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The prevalence of type 2 diabetes mellitus (DM) is increasing. Diabetic patients have a higher risk of getting dermatomycosis. Dermatomycoses, although a common health problem amongst DM, is often misdiagnosed and consequently undertreated. Studies on the association between dermatomycosis and type 2 diabetes are lacking, especially in Indonesia. Therefore, the aim of this study was to determine the prevalence, etiology, and association of dermatomycosis with diabetic control of type 2 DM.
A cross-sectional study was performed involving 87 subjects with type 2 DM. Demographic and clinical data, including age, sex, and blood glucose level, were collected. If a dermatomycosis lesion was found, a specimen would be taken for identification. Determination of serum glucose level was conducted using Roche c111 analyzer®. Statistical analysis was performed with the chi-square test and Kolmogorov-Smirnov two-independent sample test.
Seventeen (19.55%) subjects had dermatomycosis. The predominant age group affected was 51 - 60 years (42.4%). The number of clinically apparent dermatomycosis was greater in the uncontrolled than in the controlled blood sugar group, but the difference was statistically not significant (p > 0.05). The lesions were mostly found on the nails (74%) and the most common etiology was candida (50%) followed by dermatophyte (25%) and non-dermatophyte molds (25%).
Uncontrolled blood sugar tends to increase the risk of dermatomycosis in type 2 DM patients. Fungal skin infections are common in type-2 DM patients, especially in those with poor glycemic control.
Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81. doi: 10.1016/j.diabres.2018.02.023.
Soelistijo SA, Novida H, Rudijanto A, et al. Konsensus: pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia. 1st ed. Jakarta: PB Perkeni; 2015.
Schieke SM, Garg A. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw Hill; 2012.
Havlickova B, Czaika VA, Fredrich M. Epidemiological trends in skin mycosis worldwide. Mycosis 2008;51:2-15. doi: 10.1111/j.1439-0507.2008.01606.
Hayette MP, Sacheli R. Dermatophytosis, trends in epidemiology and diagnostic approach. Curr Fungal Infect Rep 2015;9:164-79. doi: 10.1007/s12281-015-0231-4.
Mehlig L, Garve C, Ritschel A, et al. Clinical evaluation of a novel commercial multiplex-based PCR diagnostic test for differential diagnosis of dermatomycoses. Mycoses 2014;57:27-34. doi: 10.1111/myc.12097.
Nenoff P, Kruger C, Ginter-Hanselmayer G, et al. Mycology - an update. Part 1: dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014;12:188-212. doi: 10.1111/ddg.12245.
Qadim HH, Golforoushan F, Azimi H, et al. Factors leading to dermatophytosis. Ann Parasitol 2013;59:99-102.
Parada H, Veríssimo C, Brandão J, et al. Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation. Rev Iberoam Micol 2013;30:103–8. doi: 10.1016/j.riam.2012.09.007.
Powers AC. Diabetes mellitus. In: Jameson JL, editor. Harrison’s endocrinology. 2nd ed. New York: McGraw Hill;2010.p.267-313.
Ngwogu A, Ngwogu K, Mba I, et al. Pattern of presentation of dermatomycosis in diabetic patients in Aba, South-eastern, Nigeria. J Med Investigations Pract 2014;9:10-3. doi: 10.4103/9783-1230.139164.
Akkus G, Evran M, Gungor D, et al. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers: a cross sectional - observational study. Pakistan J Med Sci 2016;32:891-5. DOI: 10.12669/pjms.324.10027.
Ghannoum M, Isham N. Fungal nail infections (onychomycosis): a never-ending story? PLoS Pathog 2014;10:e1004105. doi: 10.1371/journal.ppat.1004105.
Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician 2013;88:762–70.
Mayser P, Freund V, Budihardja D. Toenail onychomycosis in diabetic patients: issues and management. Am J Clin Dermatol 2009;10:211-20. doi: 10.2165/00128071-200910040-00001.
Thomas J, Jacobson GA, Narkowicz CK, et al. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 2010;35:497-519. doi: 10.1111/j.1365-2710.2009.01107.x.
Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol 2010;28:160-3. doi: 10.1016/j.clindermatol.2009.12.009.
Baudraz-Rosselet F, Ruffieux C, Lurati M, et al. Onychomycosis insensitive to systemic terbinafine and azole treatments reveals non-dermatophyte moulds as infectious agents. Dermatology 2010;220:164-8. doi: 10.1159/000277762.
Hashemi SJ, Gerami M, Zibafar E, et al. Onychomycosis in Tehran: mycological study of 504 patients. Mycoses 2010;53:251-5. doi: 10.2165/00128071-200910040-00001.
Farwa U, Abbasi SA, Mirza IA, et al. Non-dermatophyte moulds as pathogens of onychomycosis. J Coll Physicians Surg Pakistan 2011;21:597-600. doi: 10.2011/JCPSP.597600.
Cappuccino JG. Welsh C. Microbiology, a laboratory manual. 11th ed. Harlow: Pearson; 2017.
Klaassen KM, Dulak MG, van de Kerkhof PC, et al. The prevalence of onychomycosis in psoriatic patients: a systematic review. J Eur Acad Dermatol Venereol 2014;28:533-41. doi: 10.1111/jdv.12239.
Archana BR, Beena PM, Kumar S. Study of the distribution of malassezia species in patients with pityriasis versicolor in Kolar Region, Karnataka. Indian J Dermatol 2015; 60:321. doi: 10.4103/0019-5154.156436.
Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502. doi: 10.1016/j.jaad.2011.02.038.
Reddy KN, Srikanth BA, Sharan TR, et al. Epidemiological, clinical and cultural study of onychomycosis. Am J Dermatology Venereol 2012;1:35-40. doi: 10.5923/j.ajdv.20120103.01.
Neupane S, Pokhrel DB, Pokhrel BM. Onychomycosis: a clinico-epidemiological study. Nepal Med Coll J 2009;11:92-5.
de Macedo GMC, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol Metab Syndr 2016;8:63. doi: 10.1186/s13098-016-0176-y.
Sugandhi P, Prasanth DA. Prevalence of yeast in diabetic foot infections. Int J Diabetes Dev Ctries 2017;37:50-7. doi: 10.1007/s13410-016-0491-8.
Lima AL, Illing T, Schliemann S, et al. Cutaneous manifestations of diabetes mellitus: a review. Am J Clin Dermatol 2017;18:541-53. doi: 10.1007/s40257-017-0275-z.
Tzar M, Zetti Z, Ramliza R. Dermatomycoses in Kuala Lumpur, Malaysia. Sains Malaysiana 2014;43:1737-42.
Thilak S, Anbumalar M, Sneha PM. Cutaneous fungal infections in subjects with diabetes mellitus. Int J Res Dermatol 2017;3:55-8. DOI: http://dx.doi.org/10.18203/issn.2455-4529. Int J Res Dermatol 2016;44:12.
Santhosh Y, Ramanath K, Naveen M. Fungal infections in diabetes mellitus: an overview. Int J Pharm Sci Rev Res 2011;7:221-5.