorescence. es Figure 176-20 Erytivasmn. Well-demarcated reddish-brown patches inthe axilla (A) and groin (B). The potassium hydroxide preparations were negative; the Wood's lamp cxamination showed a bright coral red fluorescence. ‘Wood's lamp examination of enytrasma reveals coral-ed flarexcence caused by coproporphyrin IIL The fuorescence nay persist afer eradication of the Corynebacterium asthe pigent is within a thick satun corneum, Differential Diagnosis. ‘Tinea versicolor is distinguished from erythrasma by the lesions on the trunk being most numerous at nonintertriginous sites. Tinea crurs tends to fave an active scaling border with central clearing Inverse psoriasis usually presen as sharply demarcated plagues witha shiny red color in the integlueal clef inguinal folds, and alae Laboratory Findings. Culture of the specific Corynebacterium in abundance from the lesion corroborates the diagnosis. Gram-stained imprints of 3053the horny layer ofthe skin show rod-like, Gram-positive organisms in large numbers ‘The diagnosis is strongly suguested by the location and superficial character of the process, but must be confirmed by ‘demonstration of the charaeteristc “coral-red” fuorescence with Wood's lamp illumination. Prognosis and Clinical Course. ‘The disease may remain asymptomatic for years or may undergo periodic exacerbations. Relapses occasionally oceur even afier successful antibiotic treatment. ‘Treatment. For localized erythrasma, especially of the web spaces of the feet, benzoyl peroxide wash and 5% gel are effective in most ‘cases, Clindamycin or erythromycin (2% solution) or azole creams are several of the many effective topical agents. Fusidic acid has been used outside the United States. For widespread involvement, oral erythromycin is effective. A I-g single dose of clarithromycin has been used successfilly.** For secondary prophylaxis, an antibacterial benzoyl peroxide bar when showering is effective, TRICHOMYCOSIS AXILLARIS AND PUBIS. ‘Trichomycosis axillaris, a bacterial infection of the hair shaft (not fimgal as the name implies), is characterized by what appears to be nodular thickenings on the hair shaft, composed of colonies of aerobic Corynebacterium. The condition occurs, Doth in the axillae and pubic areas, and not justin the axllae, as the name implies. The bacteria produce various pigments, tiving the nodules a range of colors. The coneretions on the hair shaft are usually a tan color but may be reddish, yellow, oF black (Fig. 176-21). Lesions are most dense and may be present only inthe central portion of the axillary hai. Trichomycosis is asymptomatic except for the patient's concern regarding the lesions themselves and because they are malodorows, Figure 176-21 Trichomycosis axillaris. Tan-yellow concretions on the hair shafts of the axilla ‘The diagnosis is usually made on the basis of the physical findings. The concretions can be visualized wsing a potassium hydroxide preparation. Pediculosis pubis infestation with multiple eggs on the hair shaft should be ruled out, ‘The involved hnir can be removed by shaving. Benzoyl peroxide wash and gel are effective as treatment and prevention against recurrence of trichomyeosis. Topical clindamyein or erythromycin solutions can be used as well, 3084fl genameA, ouine ASM Complete Genome Sequence of Corynebacterium minutissimum, an Opportunistic Pathogen and the Causative Agent of Erythrasma Patrica K Penton: Esta Tyagi® Ben W. Hurwighouse# Jon R MeGuistont Seca smog elec a or acl Sec Pater Sar Dison Crp eee Patoge and Pato ond Centre egg ad Zena cov Dees Cer De Carla even ua Ceo US sb Pear an Rear Sar on Freee a Erergng cca trl Coie nt octets Dann Cota reas Carel ard eet a ee Corynebaceriuom minutissionum was st slated