RESUMEN
Hair follicle-penetrating nanoparticles offer a promising avenue for targeted antibiotic delivery, especially in challenging infections like acne inversa or folliculitis decalvans. However, demonstrating their efficacy with existing preclinical models remains difficult. This study presents an innovative approach using a 3D in vitro organ culture system with human hair follicles to investigate the hypothesis that antibiotic nanocarriers may reach bacteria within the follicular cleft more effectively than free drugs. Living human hair follicles were transplanted into a collagen matrix within a 3D printed polymer scaffold to replicate the follicle's microenvironment. Hair growth kinetics over 7 days resembled those of simple floating cultures. In the 3D model, fluorescent nanoparticles exhibited some penetration into the follicle, not observed in floating cultures. Staphylococcus aureus bacteria displayed similar distribution profiles postinfection of follicles. While rifampicin-loaded lipid nanocapsules were as effective as free rifampicin in floating cultures, only nanoencapsulated rifampicin achieved the same reduction of CFU/mL in the 3D model. This underscores the hair follicle microenvironment's critical role in limiting conventional antibiotic treatment efficacy. By mimicking this microenvironment, the 3D model demonstrates the advantage of topically administered nanocarriers for targeted antibiotic therapy against follicular infections.
Asunto(s)
Antibacterianos , Folículo Piloso , Impresión Tridimensional , Rifampin , Staphylococcus aureus , Folículo Piloso/microbiología , Folículo Piloso/efectos de los fármacos , Humanos , Antibacterianos/farmacología , Antibacterianos/química , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Staphylococcus aureus/efectos de los fármacos , Rifampin/farmacología , Rifampin/uso terapéutico , Rifampin/administración & dosificación , Sistemas de Liberación de Medicamentos , Nanopartículas/química , Nanocápsulas/química , Infecciones Estafilocócicas/tratamiento farmacológicoRESUMEN
Cutibacterium acnes is an opportunistic pathogen recognized as a contributing factor to acne vulgaris. The accumulation of keratin and sebum plugs in hair follicles facilitates C. acnes proliferation, leading to inflammatory acne. Although numerous antimicrobial cosmetic products for acne-prone skin are available, their efficacy is commonly evaluated against planktonic cells of C. acnes. Limited research has assessed the antimicrobial effects on microorganisms within keratin and sebum plugs. This study investigates whether an antibacterial toner can penetrate keratin and sebum plugs, exhibiting bactericidal effects against C. acnes. Scanning electron microscopy and next-generation sequencing analysis of the keratin and sebum plug suggest that C. acnes proliferate within the plug, predominantly in a biofilm-like morphology. To clarify the potential bactericidal effect of the antibacterial toner against C. acnes inside keratin and sebum plugs, we immersed the plugs in the toner, stained them with LIVE/DEAD BacLight Bacterial Viability Kit to visualize microorganism viability, and observed them using confocal laser scanning microscopy. Results indicate that most microorganisms in the plugs were killed by the antibacterial toner. To quantitatively evaluate the bactericidal efficacy of the toner against C. acnes within keratin and sebum, we immersed an artificial plug with inoculated C. acnes type strain and an isolate collected from acne-prone skin into the toner and obtained viable cell counts. The number of the type strain and the isolate inside the artificial plug decreased by over 2.2 log and 1.2 log, respectively, showing that the antibacterial toner exhibits bactericidal effects against C. acnes via keratin and sebum plug penetration.
Asunto(s)
Acné Vulgar , Antibacterianos , Queratinas , Sebo , Sebo/metabolismo , Antibacterianos/farmacología , Humanos , Queratinas/metabolismo , Acné Vulgar/microbiología , Acné Vulgar/tratamiento farmacológico , Biopelículas/efectos de los fármacos , Viabilidad Microbiana/efectos de los fármacos , Propionibacteriaceae/efectos de los fármacos , Propionibacteriaceae/metabolismo , Propionibacteriaceae/genética , Propionibacterium acnes/efectos de los fármacos , Propionibacterium acnes/metabolismo , Folículo Piloso/microbiología , Folículo Piloso/metabolismo , Microscopía Electrónica de RastreoRESUMEN
Human skin forms a protective barrier against the external environment and is our first line of defense against toxic, solar, and pathogenic insults. Our skin also defines our outward appearance, protects our internal tissues and organs, acts as a sensory interface, and prevents dehydration. Crucial to the skin's barrier function is the colonizing microbiota, which provides protection against pathogens, tunes immune responses, and fortifies the epithelium. Here we highlight recent advances in our understanding of how the microbiota mediates multiple facets of skin barrier function. We discuss recent insights into pathological host-microbiota interactions and implications for disorders of the skin and distant organs. Finally, we examine how microbiota-based mechanisms can be targeted to prevent or manage skin disorders and impaired wound healing.
