Types and rates of fungal infections vary among groups and treatment is often suboptimal

Patient Safety and Quality
Types and rates of fungal infections vary among groups and treatment is often suboptimal

Superficial fungal infections can affect the scalp (e.g., ringworm), feet (e.g., athlete's foot), nails, and the groin area (e.g., jock itch), among other parts of the body. A new study finds population-based differences in who is affected by such infections. What's more, those who have them may not be getting optimal treatment from their health care providers.

The study found more than 4 million health care visits each year from 1995 to 2004 for superficial fungal infections. Most visits were for infections of the nails (23.2 percent), followed by skin (20.4 percent), and feet (18.8 percent). Most nail infections (71.6 percent) affected individuals older than 45 years. More men had foot infections than women, perhaps related to men's greater participation in manual labor and sports. These activities involve wearing shoes for long periods, which increases the risk of such infections. Blacks, particularly poor school-aged children, were more likely to have scalp fungal infections than whites.

Troubling was the fact that ineffective treatment was provided to patients with fungal infections of the feet, skin, and groin. For example, polyenes such as nystatin, are not effective against most tinea (ringworm) infections, but were commonly prescribed for tinea pedis (foot), tinea corporus (body), and tinea cruris (groin/perineum). According to the researchers, better health care provider education is needed to help with the correct diagnosis, treatment, and prevention of these various fungal conditions. Their findings were based on analysis of data on outpatient visits, including patient characteristics, geographic region, diagnosis codes for common fungal infections, and the antifungal drugs used to treat them from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The study was supported in part by the Agency for Healthcare Research and Quality (HS14563).

See "Cutaneous fungal infections in the United States: Analysis of the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 1995-2004," by Anil A. Panackal, M.D., F.A.C.P., Elkan F. Halpern, Ph.D., and Alice J. Watson, M.D., M.P.H., in the International Journal of Dermatology 48, pp. 704-712, 2009.