The Case Analysis And Laboratory Study Of The Two Foot-one Hand Dermatophytosis

Tinea manus and tinea pedis are common chronic fungal infections.There are numerous factors that predispose to these kinds of diseases,not only environmental influence but also genetic suscepbility.As a peculiar phenomenon,"the two foot-one hand syndrome" interests many dermatologists and mycology specialists,which involves dermatophyte infections of both feet and only one hand.Although these patients are not uncommon,to our knowledge,there are limited investigations studying the "syndrome".To gain insight into this disease,we perfonned a cross-sectional study including 182 patients seen in our hospital,the Dermatology Hospital of Chinese Academy of Medical Science and the Dermatology Hospital of Jiangxi Provience over a year.By analyzing the cases,we intended to profile the epedernilogical and clinical characteristics,the pathogens distribution and the genotypes of the dominant pathogenic species trichophyton rubrum,and then to explore why only one palm was involved.The article consists of two parts as follows:Part one study on the epidemicological and clinical charecteristics of the two foot-one hand dermatophytosisObjective To explore the epidemicology,the clinical charecteristics and pathogens of the two foot-one hand dermatophytosis.Methods Patients who developed dermatophytosis of both feet and unilateral hand were recruited for the case group.And patients with dermatophytosis of only tinea pedis were recruited for the first control group,then patients suffered bilateral tinea pedis with bilateral tinea mannum were recruited for the second control group.The epidemiological conditions,clinical history were recorded,and the causative agents were identified by potassium hydroxide examination and culture isolation. Data were analyzed by spss(the Statistical Package for the Social Sciences) 13.0.Results(1) A total of 113 cases,44 first controls and 25 second controls were obtained.(2)There were more male(61.1%) than female with the two foot-one hand dermatophytosis. Most people(80.5%) developed tinea pedis approximately six years(6.2±5.9 years) earlier than the hand infected.The infection generally fell with dry,hyperkeratotic scale(tinea manuum 85.0%and tinea pedis 64.6%).The trichophyton rubrum was predominant pathogen(95.1%).There was significant relationship between the hand with tinea mannum and the hand used to scratch the feet(x~2=41.70,P＜0.001) and the scratching habit was statistical difference between the groups with hands infected and the group without hand infected.Conclusions The two foot-one trichophytosis maybe is just a stage when tinea pedis develop to the hand, which is a special phenomemon of tinea mannum and tinea pedis.The contact between hand and feet probably results in the transmission of the dermatophytosis from the feet to the hands.Part two Genotyping of the predominant pathogens Trichophyton rubrum of the two foot-one hand dermatophytosisObjective To genotype the predominant species trichophyton rubrum and presume the route of transmission by the genotypes of the strains isolated on different locations of one person.Methods A total of 268 trichophyton rubrum islolates were genotyped by PCR amplification of tandermly repetive elements(TRSs),TRS-1 and TRS-2,from the ribosomal DNA nontranscribed spacer region(NTS).Result In 63 cases who had positive strains from both feet and hand,80%cases had the same genotypes. Considering the previous results of Part one in this article,we concluded that the strains from the hand involved come from the feet in the two foot-one hand dermatophytosis patients.Conclusion The two foot-one dermatophytosis is just a stage when tinea pedis develops to the hand,which is a special phenomemon of tinea mannum and tinea pedis.The disease can develop into two foot-two hand trychophytosis,too. The analysis of PCR amplification of the NTS tandem repeated elements(TRSs) is a simple,quick,and valuable tool for differentiating T.rubrum strains.