Assessment of tinea pedis and onychomycosis frequency in diabetes mellitus patients with diabetes complications and foot ulcers. A Cross sectional – observational study

Abstract

Objective:Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer.Methods:We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection.Results:Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05).Conclusion:Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers.

Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes

“…Drying water between the toes after washing the foot is an action necessary to prevent tinea infection. Fungal infections were observed more frequently in patients with poor glycemic control [14]. The prevalence of tinea pedis is high in diabetes patients with poor glycemic control.…”

Comparative evaluation of efficacy of terbinafine and itraconazole in treatment of tinea cruris

“…Hyperglycaemia, particularly uncontrolled hyperglycaemia, aids the development of dermatophytosis and bacterial infections because such patients often have impaired cellular immunity and reduced phagocytic function of polymorphonuclear leucocytes. 16 To better appreciate potential multidrug interactions and ensure their safety, patients' hypertensive histories were also noted. 17 There were 97% of the patients who participated in this study belonged to lower socio-economic class and these patients were particularly susceptible to mycoses because of their poor personal hygiene habits and lack of proper environmental sanitation; transmission of this infection occurring via infected persons and fomites.…”

Onychomycosis in children: Safety and efficacy of antifungal agents

“…One possibility, based on the pharmacokinetics of these agents, would be to treat the nails for 2 weeks to provide a steady‐state concentration in the nail unit, followed by twice‐a‐week applications for at least 3 years because there is a propensity for the fungus to recur within 3 years of mycologic cure . The child and parents should be counseled to keep a high index of suspicion for the recurrence of tinea pedis and treat it aggressively and completely, especially in the setting of immunosuppressive disease such as diabetes and immunologic deficiency . A high incidence of familial onychomycosis has been observed; one study found 86% of family members were labeled as likely sources for infection in children .…”

“…31,37,38 The child and parents should be counseled to keep a high index of suspicion for the recurrence of tinea pedis and treat it aggressively and completely, especially in the setting of immunosuppressive disease such as diabetes and immunologic deficiency. 39,40 A high incidence of familial onychomycosis has been observed; one study found 86% of family members were labeled as likely sources for infection in children. 41 Ensuring that family members are infection-free could help reduce the recurrence of infection in children, especially if a child is not willing to cooperate with treatment.…”