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

Authors

  • Anil A. Panackal MD, FACP,

    1. From the Department of Ambulatory Care and Prevention, MGH Institute for Technology Assessment, and Center for Connected Health, Partners Healthcare, Harvard Medical School, Boston, Massachusetts
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  • Elkan F. Halpern,

    1. From the Department of Ambulatory Care and Prevention, MGH Institute for Technology Assessment, and Center for Connected Health, Partners Healthcare, Harvard Medical School, Boston, Massachusetts
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  • Alice J. Watson MD, MPH

    1. From the Department of Ambulatory Care and Prevention, MGH Institute for Technology Assessment, and Center for Connected Health, Partners Healthcare, Harvard Medical School, Boston, Massachusetts
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Anil A. Panackal, MD, FACP Department of Ambulatory Care and Prevention Harvard Medical School 133 Brookline Avenue, 6th floor Boston, MA 02215
E-mail: apanacka@hsph.harvard.edu

Abstract

Background  Dermatophyte infections lead to high costs and differentially affect certain groups. Previous population studies have been limited in size, duration, and representativeness.

Methods  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.

Results  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.

Conclusions  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.

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