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Background Painful feet and lower limb dysfunction are risk factors for falling. Toenail deformities are common disorders in elderly people, but the relationship between nail deformities and lower limb function remains unclear. The aims of the present study were to assess the impairment of lower limb function in patients with deformities of the great toe and to determine whether foot care treatment is beneficial in reducing the risk of falling. Methods Functional tests of the lower extremities were performed in 263 adults, including patients with any of hallux valgus, ingrown nail, or pachyonychia, and volunteers. Fifty-five subjects with nail disorders of the great toe received medical foot care treatment. Results The presence of ingrown nail, pachyonychia, or tenderness of the great toe was significantly correlated with impaired postural performance and reduced muscular strength as assessed by functional tests. Medical foot care markedly reduced pain levels in the great toe and improved scores on functional tests of the lower extremities. Conclusions Toenail disorders of the great toe cause dysfunction of the lower extremities and are likely to increase the risk of falling in daily life. Foot care management of toenail disorders has the potential to improve functional abilities in daily life, particularly in elderly individuals.

There has been no epidemiological survey of foot diseases in Japan. In this study we determined the prevalence of foot diseases, especially tinea pedis (TP) and tinea unguium (TU) in Japan. We conducted a randomized survey of outpatients who visited a dermatologist during the third week of May in 1999, 2000 and 2006. The most frequently reported condition was "fungal infection" in 8737 (40.0%) of 21 820 patients in 1999/2000, and 3848 (49.4%) of 7783 patients in 2006. The patients who visited a dermatologist for reasons other than superficial fungal infection but were diagnosed with TP or TU comprised 18.6% of the study population in 2000 and 24.1% in 2006. Of the patients with TP or TU, 63.2% used topical medication only. This survey showed that often patients are not aware of fungal infections and that their treatment is sometimes insufficient. Dermatologists should actively examine and treat patients with TP and TU.

Summary: 21 patients with sporotrichosis underwent treatment of local hyperthermia using a pocket warmer. The treatment was performed 1–3 times a day, totalling 40–60 minutes per day, until the lesions healed with scarformation. As a result, “complete cure” was observed in 18 patients, “relapse” in 1 and “improvement” in 2. In the 18 patients with complete cure, the period of treatment was 5–13 weeks (mean ± SD: 8.5 ± 2.5 weeks), and was not affected by sex, age, sites of lesions or clinical types. Because heat resistant strains were not detected by thermotolerance tests of isolates, the reason for failure was suspected to be mainly due to the misuse of the pocket warmer. It was, therefore, thought that the application technique of a pocket warmer was the most important factor in the success of the local hyperthermic therapy. Zusammenfassung: 21 Patienten mit Sporotrichose unterzogen sich einer lokalen Hyperthermie-Behandlung mit einem Taschenheizgerat. Die Behandlung wurde ein- bis dreimal taglich durchgefuhrt, insgesamt 40–60 min pro Tag, bis die Lasionen unter Narbenbildung abheilten. Vollstandige Heilung wurde bei 18 Patienten beobachtet, Besserung bei 2 und ein Ruckfall bei einem Patienten. Bei den 18 Patienten mit vollstandiger Heilung betrug die Behandlungsdauer 5–13 Wochen (Mittelwert 8.5 ± 2.5 Wochen) und wurde weder von Geschlecht, Alter, Lokalisation oder klinischem Typ beeinflust. Da in Thermotoleranztesten der Isolate keine hitzeresistenten Stamme gefunden wurden, wird der Grund fur die Therapieversager hauptsachlich im nicht vorschriftsma- Bigen Gebrauch des Taschenheizgerates vermutet. Daraus wird geschlossen, das die Anwendungstechnik eines Taschenheizgerates der wichtigste Faktor fur den Erfolg der lokalen Hyperthermie-Behandlung war.

Summary: A Pityrosporum infection in a 17-year-old male is reported. The clinical symptoms were erythematous macules with fine scales and appeared in both antecubital fossae. In a direct examination and in cultures of the scales, large numbers of Pityrosporum ovale and a few Pityrosporum orbiculare cells were seen. The histopathological findings, which resembled those of tinea versicolor, revealed clusters of Pityrosporum ovale around the orifices of the hair follicles. When the lesions were treated by topical application of 1% clotrimazole cream they disappeared, but left areas of pigmentation behind. Since the above findings corresponded with those of the clinical entity described by Soh, the name Malassezia intertrigo, which he proposed, is employed in this report. Zusammenfassung: Es wird uber eine Pityrosporum-Infektion bei einem 17jahrigen Mann berichtet. Die klinischen Symptome bestanden in erythematosen Macula mit feiner Schuppung und zeigten sich in beiden antecubitalen Fossae. Im Direktpraparat und in Kulturen der Schuppen fand sich massenhaft P. ovale und wenig P. orbiculare. Die histopathologischen Befunde ahnelten denjenigen bei Tinea versicolor und zeigten Anhaufungen von P. ovale um die Orifizien der Haarfollikel herum. Nach topischer Behandlung mit 1 %iger Clotrimazol-Creme verschwanden die Lasionen, hinterliesen jedoch pigmentierte Areale. Da diese Befunde mit den von Soh als klinische Entitat beschriebenen korrespondieren, verwenden auch wir den von ihm vorgeschlagenen Begriff Malassezia Intertrigo.

This document summarizes current knowledge about diagnosis and treatment of candidiasis affecting the skin and oral mucosa. Several clinical forms of mucocutaneous candidiasis are distinguished depending on a patient's age and infected site, e.g. Candida intertrigo, erythema mycoticum infantile, erosio interdigitalis blastomycetica, candidal paronychia and onychia, Candida onychomycosis, and oral candidiasis. The diagnosis of candidiasis is confirmed by observation of mycelial forms on microscopic examination. Since Candida yeasts (especially C. albicans) are normal inhabitants of the skin and oral mucosa, it must always be noted that positive culture does not always indicate the presence of candidal infection. The pathogenicity of Candida species is relatively low, and some special conditions are required for tissue invasion by the fungus. Predisposing factors, such as disturbances of the cutaneous and mucosal microenvironment and systemic or local immunosuppression, should be checked in patients with recurrent infection. Therapy for cutaneous candidiasis is dominated by topical antifungal agents. Azole antifungal cream (e.g., bifonazole, ketoconazole, neticonazole hydrochloride, lanoconazole and luliconazole) is most effective. Terbinafine hydrochloride and amorolfine hydrochloride are also useful. Cutaneous candidiasis usually requires a shorter duration of topical treatment (1-2 weeks) than superficial dermatophyte infections. For candidal paronychia and onychomycosis, oral therapy with itraconazole is recommended. The daily dose of itraconazole should be taken for several months, while its pulse therapy for candidiasis is not approved in Japan. Itraconazole oral solution is commonly used for oral candidiasis, and miconazole gel is also effective.

