1
MYCOSES 34,
273-276 (1991)
ACCEPTED: DECEMBER 13, 1990
Tinea pedis in children
Tinea pedis bei Kindern L. Terragni, I. Buzzetti, A. Lasagni and A. Oriani Key words. Dermatophytes, tinea pedis, pediatric tinea. Schliisselworter. Dermatophyten, Tinea pedis, Tinea bei Kindern.
Summary. Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent. Zusammenfassung. Tinea pedis ist eine bei Kindern ungewohnliche oberflachliche Mykose. Es werden epidemiologische und klinische Daten aus einer 20jahrigen Beobachtungszeit uber Tinea pedis bei Kindern vorgestellt mit Erklarungsversuchen fur die Bedingungen, unter welchen Kinder f i r diese Infektion pradisponiert sind. Die klinischen Bilder variieren und ahneln denen bei Erwachsenen. GroRblasige Lasionen werden bei Kindern haufiger gesehen. Die meisten Falle wurden bei uber lojahrigen Kindern erfaBt. Jungen sind ofter betroffen, vor allem in der Gruppe der 10- bis 13jahrigen. Wie bei Erwachsenen ist Trichophyton rubrum das am haufigsten isolierte atiologische Agens.
First Institute of Dermatology and Pediatric Dermatology of the University of Milan, Italy. Correspondence: Dr Luigi Terragni, Clinica Dermatologica I, via Pace 9, 1-20122 Milano, Italy.
Introduction
Fungal infection of the feet is an important diagnostic problem in the pediatrics. Erythema, scaling and vescicles are the clinical features most frequently seen and are often diagnosed as atopic dermatitis, allergic contact dermatitis, dyshidrosis, “peridigital dermatitis in children”. Only rarely a diagnosis of tinea pedis is made. There are many studies in the literature about the etiology, epidemiology, clinical features and therapy of tinea pedis in adults, but few about this dermatomycosis in children. It is a common opinion that the condition in children is exceptional [l-51. Previous studies have evaluated the occurrence of tinea pedis in children [6-lo]. English & Gibson [7] . found that 8.2% of 3900 children aged 11 to 14 years and 2.2% of 894 children aged 7 to 10 years attending three schools in Bristol, UK, had positive dermatophyte cultures. Trichophyton mentagrophytes was the predominant species while Trichophyton ru brum and Epidermophyton floccosum were isolated only rarely. Marples & Chapman [lo] found that 5.9 % of 387 New Zealand schoolchildren between the age of 11 and 14 years had positive dermatophyte cultures. Trichophyton mentagrophytes was isolated in most of the cases; Trichophyton rubrum was not recovered. Ganor et al. [8] found that only 2.7 % of 218 Jerusalem schoolchildren aged 10 to 14 years had positive cultures. Caravati et a]. [6] reported six cases of tinea pedis in children: Trichophyton rubrum was isolated in the 4 patients in whom cultures had been made. Kearse et al. [9] observed 15 children aged 2 to 13 years with foot dermatitis; 8 had positive evidence of dermatophyte infections of the feet on culture; Trichophyton rubrum was isolated in 5 cases and Trichophyton mentagrophytes in 3 patients. A survey was carried out by Ogbonna et al. [ 111 on the distri-
274
L. TERRAGNI ET AL.
bu tion of ringworm infections among schoolchildren in four primary schools in Jos, Nigeria. Out of a total of 6 987 patients, 237 (3.4%) were found to be infected with dermatomycoses. There was a high incidence of tinea pedis among the infected children (32.8%). The present investigation was made to study the frequency, epidemiology, clinical aspects and the diagnosis of tinea pedis in children and to evaluate whether this disease really has to be considered in daily dermatological practice, and, furthermore, to detect possible differences with the classical features seen in the adult.
Material and methods All cases of tinea pedis in young patients under 14 years of age seen in the Mycology Department of the Dermatological Clinic of the University of Milan from 1970 to 1989 were included in this study. The cases were diagnosed on the basis of clinical criteria and confirmed by mycological tests consisting in: (1) Microscopic examination of skin scrapings taken from the lesions and clarified with 30% potassium hydroxide;
(2) cultural studies: the skin scales were inoculated in Sabouraud glucose agar supplemented with penicillin, actidione, streptomycin, and then incubated at 25 "C for 8-10 days. We also examined all cases of mycologically confirmed tinea pedis occurring in adults in the same period of time.
Results During the period of 1970 to 1989 we found 80 cases of tinea pedis in children (Table 1) compared with 2 538 cases in adults: thus, children represented 3.1% of all cases. The age of the young patients ranged between 3 and 13 years: 46 patients were boys (57.5%) and 34 were girls (42.5%). Figure 1 demonstrates the distribution of the patients according to age and sex. Table 1. Cases of tinea pedis in children
%
Cases
46 34 80
Boys Girls Total
57.5 42.5 100.0
16
MYCOSES 34,
273-276 (1991)
ACCEPTED: DECEMBER 13, 1990
Tinea pedis in children
Tinea pedis bei Kindern L. Terragni, I. Buzzetti, A. Lasagni and A. Oriani Key words. Dermatophytes, tinea pedis, pediatric tinea. Schliisselworter. Dermatophyten, Tinea pedis, Tinea bei Kindern.