Asunto(s)
Interacciones Microbiota-Huesped , Microbiota , Piel , Epitelio/inmunología , Epitelio/microbiología , Folículo Piloso/inmunología , Folículo Piloso/microbiología , Interacciones Microbiota-Huesped/inmunología , Humanos , Piel/inmunología , Piel/microbiología , Enfermedades de la Piel/inmunología , Enfermedades de la Piel/terapia , Cicatrización de Heridas/inmunologíaRESUMEN
BACKGROUND: Red scrotum syndrome is typically described as well-demarcated erythema of the anterior scrotum accompanied by persistent itching and burning. It is chronic and difficult to treat and contributes to significant psychological distress and reduction in quality of life. The medical literature surrounding the condition is sparse, with the prevalence likely under-recognized and the pathophysiology remaining poorly understood. Formation of a cutaneous microbial biofilm has not been proposed as an underlying etiology. Microbial biofilms can form whenever microorganisms are suspended in fluid on a surface for a prolonged time and are becoming increasingly recognized as important contributors to medical disease (e.g., chronic wounds). CASE PRESENTATION: A 26-year-old man abruptly developed well-demarcated erythema of the bilateral scrotum after vaginal secretions were left covering the scrotum overnight. For 14 months, the patient experienced daily scrotal itching and burning while seeking care from multiple physicians and attempting numerous failed therapies. He eventually obtained complete symptomatic relief with the twice daily application of 0.8% menthol powder. Findings in support of a cutaneous microbial biofilm as the underlying etiology include: (1) the condition began following a typical scenario that would facilitate biofilm formation; (2) the demarcation of erythema precisely follows the scrotal hairline, suggesting that hair follicles acted as scaffolding during biofilm formation; (3) despite resolution of symptoms, the scrotal erythema has persisted, unchanged in boundary 15 years after the condition began; and (4) the erythematous skin demonstrates prolonged retention of gentian violet dye in comparison with adjacent unaffected skin, suggesting the presence of dye-avid material on the skin surface. CONCLUSION: The probability that microorganisms, under proper conditions, can form biofilm on intact skin is poorly recognized. This case presents a compelling argument for a cutaneous microbial biofilm as the underlying cause of red scrotum syndrome in one patient, and a review of similarities with other reported cases suggests the same etiology is likely responsible for a significant portion of the total disease burden. This etiology may also be a significant contributor to the disease burden of vulvodynia, a condition with many similarities to red scrotum syndrome.
Asunto(s)
Biopelículas , Eritema/patología , Escroto/patología , Administración Cutánea , Adulto , Antipruriginosos/administración & dosificación , Antipruriginosos/uso terapéutico , Eritema/tratamiento farmacológico , Eritema/microbiología , Folículo Piloso/microbiología , Humanos , Masculino , Mentol/administración & dosificación , Mentol/uso terapéutico , Escroto/microbiologíaAsunto(s)
Proteínas Bacterianas/metabolismo , Folículo Piloso/microbiología , Lipasa/metabolismo , Infecciones Estafilocócicas/patología , Staphylococcus aureus/patogenicidad , Animales , Modelos Animales de Enfermedad , Folículo Piloso/metabolismo , Humanos , Ratones , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/enzimología , Triglicéridos/metabolismoRESUMEN
Folliculitis is a common skin disease, usually benign, which causes inflammation and eventual infections of hair follicles. They may have an infectious etiology, mainly due to the bacteria Staphylococcus aureus; it also occurs due to localized irritation, such as in areas of skin friction and for long periods of immersion in water, as in athletes and workers who are continuously exposed to the aquatic environment. Herein, we report on two fishermen, from fluvial and maritime environments, who presented with chronic aseptic folliculitis associated with daily immersion of their lower extremities while exercising the profession and that regressed when there was a decrease in their contact with water.
