Mycoses and diabetes

Czech version

Authors: M. Skořepová
Authors‘ workplace: Centrum pro dermatomykózy Kožní kliniky 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Jiří Štork, CSc.
Published in: Vnitř Lék 2006; 52(5): 470-473
Category: Diabetes and other subjects (infection, dermatovenerology and rheumatology) Hradec Králové 3 to 4 June 2005

Overview

Generally, diabetic patients are more susceptible to skin infections. Although the overall incidence of skin mycoses in diabetics is not higher as compared with healthy population, diabetics seem to suffer from certain types of mycoses more frequently. They are not only tinea pedum and onychomycosis, but also candidoses (especially candidal balanitis). In older patients, sole tinea is often overlooked. Nevertheless, it impairs integrity of skin and lets in bacterial infections causing diabetic foot and aggravates nail infections. Onychomycosis in diabetics is far from being a cosmetic problem only. On the contrary, it is potentially a very dangerous disease. Hypertrophic and deformed nails damage adjacent skin and their pressure can result in decubital ulceration of neighbouring fingers or nail beds. This condition can even lead to finger gangrene. Therapy of onychomycosis in diabetics and seniors should be specific: the most effective therapeutic procedure proved to be the combination of systemic treatment with terbinafine and atraumatic chemical ablation with subsequent local treatment.

Key words:
diabetes mellitus - tinea pedum - onychomycosis

Sources

1. Tan JS, Joseph WS. Common fungal infections of the feet in patients with diabetes mellitus. Drugs Aging 2004; 21: 101-112.

2. Mayser P, Hensel J, Thoma W et al. Prevalence of fungal foot infections in patients with diabetes mellitus type 1 – underestimation of mocassin-type tinea. Exp Clin Endocrinol Diabetes 2004; 112: 264-268.

3. Kadir T, Pisiriciler R, Akyuz S et al. Mycological and cytological examination of oral candidal carriage in diabetic patients and non-diabetic control subjects: thorough analysis of local aetiologic and systemic factors. J Oral Rehabil 2002; 29: 452-457.

4. Nowakowska D, Kurnatowska A, Stray-Pedersen B et al. Species distribution and influence of glycemic control on fungal infections in pregnant women with diabetes. J Infect 2004; 48: 339-346.

5. Vitkov L, Weitgasser R, Hannig M et al. Candida-induced stomatopyrosis and its relation to diabetes mellitus. J Oral Pathol Med 2003; 32: 46-50.

6. Tosti A, Pirracini B M, Lorenzi S Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000; 42: 217-224.

7. Iverson SL, Utrecht JP Identification of a reactive metabolite of terbinafine: insights into terbinafine-induced hepatotoxicity. Chem Res Toxicol 2001; 14: 175-181.

8. Bradbury BD, Jick SS Itraconazole and fluconazole and certain rare, serious adverse events. Pharmacotherapy 2002; 22: 697-700.

9. Bond GR, Hite LK Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Acad Emerg Med 1999; 6: 1115-1120.

10. Perez-Guthahn S, Garcia-Rodriguez LA, Duque-Oliart A et al. Low-dose diclofenac, naproxen and ibuprofen cohort study. Pharmacotherapy 1999; 19: 854-859.

11. Grover C, Reddy BS, Chaturvedi KU. Onychomycosis and the diagnostic significance of nail biopsy. J Dermatol 2003; 30: 116-122.

12. Vosmík F, Skořepová M. Dermatomykózy. Praha: Galén 1995.

13. Stary A, Soeltz-Szoetz J, Ziegler C et al. Comparison of the efficacy and safety of oral fluconazole and topical clotrimazole in patients with candida balanitis. Genitourin Med 1996; 72: 98-102.