Ultrastructural Alterations in the Epidermis of Patients with Tinea Pedis

Abstract

Objective: Tinea pedis is the most common superficial fungal infection of the foot. Although light microscopic characteristics of tinea pedis have already been described and are well known, electron microscopic data is still lacking. In this study, we aimed to examine the ultrastructural changes in the epidermis of patients diagnosed with tinea pedis. Material and Methods: Biopsies were taken from the lesions between the toes of patients with untreated tinea pedis and from healthy volunteers with no fungal infections. The materials obtained were prepared for electron microscopy and examined by transmission electron microscope. Results: The ultrastructural examination revealed the following changes: (1) Disturbances in the form and organization of keratinocytes; (2) Irregular distribution and interlacing of tonofilament bundles in keratinocytes; (3) Disruption of desmosomes and detachment of adjoining keratinocytes; (4) Excessive widening of intercellular spaces between keratinocytes; (5) Dilatation of intercellular spaces between basal cells; (6) Degranulation of melanocytes in the stratum basale; (7) Migration of lymphocytes and polymorphonuclear leukocytes between keratinocytes in the stratum spinosum; (8) Degradation of basal lamina; (9) Pericapillary edema in the apillary dermis. Conclusion: The ultrastructural findings in tinea pedis are described and related to the clinical symptoms and histopathologic features of the disease.

Keywords

• Tinea pedis, transmission electron microscopy, epidermis, keratinocyte

Ultrastructural Alterations in the Epidermis of Patients with Tinea Pedis

Öz

Kaynakça

1. Das S, Goyal R, Bhattacharya SN. Laboratory-based epide- miological study of superŞ cial fungal infections. J Dermatol 2007;34:248-53. [CrossRef]
2. Hapcioglu B, Yegenoglu Y, Disci R, Erturan Z, Kaymakcalan H. Epidemiology of superŞ cial mycosis (tinea pedis, onychomycosis) in elementary school children in Istanbul, Turkey. Coll Antropol 2006;30:119-24.
3. Raboobee N, Aboobaker J, Peer AK. Tinea pedis et unguium in the Muslim community of Durban, South Africa. Int J Dermatol 1998;37:759-65. [CrossRef]
4. Aste N, Pau M, Aste N, Biggio P. Tinea pedis observed in Ca- gliary, Italy, between 1996 and 2000. Mycoses 2003;46:38-41. [CrossRef]
5. Gupta AK, Ryder JE, Chow M, Cooper EA. Dermatophytosis: the management of fungal infections. Skinmed 2005;4:305-10.
6. Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev 1995;8:240-59.
7. Wagner DK, Sohnle PG. Cutaneous defenses against dermato- phytes and yeasts. Clin Microbiol Rev 1995;8:317-35.
8. Wu H, Schapiro B, Harrist TJ. Noninfectious vesiculobullous and vesiculopustular diseases. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, editors. Lever’s Histopathology of the skin. 9th ed. Philadelphia: JB Lippincott; 2005;244-6.

9. Leyden JL. Tinea pedis pathophysiology and treatment. J Am Acad Dermotol 1994;31:31-3. [CrossRef]
10. Watanabe S, Takahashi H, Nishikawa T, et al. Dose-Ş nding com- parative study of 2 weeks of luliconazole cream treatment for tinea pedis-comparison between three groups (1%, 0.5%, 0.1%) by a multi-center randomised double-blind study. Mycoses 2007;50:35-40. [CrossRef]
11. Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G. Der- matology for the practicing allergist: Tinea pedis and its compli- cations. Clin Mol Allergy 2004;2:5. [CrossRef]
12. Woodfolk JA. Allergy and dermatophytes. Clin Microbiol Rev 2005;18:30-43. [CrossRef]
13. Roujeau JC, Sigurgeirsson B, Korting HC, Kerl H, Paul C. Chronic dermatomycoses of the foot as risk factors for acute bacterial cellulitis of the leg: a case-control study. Dermatology 2004;209:301-7. [CrossRef]
14. Roldan YB, Mata-Essayag S, Hartung C. Erysipelas and tinea pe- dis. Mycoses 2000;43:181-3. [CrossRef]
15. Lacroix C, Baspeyras M, de La Salmonière P, Benderdouche M, Coup- rie B, Accoceberry I, et al. Tinea pedis in European marathon runners. J Eur Acad Dermatol Venereol 2002;16:139-42. [CrossRef]
16. Kaufman G, Horwitz BA, Duek L, Ullman Y, Berdicevsky I. Infection stages of the dermatophyte pathogen Trichophyton:microscopic characterization and proteolytic enzymes. Med Mycol 2007;45:149-55. [CrossRef]
17. Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi, trichophyton quinckea- num and trichophyton rubrum. Immunology 1987;61:289-95.
18. Merlin K, Kilkenny M, Plunkett A, Marks R. The prevalence of common skin conditions in Australian school students: 4 Tinea pedis. Br J Dermatol 1999;140:897-901. [CrossRef]
19. Tatman-Otkun M, Gürcan Ş, Özer B, Ertem A, Şakru N, Otkun M. The prevalence of pediculus humanus capitis and tinea capitis among elementary school students in Edirne. Trakya Üniv Tıp Fak Derg 2005;22:82-7. [CrossRef]
20. Kamihama T, Kimura T, Hosokawa JI, Ueji M, Takase T, Tagami K. Tinea pedis outbreak in swimming pools in Japan. Public Health 1997;111:249-53. [CrossRef]
21. Cohen AD, Wolak A, Alkan M, Shalev R, Vardy DA. Prevalence and risk factors for tinea pedis in Israeli soldiers. Int J Dermatol 2005;44:1002-5. [CrossRef]
22. Djeridane A, Djeridane Y, Ammar-Khodja A. A clinicomycological study of fungal foot infections among Algerian military person- nel. Clin Exp Dermatol 2007;32:60-3.
23. Tagami H, Kudoh K, Takematsu H. Infl ammation and immunity in dermatophytosis. Dermatologica 1989;179:1-8. [CrossRef]
24. Davies RR, Zaini F. Trichophyton rubrum and the chemotaxis of poly- morphonuclear leucocytes. Sabouraudia 1984;22:65-71. [CrossRef]
25. Tidman MJ, Eady RA. Ultrastructural morphometry of normal hu- man dermal-epidermal junction. The infl uence of age, sex, and body region on laminar and nonlaminar components. J Invest Dermatol 1984;83:448-53. [CrossRef]
26. Madison KC. Barrier function of the skin: “la raison d’etre” of the epidermis. J Invest Dermatol 2003;121:231-41. [CrossRef]
27. Behne M, Uchida Y, Seki T, Montellano PO, Elias PM, Holleran WM. Omega-Hydroxyceramides are required for corneocyte lip- id envelope (CLE) formation and normal epidermal permeability barrier function. J Invest Dermatol 2000;114:185-92. [CrossRef]
28. Ghadially R, Brown BE, Sequeira-Martin SM, Feingold KR, Elias PM. The aged epidermal permeability barrier. Structural, func- tional, and lipid biochemical abnormalities in humans and a se- nescent murine model. J Clin Invest 1995;95:2281-90. [CrossRef]
29. Rassner U, Feingold KR, Crumrine DA, Elias PM. Coordinate as- sembly of lipids and enzyme proteins into epidermal lamellar bodies. Tissue Cell 1999;31:489-98. [CrossRef]