Asunto(s)
Foliculitis/microbiología , Foliculitis/patología , Folículo Piloso/microbiología , Infecciones Estafilocócicas/patología , Staphylococcus aureus/aislamiento & purificación , Adulto , Agua Dulce , Folículo Piloso/patología , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/microbiologíaRESUMEN
BACKGROUND: Although acne vulgaris has a multifactorial aetiology, comedogenesis and bacteria colonization of the pilosebaceous unit are known to play a major role in the onset of inflammatory acne lesions. However, many aspects remain poorly understood such as where and when is the early stage of the Propionibacterium acnes colonization in follicular unit? Our research aimed at providing a precise analysis of microcomedone's structure to better understand the interplay between Propionibacterium acnes and follicular units, and therefore, the role of its interplay in the formation of acne lesions. METHODS: Microcomedones were sampled using cyanoacrylate skin surface stripping (CSSS). Their morphology was investigated with multiphoton imaging and their ultrastructure with scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Bacterial lipase activity in the microcomedones was quantified using a dedicated enzymatic test as well as a Fourier Transform Infra-Red (FTIR) analysis. The porphyrin produced by bacteria was analysed with HPTLC and fluorescence spectroscopy. RESULTS: The imaging analysis showed that microcomedones' structure resembles a pouch, whose interior is mostly composed of lipids with clusters of bacteria and whose outer shell is made up of corneocyte layers. The extensive bacteria colonization is clearly visible using TEM. Even after sampling, clear lipase activity was still seen in the microcomedone. A high correlation, r = .85, was observed between porphyrin content measured with HPTLC and with fluorescence spectroscopy. These observations show that microcomedones, which are generally barely visible clinically, already contain a bacterial colonization.
Asunto(s)
Acné Vulgar/enzimología , Acné Vulgar/microbiología , Folículo Piloso/microbiología , Lipasa/metabolismo , Propionibacterium acnes , Acné Vulgar/diagnóstico por imagen , Humanos , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Microscopía de Fluorescencia por Excitación Multifotónica , Porfirinas/metabolismoRESUMEN
BACKGROUND: This study focused on the differences in hairy root fungal microecology between androgenetic alopecia patients and healthy individuals. METHODS: Light microscopy was used to observe the morphology of hairy roots. Morphological observations were also performed in the positive specimens using scanning electron microscopy and transmission electron microscopy. The high-throughput sequencing method was used to detect the fungal microecology of hairy roots at different sites. Moreover, the comparison of fungal loads of Malassezia in different group and scalp area were tested by PCR. RESULTS: The fungi in the hair root observed by optical microscopy are mainly Malassezia yeast. The positive rate of Malassezia in the hair loss group (60%) was higher than that in the control group (40%). The detection efficiency of Malassezia examined by scanning electron microscopy was higher than that by light microscopy. Results acquired from high-throughput molecular sequencing of fungi suggested that Ascomycota was the dominant species, whereas in the occipital hair roots of the control group Basidiomycota was the dominant species in the hair loss group. Malassezia followed by Trichosporon were the most abundant fungal genera. The changes in abundance at the top and occipital region of the control group were more significant than those of the genus Fusarium, followed by Epicoccum and Malassezia. The load of Malassezia located on calvaria in the alopecia group was significantly higher than that in the control group. In the alopecia group, the load of Malassezia on the scalp was higher than that on the occipital region. The load of Malassezia globosa and Malassezia restricta in the hair loss group was higher on calvaria and occipital areas. CONCLUSION: Malassezia had a positive correlation with the incidence of androgenic alopecia.
Asunto(s)
Alopecia/microbiología , Disbiosis , Hongos/clasificación , Hongos/aislamiento & purificación , Folículo Piloso/microbiología , Microbiota , Adulto , Femenino , Hongos/genética , Voluntarios Sanos , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Metagenómica , Microscopía , Reacción en Cadena de la PolimerasaRESUMEN
Androgenetic alopecia is the most common form of hair loss in males. It is a multifactorial condition involving genetic predisposition and hormonal changes. The role of microflora during hair loss remains to be understood. We therefore analyzed the microbiome of hair follicles from hair loss patients and the healthy. Hair follicles were extracted from occipital and vertex region of hair loss patients and healthy volunteers and further dissected into middle and lower compartments. The microbiome was then characterized by 16S rRNA sequencing. Distinct microbial population were found in the middle and lower compartment of hair follicles. Middle hair compartment was predominated by Burkholderia spp. and less diverse; while higher bacterial diversity was observed in the lower hair portion. Occipital and vertex hair follicles did not show significant differences. In hair loss patients, miniaturized vertex hair houses elevated Propionibacterium acnes in the middle and lower compartments while non-miniaturized hair of other regions were comparable to the healthy. Increased abundance of P. acnes in miniaturized hair follicles could be associated to elevated immune response gene expression in the hair follicle.
