Panackal Anil A, Halpern Elkan F, Watson Alice J
Department of Ambulatory Care and Prevention, MGH Institute for Technology Assessment, Center for Connected Health, Partners Healthcare, Harvard Medical School, Boston, Massachusetts 02215, USA.
Int J Dermatol. 2009 Jul;48(7):704-12. doi: 10.1111/j.1365-4632.2009.04025.x.
Dermatophyte infections lead to high costs and differentially affect certain groups. Previous population studies have been limited in size, duration, and representativeness.
Using the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (1995-2004), a cross-sectional analysis of ambulatory visits in the USA was performed. Outpatients presenting with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded diagnoses of tinea unguium, tinea corporis/manuum, tinea pedis, tinea capitis, and tinea cruris were identified. Trends, descriptive epidemiology, and point prevalence estimates for these conditions were determined using stratification and standardization.
There was an estimated average of 4,124,038 +/- 202,977 annual visits for dermatophytoses during the study period. Tinea unguium, tinea corporis, tinea pedis, tinea capitis, and tinea cruris represented 23.2%, 20.4%, 18.8%, 15.0%, and 8.4%, respectively, of such infections; 71.6% of tinea unguium visits occurred among those older than 45 years. Tinea capitis was significantly more common among the black than the white population (prevalence odds ratio = 12.4; 95% confidence interval, 9.9-15.7). Ineffective treatment of tinea pedis, tinea corporis, and tinea cruris with polyenes, such as nystatin, commonly occurred.
Improved healthcare provider education is needed to ensure judicious antidermatophyte drug management. Further studies, including proven diagnoses via fungal microscopy and culture, are needed to explain the prevalence discrepancy of tinea capitis among black children and tinea unguium in older adults, focusing on preventable risk factors.
皮肤癣菌感染导致高昂成本，并对某些群体产生不同影响。以往的人群研究在规模、持续时间和代表性方面存在局限性。
利用国家门诊医疗护理调查（NAMCS）和国家医院门诊医疗护理调查（NHAMCS）（1995 - 2004年），对美国门诊就诊情况进行横断面分析。识别出具有国际疾病分类第九版临床修订本（ICD - 9 - CM）编码诊断的甲癣、体癣/手癣、足癣、头癣和股癣的门诊患者。使用分层和标准化方法确定这些疾病的趋势、描述性流行病学和点患病率估计值。
在研究期间，估计每年因皮肤癣菌病就诊的平均次数为4,124,038 ± 202,977次。甲癣、体癣、足癣、头癣和股癣分别占此类感染的23.2%、20.4%、18.8%、15.0%和8.4%；71.6%的甲癣就诊发生在45岁以上人群中。头癣在黑人中比在白人中明显更常见（患病率比值比 = 12.4；95%置信区间，9.9 - 15.7）。用制霉菌素等多烯类药物治疗足癣、体癣和股癣无效的情况很常见。
需要加强医疗服务提供者的教育，以确保明智地管理抗皮肤癣菌药物。需要进一步开展研究，包括通过真菌显微镜检查和培养进行确诊，以解释黑人儿童头癣和老年人甲癣患病率差异的原因，重点关注可预防的危险因素。
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