in 1961 from infection sites of patents preseating wth erythrasma, common. ‘cutaneous infection characterized by arash, Since it discovery. minutsimua has ben dented aan opportunistic patho- gen inimmunosuppressed cancer and HIV patients. Here we report the whole genome sequence of C.minutissimum. ceed Feary 5 heaped ey 25 Pod a 015 Chao enon oa Humpa BX Won 015 Carper gare ol nna notiomun nop sehen te ‘Ststgoroynaen Conon ohot5 aera De ‘eoman 65 enon ea sin oes de bd easiest Connors vo 50 ese ‘Mote onecortrer Pascut fee niece sn. ose Marine APEC orynbacerium mints sa Gram-positive, non spore- forming faclatively anaerobic ace It the caste ‘gent of enthrasma (1) and an opportnisc pathogen fr immi- rnosuppressed cancer nd HIV patients. Cormnchaceriam minis. Su has boun sola fom anulomatous sions subeutane- ‘urabacene, and ctancou ful of wo HIV-positive patents (0,3) Bacteremia with © minutrinuneand reson eps have ‘eon porte inpatients with chronic and acute myeloid leuke- ‘mia (2,4), Maltanubioie restance has been observed with C minsssinum infection (5,5) and virulence factors associated ‘wth this pathogen remain ambiguous, thushighlghting the need {oobiain complete genomic data. The entfcation of Ene con- teasing to antbineresstance and pathogenicity may assist in ‘duciatng the mechanism of ifecton, beter weatment options, Sid accurate entation tools \Coryabctriam minatsnnmstran ATCC 23348 wan gs0¥n ‘on eatinfsion agar supplemented with S% rabbit blood s135°C ‘Svemnght. Genomic DNA was isolated via phenl-clorofora (CTAB extraction av prevoualy described (7). Genome libraries were sequenced on an Mllumina Hiseq 200 platform, generating 25c1o0pared-end sequencing Uibrares with an averapeiner sie of 945 bp. ‘Allequencereads wer filtered andl trimmed athoth hes! and ¥ endsbasedon threshold of 30 using CG-Ppeine (8). Passed Tumi reas were assembled using SPAdes version 3.1.1 (9). ‘This de nov assembly approach ied 4 large contigs (500 bp cach) with an Nag size of 207.332 bp, am average Tengh of {65991 bp anda maximum length of 403.231 bp. The resuking genome sequence was 2.663628 Mb with 200d average cover- Spe and am average GC content of $9.69. An opel map was ‘severatd forthe genome using the ARGUS whole-genome op fal mappingsjstem fom OpGen. The optical map esterbly of the single-molecule etiction maps wa generated using enzyie AE hand resulted in a single 2.687 481-bp chyomosome. The 40- ‘contig asemby wasthen converted to sice optical maps wing the Alf enzymeand mappedto the OpGen optical map for conti ‘ordering and fishing This approach rcsultedin final assay ‘F8 contig eth total ie of 2.653401 bp. OF thee 38 conti, 17 contigs comprising ttal of 2452.54 bp were ordered with respec othe optical map, and 21 contigs comprising a toa of 210847 bp were unordered. The nal assembly bad an Nyse of 2395999 bp with am average contig length of 70089 bp anda max inns cont lengih of 45231 bp CCoomebacerum reference sequences. were dowloaded ‘through NCBI and converted into oso optical maps, using restriction enzyme AI fora preliminary unweighted par group ‘witharithmetc mean (UPGMA) analysis with the whole-genome ‘Optical map of minaasinun sin ATC 2334, Teresa UPGMA tree revealed close clustering ofthe C. miisinu genome with the C dipheieand C.pendovibercdos ference quences. Annotation ofthe final sembly wing GeneNackS (00), ¢RNAscan-SE 121 (11), and RNAmmer 1.2 (12) revealed 2.469 protein-coding regions, SL UNA genes, nd 3 1KNA ” Nico sequence acesion numbers. This whole-genome shotgun project hasbeen deposited at GenBank under the Bio Proje ID PRINAISI758, “BioSample accession number SSAMNOS140511, and accession number ISEFOGGOD000. The ve sion described in ths paper i verso SEFOI 00000. ACKNOWLEDGMENTS. ‘his