Asunto(s)
Alopecia/microbiología , Folículo Piloso/microbiología , Microbiota , Burkholderia/aislamiento & purificación , Femenino , Humanos , Inmunidad , Masculino , Propionibacterium/aislamiento & purificación , ARN Ribosómico 16S/análisisRESUMEN
Tinea barbae is a rare dermatomycocis, by definition follicular bound in the beard area of adult men. Manifestation usually starts with erythema accompanied by desquamation. Deeper distribution along terminal hairs leads to folliculitis with formation of pustules and nodes as well as abscesses; fixed adherent yellowish crusts may appear. Frequently there is locoregional swelling of the lymph nodes and occasionally a deterioration of general condition with (sub)febrile temperatures. Often this leads to the initial suspected diagnosis of a bacterial folliculitis barbae or impetigo contagiosa. Tinea barbae is mostly induced by species of the genus Trichophyton (T.). The pathogens are diverse and are mostly zoophilic, sometimes anthropophilic and rarely geophilic dermatophytes. With the help of a specific anamnesis and diagnostic procedure, including mycological examinations, histology and molecular detection of dermatophytes via polymerase chain reaction (PCR), tinea barbae-in our patient induced by T. mentagrophytes-can be rapidly diagnosed. Early initiation and adequate treatment duration lead to restitutio ad integrum.
Asunto(s)
Absceso/diagnóstico , Cara/microbiología , Foliculitis/microbiología , Folículo Piloso/microbiología , Tiña/diagnóstico , Trichophyton/aislamiento & purificación , Absceso/tratamiento farmacológico , Adulto , Antifúngicos/uso terapéutico , Arthrodermataceae , ADN de Hongos/genética , Cara/fisiopatología , Dermatosis Facial/microbiología , Foliculitis/diagnóstico , Foliculitis/tratamiento farmacológico , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Tiña/microbiología , Resultado del Tratamiento , Trichophyton/clasificación , Trichophyton/genéticaAsunto(s)
Foliculitis , Dermatosis del Cuero Cabelludo , Adulto , Edad de Inicio , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Biopsia , Enfermedad Crónica , Fármacos Dermatológicos/uso terapéutico , Estudios de Seguimiento , Folículo Piloso/microbiología , Folículo Piloso/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Favus is a type of dermatophytosis known to produce yellow scutula around hair follicles. Most cases of this disease worldwide are infections of Trichophyton schoenleinii. Favus has rarely been reported in Japan throughout the last four decades, and T. schoenleinii has not been clinically isolated in any case during the period. Here, we report a case of favus of vellus hair observed in a 63-year-old Japanese woman. Fungal culture showed negative; however, we detected fungal elements in the crust and hair bulbs by Grocott staining. Pathogenic fungi were identified as T. schoenleinii by polymerase chain reaction-based DNA sequencing, targeting the internal transcribed spacer regions of the rRNA gene using the formalin-fixed, paraffin-embedded tissue sample. She was successfully treated with p.o. administration of terbinafine and topical application of luliconazole cream.
Asunto(s)
Antifúngicos/uso terapéutico , Folículo Piloso/microbiología , Tiña Favosa/diagnóstico , Trichophyton/aislamiento & purificación , Femenino , Folículo Piloso/patología , Humanos , Japón , Persona de Mediana Edad , Tiña Favosa/tratamiento farmacológico , Tiña Favosa/microbiología , Resultado del TratamientoRESUMEN
Immune cells and epithelium form sophisticated barrier systems in symbiotic relationships with microbiota. Evidence suggests that immune cells can sense microbes through intact barriers, but regulation of microbial commensalism remain largely unexplored. Here, we uncovered spatial compartmentalization of skin-resident innate lymphoid cells (ILCs) and modulation of sebaceous glands by a subset of RORγt+ ILCs residing within hair follicles in close proximity to sebaceous glands. Their persistence in skin required IL-7 and thymic stromal lymphopoietin, and localization was dependent on the chemokine receptor CCR6. ILC subsets expressed TNF receptor ligands, which limited sebocyte growth by repressing Notch signaling pathway. Consequently, loss of ILCs resulted in sebaceous hyperplasia with increased production of antimicrobial lipids and restricted commensalism of Gram-positive bacterial communities. Thus, epithelia-derived signals maintain skin-resident ILCs that regulate microbial commensalism through sebaceous gland-mediated tuning of the barrier surface, highlighting an immune-epithelia circuitry that facilitates host-microbe symbiosis.
