Tinea faciei por Trichophyton violaceum: primer caso alóctono reportado en Chile

Trichophyton violaceum es un dermatofito antropofílico endémico en África, Europa, Centroamérica y China. El incremento de los fenómenos de movilidad humana ha contribuido a su aparición en áreas no endémicas. Su principal manifestación clínica es la tinea capitis, seguida por la tinea corporis. En la población pediátrica afecta con mayor frecuencia el cuero cabelludo; y en adultos, la piel glabra. Presentamos el primer caso en Chile de tinea causada por T violaceum. Correspondió a una mujer chilena de 21 años que presentó placas faciales de un mes de evolución después de un viaje a Tanzania, África, sin respuesta a tratamientos médicos previos. Se sospechó una dermatofitosis alóctona y mediante cultivos especiales, se identificó una colonia de crecimiento lento, coloración violeta-negruzca, superficie cerosa y rugosa, con vellosidades aterciopeladas; compatible con T violaceum. Se confirmó mediante secuenciación de ADN ribosomal amplificando la región ITS. Se trató con terbinafina oral con respuesta clínica completa.

Trichophyton violaceum is an anthropophilic dermatophyte endemic in Africa, Europe, Central America and China. The increase in human mobility has recently contributed to the appearance in non-endemic areas. The main clinical manifestation is tinea capitis followed by tinea corporis. We present the first case in Chile of tinea caused by T violaceum. The case was a 21 year-old Chilean woman who presented asymptomatic facial plaques one month after arriving from Tanzania, Africa, with no clinical response to previous medical treatments. An allochthonous dermatophytosis was suspected and with special cultures, a slow-growing colony was identified with a violet-blackish color, waxy and rough surface, and velvety villi; all characteristics of T violaceum. The diagnosis was confirmed by ribosomal DNA sequencing amplifying the ITS region. She was treated with oral terbinafine obtaining a complete clinical response.

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale

Abstract Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.

A Case of Multiple Tinea Infections in an Infant Child After Contact with a Dog / 대한의진균학회지

Dermatophytosis in children is relatively infrequent than adults. Dermatophytosis in children can be different clinically and mycologically from those in adults in that children experience rapid physical changes and they have different skin features and environments from those of adults. Microsoprum (M.) canis is one of the zoophilic dermatophytes responsible for 3~30% of tinea corporis and tinea capitis in children. It is most likely transmitted by contact with infected animals such as cats and dogs. Clinical manifestations were single or multiple annular shaped, erythematous scaly patches and sometimes hard to differentiate with other skin diseases. A 6-year-old girl presented with multiple, pruritic, erythematous scaly patches on cheek and buttock. The lesion started 3 weeks before visiting our skin clinic. There was no personal or family history of any skin disease but she had a history of contacting with a dog. A fungal culture from tissue of the lesions grown on potato dextrose agar-corn meal-tween 80 showed typical Microsporum canis. The skin lesions were clinically improved after topical treatment for 4 weeks.

The Clinical and Mycological Study of Tinea Faciei in Daegu / 대한의진균학회지

BACKGROUND: Tinea faciei is a superficial dermatophyte infection on non-bearded skin of face. It is often confused with other dermatoses. Tinea faciei accounts for 3~4% of cases of tinea corporis. There have been only a few reports on the clinical and mycological features of tinea faciei. OBJECTIVE: This study aims to evaluate the demographic, clinical, and mycological features of tinea faciei in Daegu, Korea. METHODS: The medical records of 56 cases with tinea faciei from the Daegu catholic university medical center and Catholic skin clinic from January 2013 to December 2014 were evaluated retrospectively. RESULTS: The incidence was highest at 6th decade age group. The most frequent occupation of patients was agro-livestock area. Among 56 cases, the lesions were round patches in 40 cases (71.5%), followed by ring-shaped patches in 8 cases (25.0%) and plaques in 2 cases (3.5%). The most commonly isolated organism was Trichophyton rubrum (79.2%). CONCLUSION: Tinea faciei could easily be misdiagnosed clinically due to its abnormal presentation. When facing erythematous patches on face, physician should be aware of tinea faciei and undergo careful history taking with mycological study.

Polycyclic Annular Lesion Masquerading as Lupus Erythematosus and Emerging as Tinea Faciei Incognito

Tinea incognito is a dermatophytic infection induced by immunosuppressive agents that lacks the classic features of a typical fungal infection. Although the treatment of tinea incognito is simple and relatively easy, its clinical manifestation varies and can masquerade as various skin disorders, causing misdiagnosis and thus preventing prompt and appropriate treatment. Here, we report an interesting case of tinea incognito occurring after topical steroid administration in an immunosuppressed patient with dermatitis artefacta. A 40-year-old female patient who had been taking systemic glucocorticoid for 4 years for chronic inflammatory demyelinating polyneuropathy presented with itching multiple erythematous erosive lesions on the face and upper chest for 2 months. Initial biopsy produced nonspecific findings. The skin lesion was aggravated and became polycyclic and erythematous; after azathioprine was added, her chronic inflammatory demyelinating polyneuropathy became aggravated. A second biopsy confirmed hyphae in the cornified layer. Complete remission was achieved after admonishing oral terbinafine and topical amorolfine.