work we spporte though US. Goverment al The Bedi and conlson in ths report are thos of the authors ‘See Conrtand Preenton 1 Sy I Tp D, Blk 96 Enso ca Se re a eaten + ei tlc pat as pet ete ‘Soyuttan nGcd pt ae Ices haptbcdncr aos 200.83Palmoplantar Dermatoses- A Clinical Study of 300 Ca: ‘ABSTRACT Introduction: Deratosa atlecting pains and sols are aneng the most cient of all dematologic! therapeu probes Many previous stucis nave focuses on the specie cisase= Cf palmeplantar dermatoses. However, none of them have Included a comprenensive stay of pamoplnts dermatoses. Aims: Tostuty the epiderilogal spec's he age distin, ‘ser deren, te darmatonss afoctng the ame & sols ‘Sod the frequency of necvement of palm, anes or Both pis ‘Sole, ptint with palmoplntar dermatoses. Moterata and Methods: This cross sectional study was ‘conducted in the Departnent of Dermaliogy between October 2011 to September 2013, Fst 300 cases standing ‘he ‘Separment of dematsiogy marly wth complats praling to pam ard sole wor enrld inthe stay. Aer faking ‘consent a dete nistory anc cial examination paaiing to the alm ofthe study was recorded and analysed, which Included inspection of morphology ar dstnbuten of fesons ‘and paatn of any sweling. Dect microscopic examination ‘ot srapinga, wet mated wih 70% potesoum hyoue wa ‘one for cases wth sca lesions. Those wo had a pustue, ‘rem staring was dene. Paton testing ung Inaan Standard ‘Bary Series was done for these cases of eczema. A Same for biopsy was taken whon daghods could not be arived INTRODUCTION Primers edeshave anon hyn whichis marked by earacof ‘ridge ac grooves wih acoaaten wrote oach nwa wn as domatoghphies. perce whose vthood dope ‘en oocupaton whic nec marval were and waking. ts ‘goupo desascs may bo occupa Sebhrg. Various cormatses aft pans and sols, ew a speci to ‘ams and sole. ot sfoctng san elseurare ns Deg. Sue ‘ial ditrecea ent been the, which ne 0 be picked {Gp by haem bsavation. Tis haps uso ath tte dagnoss. Thotrastconwnon aarmatooe Cleat, Eoura. Paknogariat ertodenna, Pao Hand loo moun doesae, Pana ers Hypemiaesis, Blk heal an pam Pleogone pode ar Parr papules, ldpathic vecumertpaloplaia dade) oe ‘eootbes bab mally the cel Toakes nd the aetooay ‘orien warp us 1 eve st he dagnoas CCalostes ae plaques of rypaneratess caused by repated ‘ton andr pressure [] and is a ral pretecve response ‘The tom ‘Eezona of he had and fet rts to preoinant Intehmece of hands andor fos tne eer proces 2 Wis caused by chars eetelopea fazer, Bah exogenous nc ‘endogenus,Theugh any aro fare may be rahi ary 160 ‘of eczara armate along the pare endogenous, waa SES clncay. an subjected to istopattlogcal examination. Resuts: In our study of 300 patents with palnopentr ermatoces, 164 were females and 155 were males, rato bsorved being 127. Tho peak incidonce was found in the fae group 2120 years, witht eras 25%) and 35 aloo 2579. Most tequenty slected Indra in is sty ‘wore housewives 60%). The most common fve diseases of ‘amoplanardematooes wor pameplartarpsorale 20.7%) ‘once (19), palmopante hyperioe= (7), keratajse xflatva (6%) and ited kertalyas (69%) Maj of patents had involvement of both pms and soles (4.39) as compared 1 patents wit volvement of ery par (28%) and ony sole (27.3%). Tho commonest palmopianta dorratoses wth ony palm involvement was keratoaiexoltiva (16.79), th ony Soi imtvement was meniiais (496) and wh BOM alm and soles involvement was palmoplatar pscriais (11.4%) Associated nal changes wore soon in 80 c2o05 (25.6%) with maximum incidence in pslmoplansr peonais (625%) Aesocited demataioical condiians wee obsawed in 43 paints (14.350). Conclusion: Palmoplata drmatosae are Fequeny encoun fed in the darmatioge fad. Further lvetgaton wah 2 Wider and lager