Tinea pedis is contagious and typically spreads from infected to non-infected persons. The purpose of this study was to evaluate the efficacy of footwear in preventing tinea pedis adhesion. Using the stamp culture method, we investigated the effectiveness of preventing dermatophyte passage by the wearing of stockings made of nylon, socks made of cotton and tabi (Japanese socks), as well as the effect of removing dermatophytes from these items by washing with soap, cold water and cold water after turning inside-out. For sandals, sneakers and boots, we also investigated the effect of dermatophyte removal by pouring cold water into the footwear, wiping with a wet towel, and pouring boiling water into the footwear. The wearing of socks or tabi was effective in preventing passage of dermatophytes. The stocking material proved to be too thin to prevent passage. On the inner side of socks (the side of the sole), all treatments were effective at removing dermatophytes, but on the outer side of socks (the side touching the surface of the sandals), the treatment of washing in cold water after turning inside-out resulted in significantly more dermatophytes as compared with the other treatments. Pouring cold water, wiping with a wet towel and pouring boiling water were all effective for removing dermatophytes from sandals and sneakers. However, for boots, the treatment of pouring cold water was less effective. To prevent the adhesion of dermatophytes to sandals, wearing socks or tabi was effective, and the treatments of washing socks in cold water after turning inside-out and of pouring cold water into the boots were less effective than the others.

The diagnosis of tinea pedis is usually confirmed by microscopy and culture of skin scrapings. Isolating dermatophytes by fungal culture gives more reliable proof of infection and has the advantage of identifying the causative organisms. Nevertheless, culture examination is complementary to microscopy and is not routinely performed because it is time- and cost-consuming. Herein, we propose a new culturing method, the 'finger-sampling method', for collecting dermatophytes from patients' toe webs using the examiner's fingertip as a sample collection tool. Using this method, four toe webs of a foot can be examined at one time on one culture dish. Every toe web of 50 patients with untreated tinea pedis were examined, and dermatophytes were grown from 83 out of 107 (78%) KOH positive toe webs. The isolation ratio by the finger-sampling method was comparable to that by traditional slant culture of skin scrapings performed by skilled practitioners. Culture results were also positive in 19 out of 53 (36%) diseased but KOH negative toe webs and in 38 (16%) normal toe webs, suggesting the existence of unidentified infection. Additionally, we confirmed the efficacy of this method for detecting dermatophyte attachment on the healthy toe web skin of volunteers who had just been exposed to contaminated areas, i.e. Japanese public baths or a bath mat stepped on by a patient disseminating dermatophyte propagules.

Preventive measures against tinea pedis were discussed based on our mycological studies using foot-press method and house dust cultures. 1) Untreated patients with tinea pedis frequently disseminate pathogenic fungi into the environment, but dissemination could be easily controlled by simple application of antifungal agents. 2) A high proportion of dermatophytes disseminated in house dust perished naturally within a month under dry conditions, while under moist conditions they survived several months or more. Therefore, humid areas such as the floor and carpet of a bathroom should be cleaned or washed regularly. 3) Adhesion of dermatophytes onto healthy feet usually happens in public spaces where people enter without shoes. Wearing socks cannot prevent dermatophyte adhesion. Cleaning the feet by wiping with a towel or washing with soap seemed to be an effective prophylactic measure after stepping into such spaces.

At several public baths, we isolated dermatophytes from the soles of healthy volunteers by a new direct isolation method (foot-press culture method). We confirmed that a public bath is one of major sources of infection of dermatophytes. We showed that simple treatments such as (i) wiping the sole with a towel; (ii) washing with soap; (iii) 100 steps on another mat; and (iv) holding the foot up for an hour, significantly reduced the fungi on the soles of six healthy volunteers. These treatments may be effective for prevention of tinea pedis.

手掌および手指腹を直接圧抵するhand-press培養法(以下HP法と略す)を用いて手白癬について検討した。対象は1996～98年に済生会川口総合病院皮膚科を受診した直接鏡検が陽性の未治療の手白癬患者17例で,内訳は男14例,女3例,年齢は31～81歳,平均57.1歳であった。17例中16例に他の部位の白癬の合併を認めた。通常の試験管培養とともにHP法を行った。すなわち243×243×18 mmの滅菌シャーレに5-fluorocytosineなどを添加したサブロー·ブドウ糖寒天培地を作製し,この培地上に被験者の手掌と指腹を十分に圧抵した後培養した。結果は試験管培養は17例中16例(94.1%)が陽性で,Trichophyton rubrum 13例, T. mentagrophytes 3例であった。HP法は17例中6例(35.3%)(T. rubrum5例, T. mentagrophytes 1例)が陽性で,集落数は9,3,2コロニー各1例,1コロニー3例で,合計17コロニー,平均1.0コロニーであった。17例中両法ともに陽性が6例,試験管培養のみ陽性が10例,両法ともに陰性が1例であった。筆者らの検討によると足白癬患者のfoot-press培養法は113例中76例(67.3%)が陽性で,集落数は100コロニー以上の例もあった。これに比較すると,手白癬は菌の散布率,散布集落数ともに少なく,足白癬に比較して感染源になりにくいと結論した。また手白癬患者からの本人および他人の皮膚への直接感染も,手白癬の頻度が低いことも合わせて,実際には少ないと推測した。

We studied the preventive effects of socks against dermatophyte infection. Wearing various socks (cotton socks, nylon stockings, wool socks and "tabi"), a healthy volunteer walked on a bath mat on which a patient with tinea pedis had stepped earlier. The volunteer pressed her right foot with socks onto large agar medium (Foot-press method), then, took off the socks and performed the Foot-press method again. The number of colonies of isolated dermatophytes on the medium was counted. The number of isolated colonies from the sole after taking off the nylon stockings was larger than that from the foot wearing the stockings. Dermatophytes were also isolated from the sole after taking off cotton socks. In contrast, few dermatophytes were isolated from the sole after taking off wool socks or "tabi". On microscopic observation, fibers of the nylon stockings and cotton socks were seen to be loose enough for dermatophytes to pass through. In contrast with those socks, fibers of wool socks and "tabi" were tight or fluffy. In conclusion, the nylon stockings and cotton socks are unsatisfactory in preventing the adhesion of dermatophytes.

