Organ
of the
GD — Society for Dermopharmacy
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Issue 3 (2001) |
Current Affairs of Dermopharmacy
Medical Routine in all special Fields
Increasing Incidence of Mycoses
Mycotic infections of the skin and also the internal organs have increased in frequency in the last 20 years. The circumstances in life of people (for example frequent swimming or visits at the sauna) contribute to this phenomenon just like the achievements of modern medicine (for example chemotherapy, intensive medicine or transplant medicine). Good diagnostic methods of the identification of the cause and the advances in the development of new antimycotics allow, however, in many cases an early, specific and in the end successful treatment.
An important forum for the interdisciplinary knowledge transfer in mycology is the annual scientific conference of the Deutschsprachige Mykologische Gesellschaft (DMykG) (German-language Mycological Society). The DMykG is engaged in the exploration of the fungus-dependent illnesses since its foundation in 1961. Until today, they have collected plenty of findings and ensured a corresponding spread in the profession. Since short they can also be reached under www.dmykg.de in the Internet. The 35th Annual Meeting of the DMykG took place from 13 to 15 September 2001 in Marburg. President and head of the conference were professor Dr. med. Rudolf Happle and professor Dr. med. Isaak Effendy, two dermatologists, who had both already given lectures at annual meetings of the Gesellschaft für Dermopharmazie.
Dermatomycoses a
wide-spread disease
According to latest findings approximately 30 percent of the population is affected by fungal infections of the skin and integumentary appendage (finger and footnails). However, the therapeutic possibilities, especially relating to the treatment of the onychomycosis, are not yet satisfactory despite essential progress achieved in the last decade. In most cases considerable perseverance is required in order to treat a fungus infection at the nail successfully. The most effective is a systemical therapy over a period of several months, reported the president of the DMykG, professor Dr. med. Hans Christian Korting from the Dermatologische Klinik und Poliklinik of the Ludwig-Maximilians-Universität, Munich (Dermatological Clinic and Outpatient Clinic) at a press conference on the occasion of this event.
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A swifter healing of the onychomycoses can be partially recorded, if the infected nail material is removed by means of Erbium-YAG-Laser before the systemic therapy, Dr. med. Volker Kunzelmann explained, practising dermatologist from Dessau. It is true that the therapy is a service the patient has to bear himself, however, this is a fact which is in general accepted and entails a surprisingly good compliance. Possibly, this therapeutic way of proceedings gives rise to an increased interest by the dermatologist concerning the treatment of the onychomycosis.
Tinea corporis and Tinea incognita
It is quite possible that an onychomycosis may be the starting point for a Tinea corporis, as professor Dr. med. Gabriele Ginter-Hanselmayer of the University Clinic for Dermatology and Venerology of Graz explained. The causative agent Trichophyton rubrum causes a discreet extensive scale formation with not rarely blunt limitation accompanied by varying severe itching. At times, according to Ginter-Hanselmayer the aetiology of these 'Rubrophytoses' is unrecognized and incorrectly treated with topical glucocorticoids. This leads in a classical case to a Tinea incognita sometimes lasting for years.
Increase of zoophilic mycoses
Professor Dr. med. Heidelore Hofmann from the Klinik für Dermatologie und Allergologie of the Technische Universität München (Clinic for Dermatology and Venerology of the Technical University Munich) reported about a significant rise in zoophilic mycoses. Above all it has to be paid attention to the spread of the Microsporum canis, a causative agent which, owing to the marked fondness of the population for travelling, has been brought from Southern Europe to Germany. It is responsible for the Tinea capitis mostly occurring with children and transmitted by cats which are caressed during holidays. Meanwhile, however, also native small domestic animals are attacked, and so it is absolutely possible that an expensive pedigree cat causes the illness of a whole family. After cultural cause proof, a systemic therapy is principally advisable also with children (for dosage recommendations refer to boxes). In coordination with a veterinarian it is absolutely necessary that the striked pet is to be treated as well.
| Dosage recommendations for
the treatment of zoophilic mycoses |
|
| Griseofulvin: | |
| 10 - 25 mg/kg body weight/day (over the period of 8 - 12 weeks) |
|
| Terbinafin: | |
|
< 20 kg of body weight: 62,5 mg/day |
|
| 20 – 40 kg: >40 kg: |
125 mg/day 250 mg/day |
| (in each case over the period of 2 - 4 weeks)
|
|
| Itraconazole: | |
| 5 mg/kg body weight or 100 mg/day (in each case over the period of 4 weeks) |
|
| Fluconazole: | |
| 3 - 5 mg/kg body weight/day (over the period of 4 weeks) |
|
Hidden genital mycoses
Only seldom noticed and reluctantly mentioned are fungal infections in the genital area. As is known they become noticeable by itching and reddening. Due to the fact that they cannot always be unequivocally distinguished from other inflammable diseases, an exact causative agent-oriented examination by the specialist is necessary. Only in this case, as professor Dr. med. Walter Krause of the Zentrum für Hautkrankheiten der Philipps-Universität Marburg (Center for Skin Diseases) expounded, a successful treatment can be realized.
With acute vaginal mycoses a single dose of a systemical azolantimycotic is sufficient. With relapsing vulvovaginalmycoses a more comprehensive therapeutical treatment, at a higher dosage and a prolonged therapy as well as above all a more exact diagnosis are necessary. As the gynecologist professor Dr. med. Werner Mendling of the Krankenhaus am Urban, Berlin (Hospital at the Urban) stressed, a chronical relapsing vaginal mycoses is more frequently related to a Candida glabrata than a Candida albicans, but only rarely to a Candida krusei. This distinction is important for the selection of the antimycotic and the duration of the therapy. The often posed question relating to the necessity of a co-treatment of the partner has been answered by Mendling in a way that according to the corresponding diagnostics only a systemical therapy is reasonable. Investigations have shown that fungi can be found much more often in the sperm than in the exterior penis skin, from where they can lead to a steady reinfection.
Fungi: allergenic and
cancerogenic
The fact that equally fungi from the environment and food may represent a thread, offered professor Dr. Herbert Hof of the Institut für Medizinische Mikrobiologie (Institute for Medicinal Microbiology) of the University Mannheim/Heidelberg for consideration. The microbiologist emphasized that not only pollen but also fungus spores can be responsible for allergic reactions.
Besides mould in building walls, the allergens of which are picked up by inhalation, allergies could also start out from fungi contained in nearly all fruit juices. The fungi get into the fruit juices above all through the processing of fungus-attacked fruit. It can be proceeded from the assumption that most fungi maintain during the juice production. Thus the contaminated juices enter the human body by food intake. The same applies to the consumption of cutlets and chicken fillets, which can contain toxins from spoilt animal food. The general problem lies here in the fact that the consumer in general is not able to notice this form of allergen supply. Usually he only becomes aware of this problem when the allergic symptoms appear.
Some mycotoxins as for example contained in pistachios from the Iran or only recently in a cheap red wine from the South of Italy are even considered as being cancerogenic. The nonrecurring intake of this fungal poisons in small quantities is not dangerous in every case but a repeated intake can reach pathogenic concentrations and correspondingly consecutive reactions can be produced (ghw).
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