Dermoscopy - a simple and rapid in vivo diagnostic technique for tinea incognito

Abstract Tinea incognito resulting from corticosteroid abuse is becoming very common in the tropics. Its diagnosis is tricky owing to its confusing morphology, as well as practical and technical issues associated with mycological tests. Dermoscopy has now evolved as a novel diagnostic tool for diagnosing tinea incognito in such challenging situations, since the typical hair changes such as Morse-code hairs, deformable hairs, translucent hairs, comma and cork screw hairs, and perifollicular scaling may be seen despite steroid use, irrespective of mycological results.

Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review.

OBJECTIVE: Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD: The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS: A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION: Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.

Cellular immunodeficiency related to chronic dermatophytosis in a patient with Schistosoma mansoni infection: can schistosomiasis induce immunodeficiency?

Abstract: Here, we describe a case of hepatosplenic schistosomiasis that progressed to widespread persistent dermatophytosis. Significant T and B lymphocytopenia was confirmed. T-cell deficit is associated with increased susceptibility to fungal infections of skin and mucous membranes. The accumulation of a large amount of blood cells in the spleen could have played a crucial role in the development of lymphocytopenia in the present case. Alternatively, the schistosomiasis-induced increase in prostaglandin E2 levels could have inhibited the production of interferon-γ, a cytokine fundamental to fungal resistance. This case shows the potential of hepatosplenic schistosomiasis to impair the immune response.

Majocchis Granuloma Caused by Trichophyton mentagrophytes in 2 Immunocompetent Patients.

Majocchi granuloma is an uncommon deep follicular inflammation caused by dermatophytes and affects immunocompetent and immunocompromised patients. The clinical findings overlap with other skin conditions such bacterial infections and inflammatory skin diseases, thereby delaying correct diagnosis. We describe 2 cases in immunocompetent patients.

Tinea on a Tattoo.

In the last twenty years, the prevalence of individuals with tattoos in the general population has increased in Europe (1) as well as in Australia (2) and the United States of America (3). A series of complications such as acute inflammatory reactions, allergic contact dermatitis (4,5), photoinduced, lichenoid, and granulomatous reactions (6, 7), pseudolymphoma (8), pseudoepitheliomatous hyperplasia (9), skin infections (6), and skin cancers (10) may occur on tattoos. Infectious complications on tattoos include bacterial infections (pyoderma, leprosy, syphilis, cutaneous tuberculosis, mycobacteriosis) (11-14), viral infections (molluscum contagiosum, warts, herpes simplex, hepatitis B and C) (15-17), and fungal infections (sporotrichosis, dermatophytosis) (18,19). We present the case of a 29-year-old immunocompetent female patient who was consulted for the development of an erythematous-squamous placard that appeared on a tattoo about 18 days after tattooing. Dermatological examination revealed a circular, erythematous, scaly plaque, with centrifugal growth and central resolution, presenting an active, raised, erythematous, vesiculopustular edge, giving the appearance of tinea corporis. The lesion's starting point was on the tattoo in two colors located on the middle third of the left calf and subsequently evolved to beyond the surface of tattoo (Figure 1). No other skin, scalp, or nail lesions were observed. Mycological examination of the material obtained by scraping of the scales and the vesicles from the edges and the surface of the plaque revealed numerous hyphae on direct microscopy examination, and white, flat colonies with a cottony surface and radial grooves developed in Sabouraud dextrose agar culture (Figure 2). Spindle-shaped, thick-walled macroconidia and a few pyriform microconidia were observed on microscopic examinations of the colonies. Based on macroscopic and microscopic characteristics, Microsporum canis was identified. Gram stain and bacterial culture results were negative. Patient history revealed the presence of a pet dog that was diagnosed with mycosis, the etiologic agent being M. canis. After 21 days of treatment with oral terbinafine (250 mg/day) and topical application of terbinafine 1% cream once a day, the lesion disappeared and mycological examination (direct microscopy and culture) was negative. In the case of tattoos, cutaneous inoculation of a dermatophyte may occur after 1-3 weeks of tattooing, corresponding to the healing phase of the tattoo application. Dermatophyte inoculation can be done by direct contact with an infected person or animal or, exceptionally, by telluric contamination. Despite the increasing number of tattooed people, there are only a few published cases of dermatophytosis arising on tattoos (19,20). Ammirati reported dermatophyte infection caused by Trichophyton tonsurans that occurred two weeks after tattooing, clinically presenting as concentric annular lesions with active vesiculopustular edges which progressively included the entire tattoo (19). Similarly, in our case the infection with M. canis occurred during the healing phase, the dermatophyte lesion occurring after 18 days from tattoo application by direct contact with the dog parasitized with M. canis. In conclusion, dermatophyte infection of tattoos remains possible, although rare.

