I

MYCOSES 35,

375-380 (1992)

ACCEPTED: AUGUST5, 1992

Dermatophytosis due to Trichophyton rubrum in Northern Greece during the decade 1981-1990 Trichophyton rubrum- bedingte Dermatophytosen in Nordgriechenland in der Dekade 1981- 1990 D. Devliotou-Panagiotidou', T. Koussidou-Eremondi', G. Karakatsanis', A. Minas', F. Chrysomallis' and G. Badillet3 Key words. Trichophyton rubrum, dermatophytosis, Epidemiology, morphotypes, Northern Greece. Schliisselworter. Trichophyton rubrum, Dermatophytosen, Epidemiologie, Morphetypen, Griechenland.

Summary. During the years 1981- 1990 Trichopfyton rubrum was the most frequent causative agent of dermatophytic infections in Northern Greece, especially in cases of tinea pedis, cruris, corporis, and unguium, as well as dermatophytosis of the hands. Between sexes there was a prevalence in women in tinea pedis and toenail infections. Men were particularly infected in the groin, the hands and the face. The chronic follicular dermatophytosis in the lower legs was also presented in women, but tinea corporis and fingernail infections showed no significant differences between the sexes. Also studied were the age of the patients, the inflammatory component of the lesions and the morphotypes of T, rubrum isolated. Zusammenfassung. I m Jahrzehnt 1981- 1990 war Trichophyton rubrum der haufigste Erreger von Dermatophytosen in Nordgriechenland, insbesondere von Tinea pedum, inguinalis, corporis, unguium und Tinea manuum. Beim Befall der FuRe und Zehennagel war das weibliche Geschlecht bevorzugt betroffen. Manner hatten Effloreszenzen haufiger im Inguinalbereich, an den Handen und im Gesicht. Frauen zeigten auch chronische follikular-nodulare Dermatophytosen in der Schienbeinregion. Bei Tinea corporis und Tinea unguium der Fingernagel gab es keine

' Department of Dermatology, Aristoteles University of Thessaloniki, 'State Hospital of Skin and Venereal Diseases, Thessaloniki, Greece, and 3MycologicalLaboratory, Dermatological Clinic, HBpital St Louis, Paris, France. Correspondence: Dr Thalia Koussidou-Eremondi, State Hospital of Skin and Venereal Diseases, Chalkidikis 5 1, GR54644 Thessaloniki, Greece.

bedeutenden Differenzen zwischen den Geschlechtern. In der Studie wurden das Alter der Patienten, die Art der Entzundungsreaktion und die Morphetypen der T. rubrum-Isolate berucksichtigt.

Introduction

Trichophyton rubrum is a n anthropophilic dermatophyte that has a worldwide distribution [l-41. It causes the most common superficial mycoses: tinea cruris, tinea manuum, tinea pedis, squamous hyperkeratotic tinea of palms, unilateral usually, and tinea unguium. I t sometimes involves the hair (tinea barbae, tinea capillitii) and occasionally causes chronic follicular trichophytosis in the lower legs of women, and also other folliculitis. Very rarely it produces tinea similar to other skin diseases (lupus erythematosus) [ l , 2, 51. Materials and methods The Mycological Laboratory of Venereal and Skin Diseases Hospital in Thessaloniki examined 17,073 patients between 1981 and 1990. Clinical material was used for direct examination with the use of 30% potassium hydroxide solution. The specimens were also inoculated in Sabouraud (Sb) 2% glucose chloramphenicol agar and Sb 2% glucose cycloheximide chloramphenicol agar. Sometimes the following special media were also used: Sb 4% glucose agar, malt

376

D. DEVLIOTOU-PANAGIOTIDOIJ ET AL.

agar, Lactrimel medium and potato glucose agar (PDA).

Results From 1981 to 1990, 6525 dermatophytic strains were isolated. The most frequent one was 7. rubrum. It was isolated 4093 times at a percentage of 62.7%, 2112 strains in men and 1981 strains in women. The age of the majority of our patients, referring to both sexes, was 36-68 years old. A group of 29 children was analysed separately. There were 455 ( 1 1.1 yo)direct examinations that were termed negative, while the corresponding cultures were all positive for 1.rubrum. This usually happened when the specimens were obtained from the toewebs and toenails. Figure 1 presents the annual variations of Percentage (%) 57.4

58.5

58.7

64.4

62.0

isolations of 1. rubrum and the other dermatophytes. Every year during the decade T. rubrum was the most frequent isolation, especially after 1984. The ratio between male and female patients was approximately 1 : 1 (1965 men, 1834 women). In children ( < 14 years old) 1. rubrum was isolated only 29 times (16 boys and 13 girls). Table 1 presents the number and percentage of T.rubrum isolated, classified according to sex and part of body. In this study the feet were the most frequent location, especially in women (men 31.35%, women 40.5%). T.rubrum was isolated more often in the groins in men than in women (men 30.2y0, women 10.9%). The location in trunk, arms, upper legs and neck, as well as the fingernails, showed no significant differences between the sexes. Women also showed more infections in the toenails area (men 13.6y0, women 19.6%) and 60.1

62.9

I

60.0

65.5

69.1

n n

IYear

1981

1982

n

1983

1984

1985

1987

1986

1988

1909

I

I

Figure 1. Number and percentage of 7.rubrum and other dermatophytesisolated in Northern Greece, 1981-1990.

Table 1. Number and percentage of 7.rubrum isolated, classified according to sex and body location (1981-1990) ~

Location

Males

Females

n

YO ~

scalp face trunk, arms, upper legs, neck groin hands feet lower legs D. Wilson fingernails toenails Total

32 33 1 638 66 660 16 (1) 81 288 21 12

n ~______

~

0 1.5 15.7 30.2 3.1 31.3 0.8 3.8 13.6 100

2* 4 348 217 34 802 115 (53) 71 388 1981

Total

n

YO

~~~

~~

YO ~

0.1 0.2 17.6 10.9 1.7 40.5 5.8

2 36 679 855 100 1462 131