足白癬および足からの直接の進達と考えられる爪白癬以外の生毛部, 頭部, 手白癬などの感染経路に関して, まず仮説を立て, 次にこの仮説上の感染経路が実際に起こりうるか実験的に検討した。仮説として, (1)病変部→非罹患部, (2)病変部→環境(マット, 下着, その他の日用品など)→非罹患部, (3)病変部→手指→非罹患部, (4)病変部→環境→手指→非罹患部を考えた。実験方法はTrichophyton mentagrophytesによる未治療の足白癬患者(25歳男)を感染源とし, 白癬に罹患していない健常人(42歳男)を被験者とした。培地として5-fluorocytosineなどを添加したサブロー·ブドウ糖寒天培地, 培養法として被験部位を直接圧抵するfoot-press培養法(足底), hand-press法(手掌と指腹), finger-press法(指腹)など, およびhairbrush法(頭髪)を用いた。仮説に対して, (1)患者の足底に被験者の皮膚(手, 手指, 頭髪, 肘)を接触後培養, (2)患者が踏んだ足拭きマット, あるいは足底を拭いた布タオルに被験者の皮膚を接触後培養, (3)足底に被験者の右手を接触, その右手で皮膚を擦過後培養, (4)患者が踏んだマットに被験者の右手を接触, その右手で皮膚を擦過後培養した。その結果, 全20検体のうち(1)の頭髪を除くすべての検体からT. mentagrophytesを分離した。とくに直接接触よりマット, タオル, 手指を介した方が, 多数の集落が生える傾向にあった。以上から前述の仮説上の感染経路のすべてに可能性があることが証明された。

Summary. We have designed a new direct isolation method, the foot-press method, to survey dissemination of dermatophytes from the infected soles. A total of 56 untreated patients with tinea pedis were examined. The infected soles of 42 patients were pressed onto actidione-chlor-amphenicol-5-fluorocytosine (5FC)-gentamicin sulphate Sabouraud glucose medium prepared in a large culture dish; the culture media were then incubated at 25 °C. Dermatophytes were isolated in 30 out of the 42 patients, while no dermatophytes could be grown from 10 healthy controls. The number of isolated colonies from each patient ranged from 1 to 97 (mean±SD, 11±20). The isolation frequencies were higher in the patients of hyperkeratotic type and in those with tinea unguium, while causative organisms and the extent of the lesions did not affect the results of the foot-press method significantly. In order to reveal the morphology of disseminated dermatophytes, 1 times 1 cm pieces of culture media were cut out from culture dishes after pressing infected soles and were examined microscopically. Dermatophyte-like spores or hyphae, most of which were detached from cornified cells, could be seen in 10 out of 14 patients. Subsequently performed slide cultures isolated dermatophytes from approximately 70% of the pieces on which dermatophyte-like fungi were observed. Zusammenfassung Es wird uber eine neue Direktisolierungsmethode berichtet, die Fusohlen-Abdruckmethode, welche die Besiedlungsdichte der Dermatophyten auf Fussohlen zu bestimmen und ihre Ausbreitung abzuschatzen gestattet. Insgesamt wurden 56 unbehandelte Tinea pedis-Patienten untersucht. Die Fussohlen von 42 Patienten wurden auf Sabouraud-Glucose-Agar mit Zusatz von Actidion, Chloramphenicol, Flucytosin und Gentamycinsulfat in einer grosen Kulturschale abgedruckt und die Kultur bei 25°C bebrutet. Bei 30 der 42 Patienten wurden Dermatophyten isoliert, keine Dermatophyten dagegen bei 10 gesunden Kontrollpersonen. Die Zahl der pro Patient isolierven Kolonien schwankte von 1–97 (im Mittel 11±20). Die Koloniezahlen waren bei Patienten mit hyperkeratotischer Mykose und bei solchen mit Tinea unguium hoher, wahrend Pilzart und Ausmas der Lasionen auf die Resultate dieser Methode keinen signifikanten Einflus hatten. Um die originare Morphologie der Dermatophyten in situ zu erfassen, wurden unmittelbar nach dem Fusabdruck Agarstucke der Grose 1 times 1 cm ausgeschnitten und direktmikroskopisch untersucht. Bei 10 von 14 Patienten konnten Sporen oder Hyphen, meist Korneozyten anliegend, beobachtet werden, die Dermatophyten zuzuordnen waren. Im Anschlus daran konnten von etwa 70% dieser Objekttragerkulturen mit Dermatopyten-ahnlichen Pilzelementen auch Dermatophyten isoliert werden.

23歳の白人男性に生じた生毛部急性深在性白癬を報告した。タイへの旅行中に前腕の蚊に刺された部位に発症し, ステロイド外用後に悪化した。病理組織学的には壁の破壊を伴う毛包周囲の化膿性炎症像を呈しており, PAS染色では真皮内の真菌要素は認められなかった。病変部から得られた体毛には毛外性の菌寄生がみられ, 生検組織培養ではTrichophyton mentagrophytesが分離された。グリセオフルビン375mg/dayの内服3週間とクロトリマゾールクリームの外用9週間で瘢痕を残して治癒した。自験例は, 近年本邦で報告された症例と同様にステロイド外用が悪化に関与していると考えられる。一方欧米では, 本症に相当する病型は外傷を受けやすい部位に生じやすく, 家畜を扱う農業関係者にみられ, 原因菌は侵襲性, 病原性の強い動物寄生菌であることが多く, 高温多湿な環境が増悪因子となることが知られている。自験例はこうした欧米型の特徴も有しており, 人種による皮膚の性状や白癬菌に対する感受性に起因するものであることが推測される。本症の発症機序を解明するために, 本邦においても家畜との接触, 外傷の有無, 気候などの環境因子についても, より詳細に調査する必要があると考えられる。

健常な皮膚と頭髪からのCandida albicansをはじめとする真菌の検出を試みた.対象は皮膚・粘膜カンジダ症患者26例,血液疾患患者19例,ステロイド剤内服患者14例,糖尿病,悪性腫瘍,膠原病の基礎疾患を有する患者18例,基礎疾患を持たない真菌症,膿皮症などの皮膚感染症患者25例,および健常人28人の合計130例である.培地としてクロラムフェニコールを添加したサブローブドウ糖寒天平板培地を用いた.下顎,第3指間は綿棒塗抹法,指腹はFinger-Press法,頭髪はヘアーブラシ法で培養した.C.albicansは健常人の皮膚からは1人も検出されなかったが,皮膚・粘膜カンジダ症群の26例中15例(57.7%)から検出され,非病変皮膚も保菌されている頻度が高いことが分かった.血液疾患群ではC.albicansが19例中2例から検出されたが,その他の真菌の検出率は他群より低く,Penicillium spp.を1例,その他の酵母を3例から検出したのみであった.全症例の検出率を部位別にみると,Aspergillus spp., Penicillium spp.,黒色真菌,その他の糸状菌は頭髪がその他の部位より高かった.一方,血液疾患群の頭髪は化学療法による脱毛が多いために,7例しか検索できなかったが,黒色真菌を1例から検出したのみであった.以上より,皮膚の真菌は頭髪に付着した菌がfocusになっている可能性が高く,血液疾患群は脱毛のため頭髪に真菌が付着しにくく,その結果,皮膚からの検出率も低いと結論した.

