title: Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional - observational study.
abstract: OBJECTIVE
  Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer.
  
  
  METHODS
  We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection.
  
  
  RESULTS
  Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05).
  
  
  CONCLUSIONS
  Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers.
authors.affiliation: Dr. Gamze Akkus, M.D. Specialist in Internal Medicine, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Akkus
authors.affiliation: Dr. Mehtap Evran, M.D. Specialist in Internal Medicine and Endocrinology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Evran
authors.affiliation: Dr. Dilek Gungor, M.D. Research Assistant in Dermatology, Department of Dermatology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Gungor
authors.affiliation: Prof. Dr. Mehmet Karakas, M.D. Specialist in Dermatology, Department of Dermatology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karakas
authors.affiliation: Prof. Dr. Murat Sert, M.D. Specialist in Internal Medicine and Endocrinology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sert
authors.affiliation: Prof. Dr. Tamer Tetiker, M.D. Specialist in Internal Medicine and Endocrinology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Tetiker
keywords: Diabetes mellitus; Diabetic foot ulcer; Onychomycosis; Tinea pedis