Dermatophytes : Identifying prevention techniques and treatments for fungal skin infections

1. Dermatophytes: Identifying prevention techniques and treatments for fungal skin infections Aaron Mills Bio 594-Mycology November 25, 2013 6:30 p.m.

2. Agenda • Why we should be concerned • Simple prevention techniques • Advanced prevention techniques • Treatments • Potential for future research

3. Why should we care? • Out of sight out of mind….Right? • Can be debilitating • Widespread globally and economically significant • Treatments are expensive!

4. Prevention the Simple way • The best defense is offense. • Simple prevention methods • Keep skin as clean and dry as possible • Thoroughly wash hair and body with shampoo • and soap • Keep toe and finger nails short • Change your underwear and socks! • Wear loose fitting clothing • The types of socks worn is important

5. More Simple Prevention • Be smart about footwear choices • Rotate shoes • Apply anti-fungal powders as precautions • No sharing • Sandals in communal areas Boiling water is the most effective method for prevention

6. Advanced Prevention Methods • Heavy Metals • Can be used at low concentrations (makes them safe) • Inactivate intercellular proteins • Silver is primary metal • Also use copper, zinc, and cobalt

7. The Silver Ion Laundry Machine • Lowered fungal loads by 4 log10 CFU ml-1 with and without detergent • Spin cycle important step With Detergent Without Detergent Jung et. al 2007

8. Copper Lined Socks • Used to reduce fungal loads in patients • Potential preventative use • Moisture activated Gargiulo et al. 2012

9. Antimicrobial Clothing • Two types of agents • -static • –cidal • Antimicrobial clothing is a biocide • QAC- Quanternary ammonium compounds • PHMB- Polyhexamethylene Biguanides QAC PHMB

10. Antimicrobial Clothing • Effectiveness • Clothing that these compounds are added to include: sportswear, socks, shoe liners, and lingerie • Concerns with antimicrobial fabric Hammer et al. 2012

11. Ozone Gas • Two Treatment types: • Passive treatment • Effectiveness issues • Direct treatment with drying heat • Most effective treatment Gupta and Brintnell 2013

12. Ozone Gas • Potential heat resistance issue with with direct treatment • Issues with current technology

13. Treatments • Treatment for existing infections involve applications of various antifungal creams and powders. • Tolnaftate, Clotrimazole, and Miconazole are some common active ingredients • Oral prescriptions can be given in severe cases • Effectiveness depends on the PATIENT • Precautions for people with infections • Cover infected areas • Change bed clothing and linens frequently • Dry infected area last

14. The Future • Need to increase public awareness and sense of importance • Research to improve and refine preventative measures

15. Summary • Dermatophytes are a common yet under appreciated fungal infection among the global populations • Simple preventative measures can help prevent infection and spread • Personal hygiene, drying shoes, changing socks, etc. • Advance prevention methods such as heavy metal treatments, antimicrobial clothing, and Ozone gas treatments are available • General treatments are in cream or powder forms with oral medication for severe cases • Future studies and research should focus on access and affordability of advanced treatments and increasing public awareness

16. References • Achterman, R.R. & White, T.C. (2012). A foot in the door for dermatophyte research. PLOS pathogens, 8(3), 1-4. Retrieved from EBSCOhost Academic Search Complete database. • Field, L.A. & Adams, B.B. (2008). Tinea pedis in athletes. International Journal of Dermatology, 47, 485-492. Retrieved from EBSCOhost Academic Search Complete database. • Gao, Y. & Cranston, R. (2008). Recent advances in antimicrobial treatments of textiles. Textile Research Journal, 78(1), 60-72. doi:10.1177/0040417507082332 • Gargiulo, M.E., del Camen Elías, A. & Borkow, G. (2012). Analysis of the effect of wearing copper oxide impregnated socks on inea pedis base on “before and after” pictures- a statistical follow-up tool. The Open Biology Journal, 5, 17-22. . Retrieved from EBSCOhost Academic Search Complete database. • Gupta, A.K. & Brintnell, W.C. (2013). Sanitizaiton of contaminated footwear from onychomycosis patients using ozone gas: a novel adjunct therapy for treating onychomycosis and tinea pedis?. Journal of Cutaneous Medicine and Surgery, 17(4), 243-249. Retrieved from EBSCOhose Academic Search Complete database. • Hammer, T.R., Mucha, M. & Hoefer D. (2012). Dermatophyte susceptibility varies towards antimicrobial textiles. Mycoses, 55, 344- 351. doi: 10.1111/j.1439-0507.2011.02121.x • Jang, K.A., Chi, D.H., Choi, J.H., Sung, K.J., Moon, K.C. & Koh, J.K. (2000). Tinea pedis in Korean children. International Journal of Dermatology, 39, 25-27. Retrieved from EBSCOhost Academic Search Complete database. •  Jung, W.K, Kim, S.H, Koo, H.C., Shin, S., Kim, J.M., Park, Y.K., …, & Park, Y.H. (2007). Antifungal activity of the silver ion against contaminated fabric. Mycoses, 50, 265-269. doi: 10.1111/j.1439-0507.2007.01372.x • Masri-Findling, G.D. (1996). Dermatophytosis of the feet. Cutaneous Mycology, 14(1),33- 40. Retrieved from EBSCOhost Academic Search Complete database. • Neji, S., Makni, F., Cheikhrouhou, F., Sellami, A., Sellami, H., Marreckchi, S., …, & Ayadi, A. (2008). Epidemiology of dermatophytoses in Sfax, Tunisia. Mycoses, 52, 534-538. doi: 10.1111/j.1439-0507.2008.01651.x • Sahin, I., Kaya, D., Parlak, A.H., Oksuz, S. & Behcet, M. (2005). Dermatphytoses in forestry workers and farmers. Mycoses, 48, 260-264. Retrieved from EBSCOhost Academic Search Complete database. • Tostil, A., Hay, R. & Arenas-Guzmán, R. (2005). Patients at risk of onchomycosis- risk factor identification and active prevention. Journal of European Academy of Dermatology and Venereology, 19, 13-16. doi: 10.1111/j.1468-3083.2005.01282.x