Dermatophytes are usually isolated from house dust by using actidione-chloramphenicol Sabouraud glucose medium (ACS medium). We have prepared a new medium, 5FC medium, by adding gentamicin sulphate (GS) and 5-fluorocytosine (5FC) to ACS medium to achieve more efficient isolation of dermatophytes from house dust. 5FC medium was more effective in isolating dermatophytes than ACS medium or ACS medium supplemented with GS alone. Trichophyton rubrum could be grown from 13 out of 19 house dust samples from the homes of patients with tinea pedis (68.4%), and T. mentagrophytes could be grown from 17 out of 21 (81.0%). Two of 20 house dust samples from the home of a control family without dermatophytosis grew only one colony of dermatophytes in 5FC medium; the rest of the samples showed no growth. The number of colonies isolated on 5FC medium was much higher than on ACS medium (5.3 vs. 2.0 for T. rubrum and 17.2 vs. 2.1 for T. mentagrophytes). In addition, the size of the isolated colonies was much larger than that on ACS medium. Thus, 5FC medium can be regarded as a useful tool for isolating dermatophytes from various contaminated samples.

足白癬患者足底における白癬菌の存在を直接確認する培養法としてFoot-press法を試み,その有用性を検討した.対象は未治療の足白癬患者27名で小水疱型22例,趾間型3例,角化型2例であった.年齢は18～79歳(平均47.7歳),性別は男性17例,女性10例であった.Foot-press法は,Nunc社製滅菌シャーレ(243×243×18mm)に作成したアクチジオン・クロラムフェニコール添加サブローブドウ糖寒天培地に患者足底を数秒間直接圧抵した後,25℃で培養を行う方法である.その結果,27例中15例(56%)から白癬菌の分離に成功し,分離された菌はTrichophyton rubrumが9例(60%),Trichophyton mentagrophytesが6例(40%)で,同時に施行した斜面培地による分離菌のTR/TM比とほぼ同じ割合を示した.病型別では小水疱型22例中12例(55%),趾間型3例中1例(33%),角化型2例中2例(100%)で白癬菌の分離に成功した.白癬のなかでも慢性期の症状と考えられる爪病変の有無により比較すると,爪病変のあるもので8例中6例(75%),ないもので19例中9例(47%)から白癬菌が分離された.また白癬病巣が広汎に存在するものほど分離成功率の高い傾向が認められた.以上より本法は足白癬患者から直接白癬菌を分離することができ,足底における白癬菌の分布状況の検討に有用な方法と考えた.

病変を認めず,直接鏡検が陰性の舌の真菌培養を行い,Candida albicansの分離率を年齢や基礎疾患により比較した.対象はステロイド剤を内服している患者27例,糖尿病,悪性腫瘍,膠原病の基礎疾患患者51例および健常人132人の合計210例である.培地としてクロラムフェニコール添加サブロー・ブドウ糖寒天平板培地を用いた.方法は舌を滅菌綿棒で擦過し培地に塗抹し培養した.210例中Candida属を76例(36.2%)から分離した.菌種別ではC.albicansが67例と多く,血清型はA型が62例,B型が5例であった.その他の菌種はC.tropicalisが5例,C. pseudotropicalis, C. parapsilosis, C. krusei, C. guilliermondiiが1例であった.C.albicansの分離率は年齢や基礎疾患により大きな差を認めた.60歳以下の健常人の分離率は10.9%であるのに対し,61歳以上の健常人(54.5%),ステロイド剤内服患者(60歳以下で85.7%)および糖尿病(30.8%),悪性腫瘍(46.7%),膠原病(50.0%)の患者からの分離率が有意に高値であった.一般的に易感染性宿主と考えられている患者や高齢者の分離率が高いことは,易感染性宿主に皮膚・粘膜カンジダ症が好発することと関連しており,舌などの粘膜で増殖した菌が発症のfocusになっている可能性が高いと考えられた.また他の臨床検査で異常を認めなくても,直接鏡検が陰性であっても舌からC.albicansを分離することは軽度の易感染性を示す鋭敏な指標になると結論した.

足からの皮膚糸状菌の散布状況を直接評価できるFoot-press培養法(FP法と略す)を用いて,足白癬患者の抗真菌剤外用による治療後の菌散布状況を検討した.対象は足白癬患者24例で,1%塩酸テルビナフィンクリーム(ラミシール®)を1日1回単純塗布させ,皮膚所見の観察,直接鏡検,試験管斜面培地による培養およびFP法を行った.初診時のFP法の陽性率は24例中17例(70.8%)で,足白癬患者が菌を散布していることが確認された.治療後の効果判定ができた21例の最終の皮膚所見判定の改善以上(著明改善と改善)は18例(85.7%),直接鏡検陰性は15例(71.4%)であった.さらにこの21例中,初診時FP法陽性の14例では,治療開始1週後の皮膚所見の改善以上と直接鏡検陰性化率がともに20.0%であるのに対し,FP法の陰性化率は75.0%,2週後の改善以上が66.7%,直接鏡検陰性化率が41.7%であるのに対し,FP法の陰性化率は83.3%であった.3週以後はFP法はすべて陰性であった.また,1週後にFP法が陽性の1例は,病変を認めないために外用を行わなかったかかとのみから菌が分離された.以上より,臨床的に症状が残り,直接鏡検陽性であってもFP法の陰性化率は高く,抗真菌剤外用が足からの皮膚糸状菌の散布を比較的速やかに抑制することがわかった.また,病変を認めなくても,足底全体と全趾間に外用する必要があることも示唆された.

Painful feet and lower limb dysfunction are risk factors for falling. Toenail deformities are common disorders in elderly people, but the relationship between nail deformities and lower limb function remains unclear. The aims of the present study were to assess the impairment of lower limb function in patients with deformities of the great toe and to determine whether foot care treatment is beneficial in reducing the risk of falling. Functional tests of the lower extremities were performed in 263 adults, including patients with any of hallux valgus, ingrown nail, or pachyonychia, and volunteers. Fifty-five subjects with nail disorders of the great toe received medical foot care treatment.The presence of ingrown nail, pachyonychia, or tenderness of the great toe was significantly correlated with impaired postural performance and reduced muscular strength as assessed by functional tests. Medical foot care markedly reduced pain levels in the great toe and improved scores on functional tests of the lower extremities.Toenail disorders of the great toe cause dysfunction of the lower extremities and are likely to increase the risk of falling in daily life. Foot care management of toenail disorders has the potential to improve functional abilities in daily life, particularly in elderly individuals.