Asunto(s)
Linfocitos/inmunología , Glándulas Sebáceas/metabolismo , Glándulas Sebáceas/microbiología , Animales , Bacterias/metabolismo , Citocinas/metabolismo , Epitelio/inmunología , Folículo Piloso/metabolismo , Folículo Piloso/microbiología , Inmunidad Innata , Interleucina-7/metabolismo , Linfocitos/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Microbiota/inmunología , Receptores CCR6/metabolismo , Receptores Notch/metabolismo , Receptores del Factor de Necrosis Tumoral/metabolismo , Glándulas Sebáceas/inmunología , Piel/metabolismo , Fenómenos Fisiológicos de la Piel , Simbiosis , Linfopoyetina del Estroma TímicoRESUMEN
Acne vulgaris is a chronic skin disorder involving hair follicles and sebaceous glands. Multiple factors contribute to the disease, including skin microbes. The skin microbiome in the follicle is composed of a diverse group of microorganisms. Among them, Propionibacterium acnes and Malassezia spp. have been linked to acne development through their influence on sebum secretion, comedone formation, and inflammatory response. Antibiotics targeting P. acnes have been the mainstay in acne treatment for the past four decades. Among them, macrolides, clindamycin, and tetracyclines are the most widely prescribed. As antibiotic resistance becomes an increasing concern in clinical practice, understanding the skin microbiome associated with acne and the effects of antibiotic use on the skin commensals is highly relevant and critical to clinicians. In this review, we summarize recent studies of the composition and dynamics of the skin microbiome in acne and the effects of antibiotic treatment on skin microbes.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Microbiota/efectos de los fármacos , Acné Vulgar/inmunología , Acné Vulgar/microbiología , Antibacterianos/uso terapéutico , Folículo Piloso/inmunología , Folículo Piloso/microbiología , Humanos , Malassezia/aislamiento & purificación , Malassezia/fisiología , Microbiota/inmunología , Propionibacterium acnes/aislamiento & purificación , Propionibacterium acnes/fisiología , Glándulas Sebáceas/inmunología , Glándulas Sebáceas/microbiología , Simbiosis/efectos de los fármacos , Resultado del TratamientoAsunto(s)
Dermatomicosis/diagnóstico , Foliculitis/diagnóstico , Folículo Piloso/patología , Malassezia/aislamiento & purificación , Adulto , Antialérgicos/uso terapéutico , Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/patología , Quimioterapia Combinada/métodos , Foliculitis/tratamiento farmacológico , Foliculitis/patología , Glucocorticoides/uso terapéutico , Folículo Piloso/microbiología , Humanos , Masculino , Necrosis/diagnóstico , Necrosis/tratamiento farmacológico , Necrosis/patología , Tórax , Resultado del TratamientoRESUMEN
Acne is one of the most common skin diseases worldwide and results in major health care costs and significant morbidity to severely affected individuals. However, the pathophysiology of this disorder is not well understood. Host-microbiome interactions that affect both innate and adaptive immune homeostasis appear to be a central factor in this disease, with recent observations suggesting that the composition and activities of the microbiota in acne is perturbed. Staphylococcus epidermidis and Cutibacterium acnes (C. acnes; formerly Propionibacterium acnes) are two major inhabitants of the skin that are thought to contribute to the disease but are also known to promote health by inhibiting the growth and invasion of pathogens. Because C. acnes is ubiquitous in sebaceous-rich skin, it is typically labeled as the etiological agent of acne yet it fails to fulfill all of Koch's postulates. The outdated model of acne progression proposes that increased sebum production promotes over-proliferation of C. acnes in a plugged hair follicle, thereby driving inflammation. In contrast, growing evidence indicates that C. acnes is equally abundant in both unaffected and acne-affected follicles. Moreover, recent advances in metagenomic sequencing of the acne microbiome have revealed a diverse population structure distinct from healthy individuals, uncovering new lineage-specific virulence determinants. In this article, we review recent developments in the interactions of skin microbes with host immunity, discussing the contribution of dysbiosis to the immunobiology of acne and newly emerging skin microbiome-based therapeutics to treat acne.
