Characteristics, Associated Diseases, and Management of Gram­negative Toe-web Infection: A French Experience

Abstract

Gram-negative toe-web infection is a disabling painful disease with long healing time and high recurrence rate. In a French retrospective real-life study, we described features and management of Gram-negative toe-web infection and evaluated the effect of controlling predisposing factors/diseases on the rate of recurrence. Among the 62 patients included, mainly male, 31 experienced more than one episode. Pseudomonas aeruginosa was the prominent bacteria. Predisposing factors/associated diseases were eczema, suspected Tinea pedis, humidity, hyperhidrosis, psoriasis and vascular disorders. Patients in whom associated diseases were controlled did not relapse. Subsequently, an algorithm of Gram-negative toe-web infection management is proposed with a focus on associated diseases. Gram-negative toe-web infection can cause pain and disability, be complicated by a long healing time, management failure, and cellulitis, and recur due to persistent predisposing factors. To describe the clinical features and management of Gram-negative toe-web infection and evaluate predisposing factors and associated diseases, their management, and the effect of controlling them on the rate of recurrence, we conducted a retrospective real-life study of patients with Gram-negative toe-web infection. Among the 62 patients (sex ratio 9:1), 31 experienced more than one episode of Gram-negative toe-web infection. Pseudomonas aeruginosa was the most prominent bacteria. Predisposing factors/associated diseases were eczema (66%), suspected Tinea pedis (58%), humidity (42%), hyperhidrosis (16%), psoriasis (11%), and vascular disorders (40%). Patients in whom associated diseases, such as eczema or psoriasis, were controlled did not relapse, suggesting the benefit of management of such conditions. We suggest that management of Gram-negative toe-web infection be standardised, with a focus on diagnosis and treatment of associated diseases.

Skin and Gut Microbiome in Psoriasis: Gaining Insight Into the Pathophysiology of It and Finding Novel Therapeutic Strategies

“…The genus Pseudomonas, enriched with psoriatic skin, includes many opportunistic pathogens and contributes to the treatment response of psoriasis patients treated with narrowband ultraviolent B (UVB) (Assarsson et al, 2018). For example, the most prominent bacteria of Gram-negative toe-web infection, Pseudomonas aeruginosa, is closely associated with the incidence of psoriasis (Goiset et al, 2019). Chang et al (2018) also found that microbial communities in psoriatic lesions tended to display higher alpha diversity and greater heterogeneity but lower stability than healthy skin microbial communities.…”

Epidemiology of interdigital infections of toe web spaces in Shanghai, China: Etiology, risk factors, and therapeutic approaches

“…Interdigital infection is a spectrum of relatively common, troubling, and neglected disorders [3], especially in the humid and rainy climates of southern China. It was rst described as a speci c dermatologic entity by Amonette and Rosenberg in 1973 [5]. A variety of terms have been used to describe this disorder, including gram-negative bacterial toe web infection, which is characterized as an acute bacterial infection of the toe web spaces due to Pseudomonas spp.…”

“…With high recurrence rates and possible complications, such as immobility, cellulitis, wound healing disorders, and autosensitization dermatitis, interdigital infections present a frequent therapeutic challenge in clinical practice [4,5,18]. However, data supporting a standardized regimen remain insu cient [19].…”

Gram Negative Toe Web Infection – A Not So Rare but Neglected Syndrome

“…They recorded predisposing factors that included eczema and psoriasis, suspected tinea pedis and exposure to humidity or hyperhidrosis and vascular disorders. Five percent of those studied were diabetic, an interesting observation given the growing association between foot Gram negative bacteria and diabetic foot ulceration or diabetic foot studied using mixed techniques of culture plus 16S ribosomal RNA (16SrRNA) genetic analysis (7). The French study included patients with a severe spectrum of disease and over 75% had more than one episode of Gram negative infection, often following failure of initial outpatient management.…”