Old Article: https://www.ektaavadgama.com/post/coexistence-of-onychomycosis-and-tinea-pedis-in-patients-with-diabetes
So I was lucky enough to have people within the field reach out toe to me send me articles that will help with my article regarding the coexistence of O/M and Tinea Pedis in patients with diabetes and this tangent induced article was the love child, so have fun and also check out the articles I’ve referenced!
An aspect that hadn’t occurred to me was the important role that peripheral arterial disease and venous insufficiency play in onychomycosis (Fuat, et al., 2013). Fuat et al., discuss the thought of vascular problems being a contributing factor to onychomycosis, a condition for something to exist if you will. The study aimed to find the correlation between patients that have asymptomatic peripheral arterial disease and chronic venous insufficiency and onychomycosis. The article will be attached in my references so you can take a look at the results if that tickles your fancy, however, I’m keen on their discussion points! So let's get into it!
The discussion by Fuat et al., 2013 interestingly enough also bring up another study conducted by Gupta et al., that discuss PAD which I’ve also referenced as I bring their study up as well in terms of the epidemiology of onychomycosis and contributing factors (Gupta, et al., 2000). Common predisposing factors of onychomycosis are age, genetics, trauma, diabetes mellitus, immunosuppression and peripheral arterial disease (Fuat, et al., 2013). An interesting point brought up by Fuat et al., 2013 is that ABI as a measuring tool can be a little restrictive in terms of finding accuracy in patients with too much stiffness due to calcification and can interrupt detection for peripheral arterial disease amongst diabetic patients and older patients (Fuat, et al., 2013).
Since onychomycosis is a prevalent occurrence among the older diabetic population, Fuat et al., determined that using a duplex would be a better choice for detecting angiographic changes, in their study (Fuat, et al., 2013). To summarize their findings, otherwise, I’ll honestly be here all day! They found that a) men with peripheral arterial disease had higher frequencies of onychomycosis; b) patients with venous insufficiency also reported a higher frequency of onychomycosis; c) Chronic Venous Insufficiency tended to be an independent predisposing factor for the development of Onychomycosis.
Previous studies indicate a significant relationship between peripheral arterial disease and onychomycosis however, the study conducted by Fuat, et al., showed that there was enough evidence in their results to show that there is also a significant relationship between venous insufficiency and onychomycosis, but a larger study needs to be conducted as well on this subject (Fuat, et al., 2013) (Gupta, et al., 2000)
Another great insight into what’s spurred this rabbit-hole adventure is the incidence rate of onychomycosis and tinea pedis in patients with interdigital macerations. In a prospective study conducted by Legge et al., 2008, we are shown the evidence of treating patients with interdigital macerations with an anti-fungal agent due to the incidence rate of patients getting a fungal infection. Their study also showed the likelihood of an increase in fungal culture in younger diabetic patients than those with asymptomatic interdigital maceration (Legge, et al., 2008). So why? I believe the answer lies in the way the dermatophytes function, and the impact they have on keratinocytes (Weitzman & Summerbell, 1995).
Weitzman & Summerbell, discuss the enzymes produces by certain fungi that facilitate the degradation of keratin by the production of keratinase (Weitzman & Summerbell, 1995). If we take a look at T.Rubrum, an important fungi to podiatry students because it’s the colonizing dermatophyte in athletes feet, they produce 2 keratolytic proteinases; in studies conducted regarding T.Rubrum, it was found that a proteinase was found to have a pH of 4.5 whereas human skin has an acid mantle between 4-6 (Ohman & Vahlquist, 1995). It’s interesting to note different aspects of contributing factors, but it’s also nice going down a rabbit hole, unprovoked because you can learn new (and some not so new) things whilst you’re on break from Uni.
I have absolutely no clue how I ended up on the subject of skin pH, and I’m not sure if this is much of an update if I’m being honest but these are the joys of going off on tangents and I implore all students to do so! Especially if you’re a nosey person like I am!
References
Fuat, O. et al., 2013. Frequency of Peripheral Arterial Disease and Venous Insufficiency in toenail onychomycosis. The Journal of Dermatology, Volume 40, pp. 107-110.
Gupta, A. K. et al., 2000. The Epidemiology of Onychomycosis: possible role of smoking and peripheral arterial disease. European Academy of Dermatology and Venereology JEADV, Volume 14, pp. 466-469.
Gupta, A. K. et al., 1998. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. British Journal of Dermatology, Volume 139, pp. 665-671.
Legge, B. S., Grady, J. F. & Lacey, A. M., 2008. The incidence of Tinea Pedis in Diabetic versus Nondiabetic patients with interdigital macerations. Journal of American Podiatric Medical Association, 98(5), pp. 353-356.
Ohman, H. & Vahlquist, A., 1995. In vivo studies concerning a pH gradient in human stratum corneum and upper epidermis. Acta dermato-venereologica, 74(5), pp. 375-379.
Poradzka, A., Jasik, M., Karnafel, W. & Fiedor, P., 2013. Clinical Aspects of Fungal Infections in Diabetes. Acta Poliniae Pharmaceutica - Drug Research, 70(4), pp. 587-596.
Weitzman, J. & Summerbell, R., 1995. The Dermatophytes. Clinical Microbiology Reviews, 8(2), pp. 240-259.
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