Dermatofitoses: agentes etiológicos, formas clínicas, terapêutica e novas perspectivas de tratamento / Dermatophytoses: etiologic agents, clinical forms, therapy and new perspectives of treatment

As dermatofitoses têm ocorrência mundial, sendo mais prevalentes em países de clima tropical e subtropical. Dados epidemiológicos indicam que essas micoses estão entre as infecções fúngicas de maior ocorrência. O quadro clínico mais comum de dermatofitose inclui despigmentação, placas anulares, prurido e perda de cabelo, com lesões tipicamente conhecidas como tineas, ocasionadas por fungos filamentosos dermatofíticos de três gêneros anamórficos: Microsporum, Trichophyton e Epidermophyton. O tratamento das dermatofitoses, em geral, está relacionado ao uso de antifúngicos tópicos e/ou sistêmicos, apresentando como problemática o surgimento de espécies multirresistentes. Esta revisão aborda as dermatofitoses e seus agentes etiológicos de forma aprofundada em aspectos epidemiológicos, apresentando a importância clínica do tema, com ênfase na causa, prevenção, tratamento e prognóstico dessa micose cutânea (AU)

Dermatophytoses have worldwide occurrence with higher prevalence in tropical and subtropical countries. Epidemiological data show that these mycoses are among the most frequent fungal infections. The most common symptoms of dermatophytoses include depigmentation, annular plaques, itching and hair loss, with lesions such as tinea, caused by dermatophytic filamentous fungi of three anamorphic genera: Microsporum, Trichophyton and Epidermophyton. Topical and/or systemic antifungalmedications are used in the treatment of dermatophytoses in general, resulting in problems such as the emergence of multidrug-resistant species. This review discusses dermatophytoses and their etiological agents with a focus on epidemiological aspects, presenting the clinical importance of the issue, with emphasis on cause, prevention, treatment and prognosis of this skin mycosis (AU)

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas.

Tiña incógnita: a propósito de dos casos y breve revisión de la literatura / EspañolInglésPortuguésTinea incognito: report of two cases and brief review of literature

Se presentan dos casos de niños con tiña facial modificada por el empleo prolongado de corticoides tópicos de alta potencia. Las típicas placas circulares u ovaladas, únicas o múltiples bien delimitadas de borde eritemato-vesiculoso levantado activo, de extensión periférica con aclaramiento del centro lesional, poco inflamatorias y muchas veces asintomáticas que afectan la cara, tronco y/o extremidadescambian su morfología y evolución debido al efecto inmunodepresor del fármaco.

We present two cases of children with facial ringworm modified by the prolonged use of high potency topical corticosteroids. The typical circular or oval lesions, single or multiple, with well-defined and raised redscaly edge and active borders with peripheral extension and center clearance; little inflammatory activity and often asymptomatic affecting the face, trunk and / or extremities change theirmorphology and evolution due to immunosuppressive effect of the drug.

Epidemiologia e etiologia das dermatofitoses em Pernambuco 2005-2010 / Epidemiology and etiology of the dermatophytosis in Pernambuco, 2005-2010

A presente pesquisa teve como objetivos detectar, isolar e identificar espéciesdermatófitos em amostras de pele, pêlos e unhas de 5.590 pacientes oriundos de hospitais públicos de Pernambuco. Os resultados apontaram o Trichophyton rubrum como a espécie de dermatófito mais incidente. O gênero masculino e faixa etária entre 0-20 anos prevaleceram...