ヒトのMicrosporum canis感染症は動物から感染することが多いとされる. 本研究では患者宅で飼育されている動物についてヘアーブラシ法を用いて検索した. 対象は当科を受診した本症患者の22家庭 (うち6家庭は飼育せず) で飼育されているネコ20匹, イヌ7頭, ウサギ2匹である. なお22家庭中患者を含めた家族78人を診察したが, 頭部白癬11例, 体部白癬21例を認め, 本症に罹患していない人が46人いた. 動物は可能な限り来院させ, 病変の有無を診断し, ヘアーブラシ法による培養を行った. 連れて来れない時は病変の有無については問診を行い, 家でのブラッシングにより培養した. 菌が陽性で飼い主が希望するときは, グリセオフルビンを内服させ, 2週ごとに培養を行った. 飼育動物とヒトの罹患率をみるとネコを飼育している家庭ではヒトの罹患率が高値であった. 動物ではネコは20匹中18匹に病変を認め, 20匹すべてより菌を検出した. 発育集落数は病変のあるネコでは多かった. 一方イヌは全く病変を認めなかったが, 7頭中3頭から菌を検出した. 治療開始後, ネコからの菌量は4～6週後に急に減少することが多く, 10週後には10匹中6匹が陰性となった. 以上より本症の感染源として, ネコが最も重要であり, ヘアーブラシ法による培養の集落数はネコの病変の有無の判定になると結論した. またイヌは患者宅で飼育されていても感染源でないこともあると考えられた.

癜風を中心に, 菌学的な検索と色素異常および治療と再発についての統計的な検討を行ったところ次のような結果を得た. (1) 癜風患者からのMalassezia furfurの培養成績は病変部のみならず非病変部でも健常人より高値であった. また菌種ではPityrosporum orbiculare単独ないしP. ovaleとの混合が多かった. (2) 舌からはステロイド剤内服患者を含めて27例すべてが陰性であったが, 頭髪からの検出率は, 健常人でも高値であった. (3) 脱色素斑を生じやすい要因として寒冷, 露光, 治療があげられた. (4) 抗真菌剤による治療後の治癒判定を直接鏡検で行うと2週後には良好であったが, 培養成績は2週以後も40%以上と高値で, より詳細に判定できた. (5) 直接鏡検陰性により治療を中止し, 以後の再発率をみると治療中止時の培養成績により2か月以内で大きな差を認めた. すなわち陰性例では低く, 陽性例では13例中5例に達した. しかしながら両群とも3か月を過ぎると再発率は急に上昇し, 6か月では60%以上に達した. (6) 癜風病変部の毛包内では開口部から毛漏斗上部では菌糸と胞子を認めたが, 毛漏斗下部では胞子のみを認めた. (7) マラセチア間擦疹の自験例では直接鏡検と培養でovale型胞子の他に少数のorbiculare型胞子が混在していた.

There has been no epidemiological survey of foot diseases in Japan. In this study we determined the prevalence of foot diseases, especially tinea pedis (TP) and tinea unguium (TU) in Japan. We conducted a randomized survey of outpatients who visited a dermatologist during the third week of May in 1999, 2000 and 2006. The most frequently reported condition was "fungal infection" in 8737 (40.0%) of 21 820 patients in 1999/2000, and 3848 (49.4%) of 7783 patients in 2006. The patients who visited a dermatologist for reasons other than superficial fungal infection but were diagnosed with TP or TU comprised 18.6% of the study population in 2000 and 24.1% in 2006. Of the patients with TP or TU, 63.2% used topical medication only. This survey showed that often patients are not aware of fungal infections and that their treatment is sometimes insufficient. Dermatologists should actively examine and treat patients with TP and TU.

Microsporum canisによる頭部白癬に対して,ヘアーブラシ法による培養を行い,臨床症状および通常の鏡検・培養法との比較において本症の治癒判定について検討した.症例は7家族10例,内訳は男7例,女3例で,年齢は3か月から10歳(平均4.9歳)であった.臨床診断は頭部浅在性白癬5例,ケルスス禿瘡5例で,内服薬としてグリセオフルビンを8例,イトラコナゾールを2例に用いた.臨床的には鱗屑・痂皮の付着の有無を判定項目とし,菌学的には数本の抜毛を行い,半分ずつ直接鏡検と培養検査を行った.また同時にヘアーブラシ法による培養を行った.ヘアーブラシ法による培養が1ないし2回陰性になった時に治療を中止した.結果は治療期間は8から14週(平均11.7週)であった.鱗屑・痂皮残存期間は2から14週(平均8.3週)で,菌学的陽性期間は毛の直接鏡検が平均2.6週,培養が1.9週,ヘアーブラシ法が5.1週であった.10例中1例に再燃を認めた.またグリセオフルビンを体重1kgあたり10mg以下用いた症例では鱗屑・痂皮残存期間も菌学的陽性期間も長かった.以上より本菌による頭部白癬に対しては,グリセオフルビンによる治療では1日量として体重1kgあたり10mgかそれ以上が妥当で,落屑・痂皮が消失し,ヘアーブラシ法による培養が陰性化すれば,治癒とみなせると結論した.

We report 5 cases of photocontact dermatitis due to suprofen, a nonsteroidal anti-inflammatory drug introduced to the Japanese market in 1989, and available as a 1% ointment. The patients developed pruritic eczematous lesions after applying the ointment for from 2 weeks to 3 months. All 5 patients reacted positively to photopatch testing with ultraviolet A (UVA) and suprofen down to 0.1-0.01% pet., and 3 patients showed positive reactions with ultraviolet B (UVB) and suprofen down to 1.0-0.1%. Moreover, all patients showed a cross-reaction with tiaprofenic acid, which has a very similar chemical structure to suprofen. However, there was no cross-reaction between suprofen and ketoprofen. Prescribers should be aware of the existence of photocontact sensitivity due to these drugs.