Summary. Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent. Zusammenfassung. Tinea pedis ist eine bei Kindern ungewohnliche oberflachliche Mykose. Es werden epidemiologische und klinische Daten aus einer 20jahrigen Beobachtungszeit uber Tinea pedis bei Kindern vorgestellt mit Erklarungsversuchen fur die Bedingungen, unter welchen Kinder f i r diese Infektion pradisponiert sind. Die klinischen Bilder variieren und ahneln denen bei Erwachsenen. GroRblasige Lasionen werden bei Kindern haufiger gesehen. Die meisten Falle wurden bei uber lojahrigen Kindern erfaBt. Jungen sind ofter betroffen, vor allem in der Gruppe der 10- bis 13jahrigen. Wie bei Erwachsenen ist Trichophyton rubrum das am haufigsten isolierte atiologische Agens.
First Institute of Dermatology and Pediatric Dermatology of the University of Milan, Italy. Correspondence: Dr Luigi Terragni, Clinica Dermatologica I, via Pace 9, 1-20122 Milano, Italy.
Introduction
Fungal infection of the feet is an important diagnostic problem in the pediatrics. Erythema, scaling and vescicles are the clinical features most frequently seen and are often diagnosed as atopic dermatitis, allergic contact dermatitis, dyshidrosis, “peridigital dermatitis in children”. Only rarely a diagnosis of tinea pedis is made. There are many studies in the literature about the etiology, epidemiology, clinical features and therapy of tinea pedis in adults, but few about this dermatomycosis in children. It is a common opinion that the condition in children is exceptional [l-51. Previous studies have evaluated the occurrence of tinea pedis in children [6-lo]. English & Gibson [7] . found that 8.2% of 3900 children aged 11 to 14 years and 2.2% of 894 children aged 7 to 10 years attending three schools in Bristol, UK, had positive dermatophyte cultures. Trichophyton mentagrophytes was the predominant species while Trichophyton ru brum and Epidermophyton floccosum were isolated only rarely. Marples & Chapman [lo] found that 5.9 % of 387 New Zealand schoolchildren between the age of 11 and 14 years had positive dermatophyte cultures. Trichophyton mentagrophytes was isolated in most of the cases; Trichophyton rubrum was not recovered. Ganor et al. [8] found that only 2.7 % of 218 Jerusalem schoolchildren aged 10 to 14 years had positive cultures. Caravati et a]. [6] reported six cases of tinea pedis in children: Trichophyton rubrum was isolated in the 4 patients in whom cultures had been made. Kearse et al. [9] observed 15 children aged 2 to 13 years with foot dermatitis; 8 had positive evidence of dermatophyte infections of the feet on culture; Trichophyton rubrum was isolated in 5 cases and Trichophyton mentagrophytes in 3 patients. A survey was carried out by Ogbonna et al. [ 111 on the distri-
274
L. TERRAGNI ET AL.
bu tion of ringworm infections among schoolchildren in four primary schools in Jos, Nigeria. Out of a total of 6 987 patients, 237 (3.4%) were found to be infected with dermatomycoses. There was a high incidence of tinea pedis among the infected children (32.8%). The present investigation was made to study the frequency, epidemiology, clinical aspects and the diagnosis of tinea pedis in children and to evaluate whether this disease really has to be considered in daily dermatological practice, and, furthermore, to detect possible differences with the classical features seen in the adult.
Material and methods All cases of tinea pedis in young patients under 14 years of age seen in the Mycology Department of the Dermatological Clinic of the University of Milan from 1970 to 1989 were included in this study. The cases were diagnosed on the basis of clinical criteria and confirmed by mycological tests consisting in: (1) Microscopic examination of skin scrapings taken from the lesions and clarified with 30% potassium hydroxide;
(2) cultural studies: the skin scales were inoculated in Sabouraud glucose agar supplemented with penicillin, actidione, streptomycin, and then incubated at 25 "C for 8-10 days. We also examined all cases of mycologically confirmed tinea pedis occurring in adults in the same period of time.
Results During the period of 1970 to 1989 we found 80 cases of tinea pedis in children (Table 1) compared with 2 538 cases in adults: thus, children represented 3.1% of all cases. The age of the young patients ranged between 3 and 13 years: 46 patients were boys (57.5%) and 34 were girls (42.5%). Figure 1 demonstrates the distribution of the patients according to age and sex. Table 1. Cases of tinea pedis in children
%
Cases
46 34 80
Boys Girls Total
57.5 42.5 100.0
16