Majocchi's granuloma after antithymocyte globulin therapy in a liver transplant patient.

Majocchi's granuloma (MG) is an atypical and uncommon presentation of dermatophytic infection involving the invasion of dermal and subcutaneous tissue by fungal organisms. It usually begins as a suppurative folliculitis and may culminate in the development of widespread granulomas. Immunosuppressed patients are at increased risk, especially those with T-cell deficiencies. We describe a case of inguinal MG in a liver transplant patient who had received antithymocyte globulin for acute rejection.

[Majocchi's granuloma]. / Granuloma de Majocchi.

Majocchi's granuloma or dermatophytic granuloma is a mycosis observed among immunocompetent and immunocompromised patients caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism. Diabetes and the use of topical steroids are among some of the predispEl cuadro 1 no está acotado. Favor de hacerloEl cuadro 1 no está acotado. Favor de hacerloosing factors. Majocchi's granuloma has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocom-promised patients a subcutaneous nodular type is observed. Diagnosis is confirmed through histopathology, where granulomas and dermatophytes in the form of filaments or spores are observed in the mid and deep dermis. Treatment includes systemic antimycotics. We reviewed the etiopathogenic, clinical, histopathological and therapeutic aspects of Majocchi's granuloma.

Granuloma de Majocchi / Majocchi's granuloma

El granuloma de Majocchi o granuloma dermatofítico es una micosis causada por dermatofitos, regularmente del género Trichophyton, predominando T. rubrum en 50%. Se presenta en pacientes inmunocompetentes o inmunodeprimidos. No se sabe cómo se produce la infección, al parecer inicia con trauma físico que guía a alteraciones del folículo piloso y a la introducción pasiva del hongo. Para el desarrollo de la infección se requieren factores predisponentes y desencadenantes, los más importantes son la diabetes y el uso de esteroides. Clínicamente se clasifica en papular perifolicular o superficial en pacientes inmunocompetentes, y en nodular subcutánea o profunda en pacientes con inmunosupresión. Se confirma el diagnóstico por histopatología, encontrando granulomas en dermis media y profunda, con estructuras dermatofíticas en forma de filamentos o esporas. El tratamiento es con antimicóticos sistémicos. Se hace una revisión del tema resaltando los aspectos etiopatogénicos, clínico-patológicos y terapéuticos de la enfermedad.

Majocchi's granuloma or dermatophytic granuloma is a mycosis observed among immunocompetent and immunocompromised patients caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism. Diabetes and the use of topical steroids are among some of the predispEl cuadro 1 no está acotado. Favor de hacerloEl cuadro 1 no está acotado. Favor de hacerloosing factors. Majocchi's granuloma has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocom-promised patients a subcutaneous nodular type is observed. Diagnosis is confirmed through histopathology, where granulomas and dermatophytes in the form of filaments or spores are observed in the mid and deep dermis. Treatment includes systemic antimycotics. We reviewed the etiopathogenic, clinical, histopathological and therapeutic aspects of Majocchi's granuloma.

Isotopic response of fungal granuloma following facial herpes zoster infections - report of three cases.

BACKGROUND: An isotopic response is the occurrence of a new skin disease at the site of another unrelated, healed skin disorder. METHODS: We report three cases of unilateral granulomatous fungal infection in immunocompetent patients at sites of resolved herpes zoster on the face. Diagnoses were made by potassium hydroxide preparation, histopathologic findings, and fungal culture. Two patients had Candida albicans folliculitis, and the other was infected with both Epidermophyton floccosum and Trichophyton mentagrophytes. RESULTS: The patients responded well to antifungal therapy. CONCLUSIONS: Localized isotopic fungal infections, although rare, can occur in immunocompetent patients.

Incontinence in the aged: contact dermatitis and other cutaneous consequences.

Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence of ageing but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital active lives as well as avoid the cutaneous sequelae of incontinence.

Invasive Trichophyton rubrum infection occurring with infliximab and long-term prednisone treatment.

BACKGROUND: A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum. OBJECTIVE: To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor alpha (TNF-alpha)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis. CONCLUSION: Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-alpha inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.