Microsporum canis 感染症患者の非病変部の菌の検索を行った.対象はM. canis 感染症患者 9例で, その内訳は頭部白癬5例, 体部白癬4例であった.性別は男性3例, 女性6例で, 年齢は3歳から46歳 (平均14.9歳) であった.培地としてアクチジオン・クロラムフェニコールを加えたサブロー平板培地を用いた.培養法として, 手指腹にはFinger-press法を, 手背, 頚部, 背部には綿棒法を, 頭髪にはヘアーブラシ法を用いた.結果はすでに報告した病巣のない頭髪と同じようにその他の部位の非病変部から高率にM. canisを検出した.とくに本菌による手白癬はまれにもかかわらず, 手指腹は9例中7例 (77.8%) が陽性で, 陽性症例では10本すべての指の圧抵部位より菌が発育する症例が多かった.その他の部位では手背が6例中3例 (50%), 頚部が9例中4例 (44.4%), 背部が5例中2例 (40%) とそれぞれ高率に菌を検出した.また頭部白癬患者にはグリセオフルビン内服療法, 体部白癬患者には病変部のみ抗真菌剤の外用療法を行ったが, 手白癬を含めて全例で非病変部に新たな発病はみられなかった.以上よりM. canisは病巣中から周囲に大量に散布されるために, 病変がない皮膚からも頭髪と同様に高率に菌が検出されるが, 菌は多くの場合, 単に付着しているにすぎないと結論した.

スプロフェン軟膏による光接触皮膚炎の5例を報告した。症例は女子4例, 男子1例, その原疾患はアトピー性皮膚炎3例, 接触皮膚炎2例で, 外用開始後2週∼3ヵ月で発症した。UVA6J/cm2照射による光パッチテストでスプロフェン濃度0.01%まで陽性, 約2/3MEDのUVB照射による光パッチテストでも濃度0.1%まで陽性であった。また可視光では陰性であったことより, その作用波長はUVAを主体とし, UVBに及ぶ領域にあると考えられた。また潜伏期間, 光パッチテストの結果より光アレルギー性機序が推測された。他の非ステロイド抗炎症剤を用いた光パッチテストで, 全例チアプロフェン酸に対しても陽性を呈したことから, スプロフェンとチアプロフェン酸の交差感作が示唆された。

Pityriasis versicolor and malassezia folliculitis were studied clinically and mycologically. The main results were as follows: 1) The average age of pityriasis versicolor patients has gradually become higher. 2) Negative rates of Malassezia furfur after treatment were very high by direct examination but relatively low by culture. 3) Patients who were negative by culture on completion of treatment seldom recurred within 2 months. 4) We can evaluate the effectiveness of antifungal application by using Malassezia furfur as normal skin flora on the volunteer's back. 5) Malassezia furfur (orbiculare or ovale type) is detected in follicular contents of steroid acne and acne vulgaris, which makes it necessary to establish criteria for diagnosis of malassezia folliculitis.

The mycological examination by the cotton swab method and the taste disorder test using the filter-paper method were taken for the tongues of diabetes mellitus (DM) patients. Candida albicans was isolated from 29 out of 81 patients. The mean serum HbA1c level of patients with C. albicans was significantly higher than that of patients without it. DM patients demonstrated significantly higher incidences of taste disorders than healthy controls, but there was no relationship between C. albicans of the tongue and taste disorders. The taste disorders tended to occur in the DM patients who had nerve complications. The results suggested the taste disorder test using the filter-paper methods contributes to easy detection of the nerve complications in DM patients.

Exophiala jeanselmeiによる黒色真菌症を報告した。症例は76才女子で, とくに誘因なく, 左手背に皮下結節を生じた。近医にて切開·排膿, さらに切除したが, 4ヵ月後, 手術瘢痕両側に同様の皮下結節を2個生じた。1個切除したところ, 病理組織学的に菌要素を認めたため, 当科を紹介された。初診時, 左手関節背に直径8mmの下床とは可動性のある境界鮮明な皮下結節がみられた。結節は嚢腫状に弾性硬に触れ, 皮膚には軽い発赤がみられた。その他に手術瘢痕を2個認めた。組織片よりExophiala jeanselmeiを分離した。病理組織学的には, 皮下に巨細胞を混じた組織球と小円形細胞の浸潤よりなる壁に囲まれた膿瘍がみられ, 褐色調の胞子連鎖, 菌糸を認めた。他の施設で切除した2個の組織標本もほぼ同様な所見で, PAS陽性に染まる菌糸, 胞子, 胞子連鎖を多数認めた。単純に切除縫合したのみであるが, 再発はみられていない。自験例は臨床および病理組織学的には, 典型的な皮下嚢腫であつたが, その直径が8mmと非常に小さかつたことが特徴的である。また自験例は計3ヵ所の病変を認めたが, 多発した機序としては, 原発巣の切開·排膿あるいは切除時の播種ないし不十分な切除による局所再発が, 最も考えやすいと思われた。小さい皮下嚢腫を, 診察する際には, 常に本症も頭にいれ, 充分注意の上, 切除などの治療を行うとともに, 菌学的ならびに病理組織学的検査を行う必要があろうと考えられた。

体部白癬(両耳介)と手白癬(右手掌)を伴うケルスス禿瘡の10歳男児例を報告した.病毛の直接鏡検で,毛内性大胞子菌性寄生を認め,耳介と右手掌の鱗屑中にも菌要素を認めた.すべての病巣より淡褐色湿性の集落を得たが,オートミール培地上で淡紅色の色素を産生し,サイアミン添加BHI培地を用いた巨大培養で,単純性で短い長楕円形の小分生子を多数認めたことより,Tricophyton violaceumと同定した.頭頂部の結節の病理組織学的所見は,毛包壁の破壊と毛包内外の膿瘍で,PAS染色では毛の中に胞子連鎖を多数認めた.グリセオフルビン2錠/日内服と抗真菌剤外用を行ったところ,手と耳は3週間で,頭は9週間で治癒した.しかし約1年後に両耳介に体部白癬が再発し,同じ菌が分離された.以上よりオートミール培地はT.violaceumとT.glabrumの鑑別培地として有用で,サイアミン添加BHI培地を用いた巨大培養は,分生子形成法として有用である.また治療中止後,再発するまでの無症状の1年間は,subclinicalな感染状態であったと考えられた.

Tinea pedis is contagious and typically spreads from infected to non-infected persons. The purpose of this study was to evaluate the efficacy of footwear in preventing tinea pedis adhesion. Using the stamp culture method, we investigated the effectiveness of preventing dermatophyte passage by the wearing of stockings made of nylon, socks made of cotton and tabi (Japanese socks), as well as the effect of removing dermatophytes from these items by washing with soap, cold water and cold water after turning inside-out. For sandals, sneakers and boots, we also investigated the effect of dermatophyte removal by pouring cold water into the footwear, wiping with a wet towel, and pouring boiling water into the footwear. The wearing of socks or tabi was effective in preventing passage of dermatophytes. The stocking material proved to be too thin to prevent passage. On the inner side of socks (the side of the sole), all treatments were effective at removing dermatophytes, but on the outer side of socks (the side touching the surface of the sandals), the treatment of washing in cold water after turning inside-out resulted in significantly more dermatophytes as compared with the other treatments. Pouring cold water, wiping with a wet towel and pouring boiling water were all effective for removing dermatophytes from sandals and sneakers. However, for boots, the treatment of pouring cold water was less effective. To prevent the adhesion of dermatophytes to sandals, wearing socks or tabi was effective, and the treatments of washing socks in cold water after turning inside-out and of pouring cold water into the boots were less effective than the others.