populaten Is necessary to understand the spidemology, Dad on whics accurate agnosis and proper retest old be ached ‘hat onthe dora pect is oxoganeus. Tho orogenous eausse iret intr and alow contact dara. and endoneneue ‘aves inaudoatpie dab, decodoezara, poral and Iyporratote ecoma Pamoplrsarkrtoceana PPK caries aheleregeraoungyoup of doors of keratnzaton. They ae dasias by merpdo3} feet aerion of hypertercoss, ganete Yoramase, and fresno of akin leona cn arene cer han ps and aos a ‘Sheet encet [Troy canto cused by a oct of dernaingeal Geer, grctic or tequres a he nl ate chang ore 2 Da of or wicgmod Garrats, or ven ae 3 notation ‘tan etemal aad Pots on pas and cles may reser: yc scaly atchas cnn tne sry sei can be evoked seracheg which ae ‘Stay demarcated an stop athe paris nce and soar ot ingers, fess wel ceped plans, ustuoss or Mus TOME cca occu, Mary batt, rg and val erga can pretce petary for seconcary isctone ch pane and soe Connatacah Inectons afectng pairs ano sos re sytvasma and pied eraahols Eyivasna commeniy presets 2s asymotorae csi seauing enamacestonnvching ts webenso28 foes Pie heraoyt usualyvohes the sles an posers 35 pale “ert ne ne pe ne 06, WOOLrc ual of Mirna 45, 3, 71-784 2018) Copy ©2014, Sexe Bain de Masini ‘ev scoop Interdigital foot infections: Corynebacterium minutis imum and agents of superficial mycoses Fatma Mutly Sariguzel!, A. Nedret Kac, Githan Yagi! life Berk! "Department of Microbiology, Kayseri Education and Research Hospital, Kayser, Turkey. “Department of Microbiology, Exiyes Univesity Meical Sco, Kayser, Turkey. Abstract Interdit! fot infections ae mostly caused initially by dermatophytes, yess and less rerty ty taco. Eeylranen caused by Conmchectriom mimic ca be confused with peta mycoses. The aim of the stly was to determine te prevalence of tis ctiologic ages of supa ‘myeos ad he frequency of Corsnchoterium minaissium i itragitalfot nections. Al he Sanples obtained fom the 121 paca wit tedigital foot infections wer examined dicey With the se oF 20% potassium hydroxide mounts and Gram tain under the mistosope and cultured oo Sshouraal’s deutrose ager pats tn Wentiicaion of superficial mycoses the rte wa ound be 1H withthe cultural meted and 14% with direct misroscpic examination. Using a combination of ret microscopic examination and clr, 253.8% rato was ahiesed. nthe cute theses es, the most solted factor Was Trichophyton rabrun (33.7%) In 24 ofthe patcats (19.8%) Corynchcterium natissiman ws detect by Gram sting, m6 ofthese pains Trichophyton ‘bran Was found, Trichophyton mentagrophites Was found in? and Trichospron pp Was found {21 The examination ofiterdigitl foot ston ine laboratory the coexistence of ert with ‘dermatopytes and yeast should be considered. Key words: interdgil foot infestions, supericial mycoses, dermatophyte yeast, Conmebctertam inaissimaon Introduction Interdigal fot infections ae frequent sen in hie ‘mans an although not e-hentening, let the quality fife of sufrers in our country apd allover the world. Several pathogens apd factors may play aol intoe web in- (tion The eiloge agents of fection between fetes ae mest Hequenly dematophytes, followed by yeast, saprobes mols and less fequently baci, Superficial mycoses ae intions of the Keatiaous ssc caused by dermatophyes, yeasts and environmental ung Dermato> ples follow a course sich as kin sealing, vesicle fora tion and somtimes teflon and itis possible forthe to spread from human to human, aria o human, and n= ‘ure tofuan (Sunmerbele af, 2007) The determination ov supericial mycotic agent according vo region will r= ide data or epidemiology, a well increase the success of eaten ‘inca pedis whichis alo Anon asathle' bt 2 onic finda nftion ofthe fet. Tine pss com ‘mon fungal infection