**4. Conclusion**

46 Epidemiology Insights

Most dermatophytes can infect hair, the exceptions are, however, some species such as *Epidermophyton floccosum*, *Trichophyton rubrum*, *Trichophyton interdigitale*. Conversely, some dermatophytes (*Microsporum audouinii*, *Trichophyton schoenleinii*, *Trichophyton violaceum*) have a strong affinity for hair structures. It was found that all the dermatophytes, which cause fungal infections of the scalp can also infect glabrous skin (Kobierzycka et al., 2005). Pathogens that cause *tinea capitis* differs between countries and geographic regions. In recent years, it has been observed in most European countries, an increase in the frequency of infections caused by *Microsporum canis*, whereas in the U.S. urban environments - a larger share *Trichophyton tonsurans* was seen (Elewski, 2000b). Mycosis of the scalp concerns mainly children. Peak incidence falls on 4 – 6 years of age, and the infection is spreading especially in boys. Higher incidence of fungal infections in children is associated with the difference of biological characteristics of the skin, including the different composition of sebum in children and adults (Szepietowski & Baran, 2005).

In a study of Lange *et al*, of the pediatric population in the region of Gdansk (midsouthern Poland), fungal infections of skin were usually caused by dermatophytes, which accounted for 60% of all infections. The highest incidence of skin fungal infections was observed in children aged 4-7 years. In this age group, the lesions caused by *Microsporum canis* affected the scalp. In slightly older children, aged 8-12 years, the number of infections of the scalp decreased rapidly, and over 13 years of age lesions in this location rarely have been observed. Most common form of fungal infection, that was seen in the pediatric population studies, was fungal infection of the glabrous skin (30%), mostly caused by *Microsporum canis*, rarely by *Trichophyton mentagrophytes* and by *Trichophyton rubrum*, occurring most often in children aged 8 - 15 years. It is interesting that in children above 12 years of age athlete's foot was also observed (11%), in most cases caused by *Trichophyton rubrum* and *Trichophyton mentagrophytes*, and also fungal infections of the toenails (8%) caused by *Trichophyton rubrum* were seen (Lange et al., 2002). Similar results were obtained in the studies of pediatric patients in the region of Poznan (Central-West Poland) (Zaba &

Many authors underline the rarity of these forms of mycoses in children before puberty, in contrast to the fungal infections of glabrous skin and scalp, considered to be typical for the childhood. Accepted view is that the athlete's foot and onychomycosis are very common skin and nails diseases in adults, and their incidence increases with age. However, epidemiological studies on the population of children of different ages and in different regions of the world indicate that the athlete's foot may relate to 2.2-8.2% of the pediatric population (Lange & Bykowska, 2004) In addition, there are also cases of athlete's foot in pediatric patients like *tinea incognito*, proceeding without symptoms or mistakenly acknowledged as bacterial lesions or allergic changes and treated with antibiotics or topical

Studies of Lange and Bykowska on recognition of fungal infections in pediatric patients in years 1993-2002 showed an increase in the prevalence rates of onychomycosis in children (Lange & Bykowska, 2004). In the literature, individual national studies of mycoses of the feet and toenails in children and adolescents refers to the area of Wroclaw (Lower Silesia, southwestern Poland), where there has been considerable percentage of fungal infection of the feet and toenails in children under 15 years of age (16.3% and 21%, respectively)

Danczak-Pazdrowska, 2001).

cortycosteroids (O`Grady & Sahn, 1999).

(Szepietowski, 1997).

Fungal infections are a serious problem - not only clinical, but also therapeutic and social. Fungi are widespread in the environment of human life, are ubiquitous, so the disorders caused by them could be classified as a lifestyle diseases, affecting people independtly of age, sex, race or social status. Fortunately, our knowledge about these parasites of the skin and its appendages is growing, new therapies and new methods of treatment of fungal diseases are developed, which allows us to effective protection against these pathogens.