Environments may act as reservoirs for pathogenic fungi, a determinant of the establishment of fungal infection, or an exacerbating factor of disease. In recent years, skin disease caused by geophilic fungi has been decreasing, while case reports of zoonoses from various animals are increasing. Outbreaks of anthropophilic T. tonsurans infection pose a problem to medical mycologists. Tinea pedis is the most common exogenous dermatomycosis in Japan. Although T. rubrum is presumed to be the dominant pathogen of this disease, T. mentagrophytes is detected more frequently from various environments, so far, the reason for this discrepancy has not been fully understood. The latest knowledge about the route of dermatophyte foot infection is as follows: (1) Dermatophyte propagules disseminated from patients may contaminate not only bath-mats but also wood floors, Japanese style mattings, concrete floors, slippers, cushions, etc., and from them adhere to healthy skin. (2) The agar stamping method can easily detect dermatophytes from the skin and the environment. (3) Propagules of T. mentagrophytes can survive for more than three months under certain conditions such as in rubber boots. (4) In order to eliminate dermatophytes gathered in socks and footwear, simple procedures (washing, bathing with hot water, or wiping with a towel) are all effective. (5) Prior application of an antifungal agent promptly eradicates dermatophyte propagules adhering to the skin from the environment. The author also mentioned the possibility of asymptomatic dermatophyte colonization, and the high prevalence of dysgeucia in oral carriers of Candida albicans.

Impairments in taste perception may be caused by a number of factors, including the presence of Candida albicans in the oral cavity. We attempted to establish whether the presence of Candida albicans on the tongue is a cause of taste disorders by studying taste disorders in patients with candidosis of the tongue and in healthy "carriers" and "non-carriers" of C. albicans. Taste disorders and their severity were objectively assessed by the filter-paper disk method in 18 patients with candidosis of the tongue and in 33 healthy "carriers" and 167 healthy "non-carriers" of C. albicans. The gustatory function was re-tested in 7 patients and 8 "carriers" after treatment with topical anti-mycotic medication to detect any improvement. Patients with candidosis of the tongue and "carriers" of C. albicans demonstrated significantly higher incidences (p

The infection rate, causative dermatophytes, and dermatophyte dissemination of tinea pedis in young healthy Japanese were studied by direct microscopic examination, slant cultures, and foot-press culture method. Questionnaires on subjective symptoms and treatments were also distributed. Among fifty-eight medical students with a mean age of 23.9 years, thirteen (22.4%) showed positive by direct microscopic examination and T. mentagrophytes was more dominant than T. rubrum by slant cultures. In one hundred and sixteen student feet, twelve were infected and disseminating dermatophytes, four were infected but not disseminating, three were not infected but adhering dermatophytes. The infection rate of tinea pedis was thus 24.1%. Among thirty-seven research workers (mean age: 34.8), twenty-one (56.8%) showed positive by direct microscopic examination. All the dermatophytes isolated by slant cultures were T. mentagrophytes. In seventy-four feet, twenty-nine were infected and disseminating, ten were infected but not disseminating, and three were adhering dermatophytes. The infection rate was 64.9%. Among thirty-one females wearing boots (mean age: 21.0), seven (22.6%) were infected and T. mentagrophytes was more dominant. In sixty-two feet, eight were infected and disseminating, one was infected but not disseminating, and five were adhering dermatophytes. The infection rate of tinea pedis was quite high and T.r/T.m rate was low in the three groups. Most of the patients had had no treatment and were disseminating dermatophytes.

We report herein a case of 61-year-old man with Unna-Thost disease (nonepidermolytic hereditary palmoplantar keratoderma) who had been suffering from refractory dermatophyte infection. Diffuse palmoplantar hyperkeratosis developed in his infancy. Coarse scaling, fissures, marked erythema, and nail deformities appeared in his early adult life. Microscopic examination revealed fungal elements in scales and nail particles. Cultures of those scales isolated Epidermophyton floccosum. Genealogical study demonstrated that his mother, sister, brother, daughter, and niece had had similar tylosis, and all of the affected individuals except his daughter had been proved to have E. floccosum or Trichophyton rubrum infection. Oral itraconazole (100mg/day) was highly effective in treating his dermatophytosis without any adverse effects. Scaling, fissures and underlying erythema disappeared within four months.

We provide foot and nail care services to outpatients at our dermatology clinic in Saiseikai Kawaguchi General Hospital. Patients with dermatological foot problems such as onychogryphosis, onychomycosis, and ingrown nails are recommended by dermatologists to obtain foot and nail care services performed by a specially trained nurse. These services include a footbath, foot massage, nail clipping, and corn and nail filing. If ingrown nails exist, a small piece of cloth is placed under the nail edge.

The scalp hair of patients with dermatophytosis due to M. canis but without scalp lesions, and that of their family members without dermatophytosis were examined using the hairbrush method. The dermatophyte was detected in 93.8% of the scalps of those who lived in homes where cats were kept, and in 25% of those without cats. After the source of infection had been treated, the dermatophyte showed a gradually decreasing presence, finally disappearing altogether, so that no case of the disease on the scalp hair could be found. We inferred from the above findings in M. canis infections that, since the dermatophytes are seen in a high proportion of cases without scalp lesions, the dermatophytes, in many cases, exist only as saprophytes on the hair.

The patient was a 19-year-old female student who purchased a puppy from a pet shop four weeks earlier. At the time of her first examination, an annular edematous erythema with adherent scales and vesicles surrounding its margin was seen on the left forearm. On direct examination of the vesicles, fungal elements were detected, and Microsporum canis was isolated. The puppy was a Pomeranian and was kept in the house at all times. No clinical lesions were seen on the puppy, and the Wood's lamp test was negative. However, M. canis was isolated from the animal by the hairbrush method. Symptoms disappeared after the patient was treated topically with terbinafine cream for three weeks. Although the dog received no treatment whatsoever, there was no evidence of the disease on the pet. Results of the hairbrush method performed on the pet two and three weeks later were negative, but, at five weeks, it was again positive. Human infection with M. canis from an asymptomatic dog was demonstrated in this case. Attention should be paid to preventing infections from animals without lesions.

