Onychomycosis was considered uncommon in children. This survey was carried out to estimate the frequency of fungal nail infections in children and adolescents (0-18 years of age) attending our clinic in the last decade and gain more insight into the aetiology and clinics of this entity in the paediatric age group. This study is based on data obtained from 2320 children and adolescents suspected of superficial fungal infection. Onychomycosis was diagnosed in 99 cases, representing 19.8% of all mycologically confirmed superficial mycoses (500 cases) in our material. Fingernail onychomycosis was recognized in 52 (10.4%) cases; children under 3 years of age were predominantly involved. Candida albicans was the most common isolated pathogen. Toenail onychomycosis concerned 47 (9,4%) patients; the incidence increased steadily with increasing age. Trichophyton rubrum was the most common aetiological agent with respect to toenail infection followed by T. mentagrophytesvar. interdigitale and T. mentagrophytes var. granulosum. The majority of fungal nail infections were characterized clinically by distal and lateral subungual onychomycosis. The growing trend towards the frequency of toenail and fingernail onychomycosis in children and adolescents was found in the last decade in north Poland. The results of our study show that onychomycosis in prepubertal children is not exceptional and should be considered in differential diagnosis of nail plate disorders.

IntroductionThe role of a number of inherited, acquired and environmental factors has been identified to increase the risk of onychomycosis. The literature data on psoriasis as a risk factor are contradictory. The potential relationship between these pathologies is very important as it influences the patient management.AimTo evaluate the frequency of onychomycosis and etiological factors in patients with psoriasis compared to controls.Material and methodsThe studied group (n = 2427) included 2325 patients with nail abnormalities raising a clinical suspicion of nail onychomycosis (with no history of psoriasis) and 102 psoriatic inpatients. The control group included 100 patients with clinically normal nails. The assessment of psoriasis severity using Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) was performed in all psoriatic patients. The presence of fungi was confirmed in direct microscopy and culture.ResultsA significantly higher incidence of onychomycosis was observed in psoriatic patients as well as in non-psoriatic patients with clinically abnormal nails compared to controls. The prevalence of onychomycosis did not differ significantly between psoriatic patients and non-psoriatic patients with nail alterations. The characteristics of isolated fungi differed significantly between psoriatic and non-psoriatic patients. NAPSI ≥ 40 and receiving systemic treatment increased the risk of onychomycosis in psoriatic patients.ConclusionsThe presented study showed a relatively high prevalence of onychomycosis in patients with psoriasis, what confirms the accuracy of performing screening mycological examination in this group. Further studies are warranted to evaluate the role of specific risk factors, explain the differences observed in previous studies and to determine optimal patient management.

Tinea incognito is a dermatophytosis of atypical clinical character, usually misdiagnosed and treated with corticosteroids. We report a case of tinea faciei modified by high potency topical corticosteroids in a 54-year-old woman. Deep, intense inflammatory plaque with boggy, pustular surface located on the right cheek was found. Direct microscopy and culture confirmed dermatophytosis and led to the identification of Trichophyton mentagrophytes var. mentagrophytes. Complete resolution occurred after treatment with oral terbinafine.

Dermatophytes are keratinophilic molds that infect human hair, nails and skin. Diagnosis of dermatophytosis is based on morphological, serological and biochemical features. However, identification is difficult and laborious due to similarities between microorganisms. Thus, there is considerable interest to develop mycological diagnostic procedures based on molecular biology methods. In this study, fast, two-step DNA extraction method and real-time PCR was used for detection of dermatophytes DNA using pan-dermatophyte primers and identification of Trichophyton rubrum from pure cultures. The applied method allowed correct detection of all dermatophytes and correct identification of Trichophyton rubrum in less than 2 hours.

During a 3-year period (1999-2001) a total of 94 cases of dermatophytosis were seen in patients from 0 to 18 years of age attending the Department of Dermatology, Venerology and Allergology of Gdańsk Medical University. Mycoses were diagnosed on the basis of clinical picture and direct microscopy and were confirmed by positive cultures. The most frequent pathogens were Microsporum canis (62%) and Trichophyton rubrum (12%). The most often forms of dermatophytosis in children were tinea cutis glabrae (42%) and tinea capitis (30%). Microsporum canis predominated in both locations. Glabrous skin lesions were the most frequent in children aged 8-15 years; the peak of scalp lesions was observed mainly in children aged 4-7 years. Tinea pedis occurred more frequently than suspected. Tinea pedis was observed mainly in adolescents (above the age of 12 years)--the majority of cases were caused by T. rubrum and T. mentagrophytes var. granulosum. Onychomycosis was highly uncommon, caused mainly by T. rubrum. Dermatomycoses in general were most frequent in October and November.