On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.84 no.5 Rio de Janeiro Sept./Oct. 2009
Kátia Sheylla Malta PurimI; Camila Fernanda Novak Pinheiro de FreitasII; Neiva LeiteIII
IPh.D. in Dermatology, Universidade
Federal do Paraná. Dermatologist and collaborating professor of Undergraduation
and Graduation, Department of Clinical Practice, focus on Dermatology, Hospital
de Clinicas, Universidade Federal do Paraná (UFPR) Curitiba (PR),
IIUndergraduate, Medical School, Universidade Federal do Paraná (UFPR) Curitiba (PR), Brazil
IIIPh.D. in Pediatrics. Master in Rehabilitation. Joint Professor, Department of Physical Education, Universidade Federal do Paraná (UFPR) Curitiba (PR), Brazil
Athletes present risk of cutaneous mycosis. A study was carried out with 23 soccer players using clinical and mycological examination (direct microscopic examination and culture) and nail clipping. Eighteen (78.26%) did not present mycosis; two (8.70%) presented tinea pedis, and three (13.04%) presented onychomycosis associated to tinea pedis, mainly for Trichophyton mentagrophytes. Infected tinea pedis has produced cellulitis in one of the athletes. It is necessary to create an educative program of skin care during sports practice.
Keywords:Foot dermatoses; Onychomycosis; Tinea pedis
Cutaneous mycosis is normally associated with sport practice, but in the literature there are few studies in the population that practices sports as an occupation. In soccer playing, tinea pedis, especially when infected or associated with onychomycosis, goes beyond the individual subject and reflects the collective environment, which is essential for prevention purposes 1-4.
This transversal and descriptive survey approved by the Ethics Committee of HC-UFPR, it assessed the prevalence of feet dermatophytosis in 23 male players of professional soccer in Curitiba (PR), using direct mycological exams and feet culture: nails, plantar region and interdigital area, and histopathological exam of nail fragment, stained with PAS by digestion 5.
The athletes were aged between 18 and 30 years (mean age 23.48 γ 3.06), weight 75.57 γ 6.29 kg, height 1.79 γ 0.05 meters, time in the job 6.13 γ 2.77 years, and ten were Caucasian (43.48%), nine were mixed Brazilian (39.13%), and four were Black-descendants (17.39%). They came from the South (39. 13%) and Southeast (21.74%) of the country. Eighteen athletes (78.26%) had taken 4 to 8 years of regular schooling; four athletes (17.39%) had complete high school education, and one (4.35%) was studying Physical Education at university.
Three cases (13.04%) presented onychomycosis, associated with tinea pedis, and two (8.70%) had only tinea pedis. All cases of onychomycosis were associated with interdigital tinea pedis (Table 1).
In two cases (9.09%), direct mycological exam showed dermatophyte in the plantar region, in two cases (9.09%), in the foot interdigital area, and in one case (4.54%) in the toe nail. Histopathological examination of nail clipping was positive in two cases (9.09%). In four cases (18.18%), the culture of the interdigital region of the foot was positive and in two cases (9.09%) it was positive for the toe nails, and one athlete had positive culture in the interdigital region and the nail (Table 2).
In our study, the percentage of tinea pedis cases (21.74%) was lower than the results reported by the Brazilian project Achilles6,7. Trichophyton mentagrophytes (60%) was the main etiological agent, followed by Trichophyton rubrum in 20%. In two cases with tinea pedis (8.70%) there was history and previous diagnosis of mycoses. One athlete was excused from the games because of lower limb cellulitis caused by infected tinea pedis, generating added costs and individual and collective adaptations. Frequent exchange of shoes and equipment in the team has probably minimized the conditions for the development of fungi.
In the three athletes (13.04%) with onychomycosis associated with tinea pedis, the halux was the most affected site, which is a common finding 2,7.
There were more positive results of the direct examination (66.7% p=0.0344) and the culture (66.7% p=0.0119) in the interdigital region of the athletes that did not dry regularly their feet, and Trichophyton mentagrophytes was the most prevalent agent .7 Nail keratin histological test complemented the mycological investigation and presented positive correlation with the results 5.
Calluses (95%) and blisters (26%) together pointed to a number of attributes that could be named tinea pedis. The anatomical-functional clinical characteristics of the athletes feet (deviation of the toes and halux valgus), emphasized by specific working conditions (gestures, positions, movement, efforts, rhythms, different aggressive factors) had been directly and indirectly caused, maintained or aggravated by the professional activity.
The limitation of the study was its small number of cases. Complementary investigations may better elucidate the relationships with fungal infections in soccer.
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Kátia Sheylla Malta Purim
Hospital de Clínicas da UFPR
Serviço de Dermatologia
Rua General Carneiro, 180 Centro
80060 150 Curitiba, Paraná
Tel./Fax: +55(41) 33601800
Conflict of interest: None
Financial funding: None
How to cite this article: Purim KSM, Freitas CFNP, Leite N. Dermatofitoses podais em futebolistas. An Bras Dermatol. 2009;84(5):550-2.