Malassezia (Pityrosporum) によって生じるとされる Malassezia (Pityrosporum) folliculitis (MF) を菌学的, 病理組織学的に癜風と比較して検討した. 菌学的には, MFの毛包内容の Pityrosporum 陽性率は, 直接鏡検および培養ともに尋常性座瘡, ステロイド座瘡に比べて有意に高かった. 非病変部の培養陽性率は癜風患者の非病変部よりも高く, また尋常性座瘡, ステロイド座瘡患者の非病変部より有意に高かった. 病理組織学的には, MFでは毛包開口部の狭窄に伴う毛漏斗拡大, 毛包壁の肥厚と破壊, 周囲の炎症性細胞浸潤とともに毛漏斗内に orbiculare 型胞子の集団をみたが, 菌糸はみられなかった. 一方, 癜風の毛包内菌要素をみると, 菌糸は開口部から acroinfundibulum にあり, 胞子はすべて orbiculare 型で, infrainfundibulum の毛の周囲にも少数みられた. また胞子が毛に沿って infrainfundibulum から開口部まで連続し, そこで菌糸を生じている例もあった. 以上よりMFの発症に関しては, 菌学的には癜風におけると同様に非病変部は, 発症の準備状態にあり, これを基盤として発症していること, 病理組織学的には癜風では毛包内で増殖した P. orbiculare が開口部で菌糸を形成して皮表に病巣が拡大していくのに対し, MFでは開口部の狭窄と毛漏斗の拡大により毛漏斗内のみで P. orbiculare が増殖して炎症反応を起こし, 毛包炎を形成するものであると推論した.

5歳男児と33歳母にみられたケルスス禿瘡と頭部白癬の母子例. 母子とも頭毛に black dot を認め, 顕微鏡的に毛内性大胞子菌性寄生をみとめた. サブロー培地にて T. violaceum の定型的集落をえ, サイアミン加BHI培地にて小分生子と大分生子を認めた. 母子の被髪頭部から Hair brush 法により本菌を分離, また共用していた櫛, 家塵からも本菌を分離. 大分生子の証明, 家塵からの分離共, 本邦2例目. 家塵および母子共用の櫛から菌を分離したことは感染経路を考える上で興味深い. また治療により母子の頭部および家塵より菌が分離されなくなったことから, このような検索法が, 治癒の判定, 再発の防止に大いに役立つものと考えた.

症例1は5才姉。とくに誘因なく, 頭頂部にそう痒を伴う落屑性局面を生じ, ステロイド軟膏の外用で悪化した。初診時, 頭頂, 後頭, 左側頭部に境界鮮明な不整形の脱毛巣があり, 鱗屑と痂皮が付着し, 浸潤をともなう小豆大の扁平な紅色小結節が多発していた。トリコフィチン反応(ト反)は陽性であつた。病毛の直接鏡検で, 小胞子菌性寄生を認め, Microsporum canisを分離した。ケルスス禿瘡と診断し, グリセオフルビン内服で治癒した。症例2は3才弟。姉の発症6週後に, 頭頂部に落屑性脱毛局面を生じた。初診時頭頂部に細かい鱗屑を付着した鶏卵大の不完全脱毛巣があつた。ト反は陰性であつた。同様に小胞子菌性寄生を認め, M. canisを分離した。頭部浅在性白癬と診断し, グリセオフルビン内服で治癒した。ヘアーブラシ法による検索では, 両例ともに全部のスパイクから菌が生えた。また洗髪の前後では, 洗髪後に菌量の減少をみた。両親は病巣はなかつたが, 頭髪よりともに同菌を検出した。とくに治療しなかつたが, 4週後には陰性化し, 発病しなかつた。さらに初診の診察後の医師の頭髪より, 同菌を検出したが, 翌日には陰性化した。以上よりM. canis感染症では家族などの病巣のない頭髪より菌が分離されるが, 成人では治療の必要がないこと, 頭部白癬患者は空中に菌を散布しており, 直接の接触がなくても, 他人の頭髪に付着すること, 感染予防に頭部白癬患者の洗髪もある程度有用であることなどがわかつた。

ALLの強化療法中の17才女子に生じた原発性皮膚クリプトコックス症を報告した。症例は8年前よりALLに罹患していた。PVDAによる強化療法のため入院中に右1指に外傷を受け, 数日後血疱を生じた。初診時右1指尖は発赤, 腫脹し, 痂皮を付着した易出血性の米粒大までの肉芽腫性丘疹が数個みられた。リンパ節は触知しなかつた。組織片と痂皮よりCryptococcus neoformans(serotype D)を分離した。喀痰, 血液, 髄液の培養は陰性であつた。また胸部レ線と髄液に異常なく, 髄液のクリプトコックス抗原, 抗体と血清中の同抗体は陰性であつた。OKT4/OKT8比は逆転し, ツ反とSKSDは陰性であつた。病理組織学的には潰瘍を伴う慢性肉芽腫像で, PASとムチカルミン染色で菌要素を多数認めた。5FCとmiconazole Fを併用したところ一旦は皮疹が消退したが, 2週後に生検瘢痕部両端に丘疹を生じた。しかし以後5FC内服のみ行つたところ, 約12週で治癒し, 治療を中止したが再発していない。自験例は皮膚原発性と考えられたが, 基礎疾患があるのはまれである。また菌株の血清型がD型の症例は文献的に5例あるが, すべて皮膚からの分離であり, D型の菌株は皮膚に病巣を生じやすく, 全身的感染を起こしにくいと考えられた。

癜風の真菌学的な治療効果判定を直接鏡検とともに培養を用いて行い, 併せて再発率について検討した. 癜風140例と健常人56例を対象とした. 治療は1～4週間行い, 治療中止後約1ヵ月毎に再発の有無を検査し, 培養を行った. 結果は最終の直接鏡検陽性率が8/129 (6.2%) であるのに対し, 培養陽性率は37/90 (41.1%) と高値であった. 使用薬剤別ではイミダゾール系のクリームが最も良好で, 液剤は劣った. 再発率は1ヵ月以内7/48 (14.6%), 2ヵ月以内10/37 (27.0%) であったが, 3ヵ月以内では17/33 (51.5%) と上昇し, 6ヵ月以内では22/34 (64.7%) と極めて高値であった. 治療中止時 (直接鏡検は陰性) の培養陰性例では2ヵ月以内の再発率は1/15 (6.7%) と低いが, 6ヵ月以内では8/12 (66.7%) であった. 治療後 (非再発例) の培養成績は1ヵ月後22/32 (68.8%), 2ヵ月後13/23 (56.5%) で, 3ヵ月後には10/12 (83.3%) と高値になった. 以上より治療効果判定には直接鏡検とともに培養も重要であること, 再発率は極めて高く, 治療中止時の培養成績は早期再発率に大きく関係すること, 治療中止後の培養陽性率は非再発例においても3ヵ月以後は高いことなどがわかった.