Asunto(s)
Acné Vulgar/microbiología , Folículo Piloso/microbiología , Propionibacterium acnes/genética , Glándulas Sebáceas/microbiología , Staphylococcus epidermidis/genética , Acné Vulgar/tratamiento farmacológico , Disbiosis/microbiología , Humanos , Metagenoma/genética , Microbiota/genética , Propionibacterium acnes/aislamiento & purificación , Staphylococcus epidermidis/aislamiento & purificaciónRESUMEN
BACKGROUND: The ultraviolet-induced red fluorescence (UVRF) from human skin follicles was suggested to be a result of Propionibacterium acnes and was used for the monitoring of acne. More recent studies suggested that the UVRF may be more related to sebum rather than to microorganisms. OBJECTIVE: To clarify whether human sebum or follicular microorganisms are the source of UVRF. METHODS: We examined the fluorescence of human-derived SZ95 sebocytes, human sebaceous glands, sebum extracted from the sebaceous glands, and bacteria isolated from human hair follicles under ultraviolet light. RESULTS: SZ95 sebocytes, human sebaceous glands, and sebum do not emit UVRF. Two types of UVRF peaking at about 635 nm and at about 620 nm were detected in P. acnes and Staphylococcus epidermidis, respectively. This is the first report that S. epidermidis emits UVRF when it is anaerobically cultured and then exposed to air. CONCLUSION: Human follicular UVRF is emitted by resident bacteria, not by sebum. Therefore, UVRF may be used to monitor certain species of skin microorganisms.
Asunto(s)
Folículo Piloso/microbiología , Propionibacterium acnes/química , Glándulas Sebáceas/química , Sebo/química , Staphylococcus epidermidis/química , Acné Vulgar/metabolismo , Acné Vulgar/microbiología , Color , Fluorescencia , Folículo Piloso/química , Folículo Piloso/citología , Humanos , Rayos UltravioletaRESUMEN
Dermatophytes are capable of infecting the skin and its appendages such as nails and hairs producing a variety of clinical conditions. Hair invasion by dermatophytes is a key feature of tinea capitis and tinea barbae but not of tinea of glabrous skin. In this project, we studied the clinico-mycological aspects of follicular involvement in patients with dermatophytosis of the glabrous skin. In total, 16 patients, eight males and eight females, were included in the study. All were adults except for one girl. The disease durations ranged from one month to more than ten years. Fourteen (78.5%) had multiple lesions, and most of them had undergone treatment with antifungals, antibiotics, or steroids. Dermoscopic examination showed infected hairs in the form of broken stubs, coily, curly, or as black dots on the surface of the lesions. Pathogens were either anthropophilic (seven cases of Trichophyton rubrum) or zoophilic (six cases Microsporum canis, three cases of the T. mentagrophytes). Patients responded well to oral griseofulvin or terbinafine, and topical antifungals. No antifungal resistance developed during the treatment course. Follicular involvement of glabrous skin is not as rare as previously thought and should be considered for systemic antifungal treatments.
Asunto(s)
Griseofulvina/uso terapéutico , Naftalenos/uso terapéutico , Tiña/tratamiento farmacológico , Tiña/microbiología , Adulto , Anciano de 80 o más Años , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Niño , Femenino , Griseofulvina/farmacología , Folículo Piloso/microbiología , Folículo Piloso/patología , Humanos , Masculino , Microsporum/efectos de los fármacos , Microsporum/aislamiento & purificación , Persona de Mediana Edad , Naftalenos/farmacología , Taiwán , Terbinafina , Tiña/patología , Resultado del Tratamiento , Trichophyton/efectos de los fármacos , Trichophyton/aislamiento & purificaciónRESUMEN
Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80-year-old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin-embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real-time polymerase chain reaction (RT-PCR). For sequencing, DNA was isolated from paraffin-embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real-time PCR (qRT-PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin-embedded formalin-fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin-embedded skin tissue can been increased.