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Evaluation of the relationship between fungal infections of the feet, cellulite and diabetes.

Some study suggest that fungal infection of the feet is a factor in the appearance of cellulite on the lower membranes, but further research to confirm these findings are required and to quantify the risk posed by fungi, particularly for patients with diabetic foot.

Introduction

Diabetic patients have a higher risk of developing infections. Cellulite is a serious infectious disease of the skin or subcutaneous tissue that commonly affects the lower points. The condition is common in older adults and can often be the cause of prolonged hospitalization of diabetics.

Fungal infections of the feet are very common inflammatory diseases. Studies have shown an increased incidence of fungal infections of the skin and nails in diabetics.

Fungal invasion of the corneal layer can lead to the appearance of clinical signs of disease with cracked skin that provide a gateway for bacteria and favor the appearance of cellulite. Although ringworm infection is frequently mentioned in literature as a risk for cellulite, few studies have attempted to quantify this risk.

Drs. Spruce MC Bristow IR carried out a review to assess the relationship between fungal infection of the feet (tinea pedis and onicomicosisungueal) and cellulitis of the low extremities, so as to determine the possible consequences in diabetics.

Methods

In order to prepare this study, a structured review of the databases MEDLINE, EMBASE and CINHAL was conducted to identify publications that investigated the role of fungal infection of the feet as a risk factor for the appearance of cellulitis. The keywords for the search were erysipelas, cellulitis, leg, foot, feet, pre-tibial lower limb, tineapedis, mycosis, onychomycosis, dermatophytes, fungal and skin. The search was pointed out by the addition of the words diabetes and hyperglycemia. Of the 103 studies initially found, a manual selection was performed to determine those that arose in the fungal infection as a risk factor of cellulite. Only 16 studies met these requirements, given the different designs, it was not possible to conduct a meta-analysis, so it was decided to do a semi quantitative analysis of the evidence.

Results

All documents reviewed, the diagnosis of cellulites was based on clinical appearance. The presence of fungal infection was established through studies by microscopy and culture of the lesions was performed in only three of the studies. Only 2 of the research used a prospective case-control with full laboratory tests for diagnosis of fungal infection. The first study compared 243 cases of cellulites with 467 control subjects, with microbiological testing to determine the presence of dermatophytes. The infection rate was significantly higher in patients with cellulites (56.1%) than in controls (36.4%). Moreover, the results showed that fungal infection of the feet was a significant risk factor for cellulites, a risk which manifested in interdigital mycoses, onychomycosis and sole infection. The second study compared 100 patients with mycosis of the foot with 200 control subjects. The analysis of fungal cultures demonstrated a positive relationship between the dermatophytes infection and cellulites.

In other studies, the majority established the presence of ringworm infection from clinic rather than through microbiological evaluation methods. Three studies established a significant relationship between the sites of fungal infection and the appearance of cellulites. In 5 studies the recurrent cellulites was analyzed, and in 4 of them the conclusion was that a yeast infection is a risk factor for cellulites. Only 1 study found no relationship between fungal infection of the skin and cellulites, but it was established a relationship with onychomycosis.

In 8 of 9 studies it was not found a relationship of this disease to diabetes, while one was found that type 2 diabetes is a significant risk factor for recurrence of cellulites.

Discussion

Although most studies suggest a relationship between these diseases, only two case-control studies used microbiological diagnostic methods to demonstrate that fungal infection was a risk for the appearance of cellulites in the legs, especially when the infection was found between the toes. There was little information that claimed that fungal infection is an increased risk for diabetics.

The revised data suggested that ringworm is just one of the possible factors that may favor the appearance of cellulites. Other identified risk factors included lymphedema, the saphenous, ulcers and injuries. However, fungal infections of the feet are likely to be changed more easily, by the simplicity and effectiveness of treatments, even in diabetics.

Conclusion

Fungal infections of the feet are common conditions that have been identified as a risk factors for bacterial cellulitis of the lower limbs. In this review, only 2 case-control studies well designed showed enough evidence to suggest that the fungal infection of the feet is a risk factor. More studies with adequate research designs are needed to determine whether the risk is higher in diabetics. Meanwhile, it should encourage health professionals to provide better monitoring and treatment of ringworm infections of the feet to reduce potential complications.

 
Bristow IR, Spruce MC.

Fungal foot infection, cellulitis and diabetes: a review

Diabet Med 26(5):548-551, 2009