in dls, afecting Between 30 snd 0% of the population (Al Hasan a, 2008), Rnyteasa ia a superficial infition camied by Corynebacterium minutissinum and affects the major mcr epons of the fet 1961 it as found forthe fist tae that C. minis was a factor fo erthas (Grown, 1998), It 6 bareterizad by erytbematos plo ‘ue, oun, scaly patches, vesicles, listers and maces tion The course ofthe disease is chronic and remission hoes nt eno occur miami fen cess oer bacteria dermatophyte and yeast (Sumimebel ea, 2007, Svejenard era 1986) Sel eepenlons io FM Saige Drm of oto: Ks Edcain nf Resos ont R380 Ker Tek Ema ‘stile conDetermination of C:mintsimu susully made by ret examination of skin seopings foe the infected sh Enyrasma exits cora-edMuoeescence under Wood's lamp. Due wo the coeisence of eryhrasma with agents of superficial mycoses, intenigitl foot infections should be viewed by direct miroseopy. Direct miresepicexamina- ‘on (rat sin) shows esters of lng, ge cis uch 5 are common in pith ell. Cultures ae sully use Successful and not required to esblish a dagaoss of ey- ‘haa (Henry, 2001), ‘The purpee of this study was w investigate the agents ofsperticial mycoses and detemine the Hequsney {OF minasimum in patents wih inerdigal To l= Material and Method Specimens wre taken fom te interigta fot l= Sons of 121 patents with prosdenticaion of superficial snycoaes andor erytasmna which Were sca tothe Mycol- ‘oy Labortry from the dereatology clinics i the Hospi tal of Exijes University Medial Faculty. Specieas consisting oF epidermal scale and macerated sin were Scrape fom therm of esos using a sterile lp! blade following the cleaning of the affected ses wilh 70 wv ‘soppy! alcoho. The scrapings were collected stele pet ih. Mot cotion swabs were wad o elle ps fen ioe ‘amsmatory lesions. The samples were divided imo two portions ne for erescopicexaination and ove fr cue {ure. The diet examination ofthe sample was performed by using potassium hydroxide (KOHL, 20%) fo the fangus autho space fo Cmimutesimum was fixed with chor fn slide and then Gram Staining was performed. Saboue ‘aud dextrose agar SDA} (Aurea) and SDA with elo- famphenical (Sigma) and cycloheximide plus hloramphenical (xox) were used for calture Specimens ‘were incubate a 37"C and 25 °C fr tree weeks, Molds growing im culture were valstd with expect thirate ff growth, emperatre tolerance an terpertire enhance: ‘ment surface toponaphy, urea hydra special nut tial sequrements, cuistnce of pigmcats inthe colony tdi vito tne perforation, Vest colonies wee beatified according to astnilation of carbonate with APL AUX (C20 Biomerieu, France) kis, with spect to te micro scopic and macroscopic mompologies ofthe colony, germ tube tet, capability of growing a 37°C, urea hydalysis and sensitivity for eyloioximide Resut Direct microscopic findings The rate was found tobe 1% with dret microscopic examination, Gram postive rods tlated 10 C. minutsinum were determined in 24 (09.8%) ofthe specimens (Table 1). Culture findings: The fungus wasisoatdin 8 ofthe total eulures (67:95). Dinct microscopic examination ws found to be postive in 4138.) ofthe growing cultures Hewever, the microsopie examination ofthe other 17 samples (14%) were found o be negative (Table 1). "The slated stains were enti dermatophyte in as (36%), as yest fn 9 (749), a Yast and derma tophytes in (0.8%) and as mold in 3 (2.4%). The soa ‘rmatophyics werden as rubra i and nT ‘mentagrophyts in. The slated yeasts were idetifed as Calbicans in 3, C glabrata in I asCparapsilsis 1, ' Rhadotorta sp. |, 88 Trichosporon sp nd. One of the mold stains was identified as Aspergillus spp. 1 as Fusarium sp. and 1 as Aeromonas 59. T rubrum was isolated fom 6 ofthe 24 pati who had C minaissimum. T-montagrphytes and Trichosporon ‘pp. were ls olated fm 2 and 1 f hese 24 patents oe spectively Table) Clinical Features: The most common sinc sign was sealing hich afte 826 af patos (Table 3}. Discussion Supesicial myeoses are quite common infections a thee prevalence changes according to diferent couiries and repios. Alb, inthe Same arc, the prevalence may ‘hangs over time. Direct mcrscopy and clare methods tue used for the laboratory Mention of superficial lnyeoses Duet he fact that cule results are obtained in 2-3 weeks, det micrscopic examination is of impor- tance in predignoss, Using a combination ofthese meth- ts inereses the rate of dignoss Inthe iterate eat to 1p be direct microscopic ivcstigaion and culture sfowth, the pereentage of positivity was found to be be- tween 223 ad 66.7% (Kraze af, 1999, Khosravi ta. 1984, Manzano-Gayosso ea, 1994) Koksal ra (2008) reported that when using a combination of dicet miro scopic examination and cult, 97% aio was acoso However, only 3% of the samples were determined using cultures without det microscopy. The ratio ebiained foe this atudy was inthe ange ofthe Ieratre values 3%, Although direct microscopic evaluation provides in. Sormation about pre-demicaon, culture creases the ae tio ofientifeatn, In stidis cried tim our country, ‘ep ete tpt psc) ” 1 pake)ces ” “ pacer « ” De) Dacca panive DM: Dae mioncpc mae (ae Ce Cae eseCoral-Red Fluorescence of Erythrasma Plaque “Gonz acorn Sado vias Snag? ad Pe Lpes? Antonio Marine Lope SA C59) be gly al Og AIG ans SL al oA ao BA gure 1A 8:4: tse bros wel dfn eal pag inet inguin ofa 0-year man Neth "pret paper apesance Woods ight sin examination of the pagar showing bight cored oreence areata Ace ema ey ons Coop of raat, Grd Spas, i 2015 with a aighly pantie rah on the eft grin, sich he had had for two years, He had attended the hospital previously and een dagrosed with eczema and. tinea cru. Ths Bad been freed with topical stemids and antiings! rage (onehypredniclone and eetconszole) for several month withoutimprovement. A physic examination ofthe patient showed ifs, row, well debe scaly plage inthe left inguinal region Figute1A). A potassium hydroxide preparation of tissue scrapings sre tagaie ofa lament cles Tea ed arescence of the plague under a Wood’ lamp (WL) examination was characteristic of eythrasms Figure 18). The pation was tested with 500 of oral erythromycin every 12 houts for 14 days, with prograse healing obvered over thee weeks Comment Erythasma i a loalised and chon hin infection caused by Corynobactertum minutisimu’ i appear ax puches that ae ether aymptomtic and velldefined ot iregule in shape and sae and red! own in colour™ The diagnosis is usualy cline bta WL examination can show craters uo ‘seence doe to coproporphyin il produced By the buceria The WL emits ultraviolet A radiation with “ip ee Aa ig Rn apa pi Dern fs iy ap Cp eelCantina emenroe tyne an waelengts betwen 320-40 am and isusefl inthe lgnoss of sores of pigmentation, skin infectons (such as eryhrasma) and porpyras? However, rnicscopc examinations (eg. Gram ning of an pierm raping to reveal Gram postive Sime sed ds and clare on dftrent pes of medi es 26 fea bovine serum. 2% aga and 78% usu cure edi #199) maybe segue in crt cass A potassium hydroxide prepuation of tissue srpings fan rue aut concomitant nkctons, especaly aint ith nerd ivelement The erential lgnons oferta inclen candi pais Sand demsopyose "The most fective tetment 1500 mg of reheat dao 1 das i, ute te a igh 2 100% Doweve other eaten ‘wth topical anubioes and anungals have ao demonstrated god sponse" 282 | References tepid | ad a al sa sahoctnaa [ecto Se fdr nog yeep ford Sener) sane eo penta seston arena " Gov HL Cate Ps Sal wa Siow awionnpieeasintasmc ‘ices Am fan cee