Tinea Incognito Caused by Application of 0.03% Tacrolimus (Protopic(R)) Ointment in Atopic Dermatitis Patient / 대한의진균학회지

We report a case of tinea incognito in a 29-year-old man after applying the 0.03% tacrolimus ointment. He was known atopic dermatitis patient and has been treated with intermittent application of tacrolimus. For his facial pruritus 0.03% tacrolimus ointment was prescribed, and after one week he developed annularly grouped erythematous plaques and patches around the ointment-applied area. The KOH smear revealed multiple fungal hyphae. Dermatologists should be aware of the possibility of topical tacrolimus to be the causative agent for tinea incognito.

Un caso infantil de tinea faciei por Trichophyton tonsurans en Guatemala / A child case of Trichophyton tonsurans tinea for faciei in Guatemala

El Trichophyton tonsurans es un dermatofito antropofílico de distribución mundial, asociado a brotes epidémicos de tinea capitis, pero que también se puede aislar en tinea ungueum y faciei. Se presenta un paciente de sexo masculino, de 3 años de edad, procedente de Guatemala, que tiene una lesión eritematosa de bordes bien definidos, con descamación gruesa en la mejilla derecha, de dos semanas de evolución, de la cual se aisló Trichophyton tonsurans. Curó luego del tratamiento con crema de ketoconazol al 2% durante 15 días.

Trichophyton tonsurans is an anthropophilic dermatophyte with a worldwide distribution that is associated with epidemic outbreaks of tinea capitis and sometimes it is also isolated from tinea ungueum and faciei. We report a 3 year-old male from Guatemala, with a two weeks history of a scaly erythematous lesion on the right cheek. Trichophyton tonsurans was isolated and the lesion resolved after a 15 days-course of 2% ketoconazole cream.

A Case of Rosacea-like Tinea Faciei Caused by Trichophyton rubrum / 대한의진균학회지

We report a case of rosacea-like tinea faciei in a 62-year-old female. The lesions were manifested by 2.0x2.0 cm and 2.0x2.0 cm-sized, two, pruritic, well-demarcated, erythematous macules on the nose and left ala nasi. Histopathologic examination of the skin lesion showed chronic dermal inflammation with presence of fungal hyphae in the honey layer of the epidermis. Fungal culture of the biopsy specimen grew out typical white cottony colonies of Trichophyton rubrum. The patient was treated with 250 mg of terbinafine daily for 1 month and topical lanoconazole application. Skin lesions improved one month after the treatment, and recurrence has not been observed.

A Case of Tinea Faciei Caused by Trichophyton mentagrophytes with Atypical Presentation / 대한의진균학회지

Tinea faciei is a dermatophyte infection of the glabrous part of facial skin most commonly caused by the Trichophyton species. Tinea faciale has been classified as part of tinea corporis but recently for its unique features, it is being considered a separate disease entity. Tinea faciale is a relatively rare dermatophytosis and is characterized by clinical polymorphism, which leads to frequent misdiagnosis and mistreatment with corticosteroids. Long term treatment with glucocorticoids can subsequently lead to tinea incognito. Herein we describe an unusual case of tinea faciei caused by T. mentagrophytes in a 40-year-old women with erythematous facial eruptions, initially misdiagnosed as allergic contact dermatitis and rosacea. By using mycological and histological examinations, dermatophytosis caused by Trichophyton mentagrophytes was confirmed. Oral terbinafine was administered together with topical clotrimazole and hydrocortisone for 4 weeks.

A Clinical Characteristics of Tinea Faciei and Its Mycological Findings / 대한의진균학회지

BACKGROUND: Tinea faciei (TF) is a dermatophytosis of the non-beard areas of the face. Its clinical features may be similar to that of contact dermatitis, discoid lupus erythematosus, polymorphous light eruption or seborrheic dermatitis. A differential diagnosis should be considered for these. It is important to find hyphae through potassium hydroxide (KOH) preparation. OBJECTIVE: The purpose was to evaluate clinical characteristics and mycological findings of TF. METHODS: Clinical charts of 93 patients with TF were reviewed. KOH preparation (+) and/or culture (+) from the skin lesions confirmed the diagnosis of TF. RESULT & CONCLUSIONS: Patients with TF were most prevalent under 10 years old, and relatively even in 20s to 50s. Overall male to female ratio was 1.07: 1, but differed in each age groups; male was predominant in age groups of 20s, 40s and 50s, while female in age groups of 30s and over 60. Most (74.3%) of the lesion was single and the cheek (32%) was the most frequently involved site, followed by the nose, periorbital area, chin, ear, forehead and perioral area in decreasing order. 29 patients (31.2%) had coexistent dermatophytosis in other areas of the body; tinea pedis et unguium (17.2%), tinea corporis (8.6%), tinea capitis (5.4%). 38 patients (86.4%) were treated for contact dermatitis and eczema by primary care physician before the diagnosis of TF. KOH preparation from the lesions showed positive for 95.7% of the patients. 46 strains (49.5%) were identified from the 93 patients. They were Trichophyton (T.) rubrum (65.2%), T. mentagrophytes (26.1%), Microsporum canis (6.5%) and T. verrucosum (2.2%). All of these findings suggest that localized erythematous facial lesions and if there is no response to treatment of dermatitis, examination for fungus should be considered.

Three Cases of Tinea Faciei Misdiagnosed as Contact Dermatitis / 대한의진균학회지

Although tinea faciei has its own characteristic clinical features, its clinical features may be similar to contact dermatitis, discoid lupus erythematosus, polymorphous light eruption, and seborrheic dermatitis. So we should always considered them in differential diagnosis. Recently we have seen three patients with erythematous scaly skin lesions on their faces. Their clinical features were very similar to that of contact dermatitis. All of them have been using topical steroids prescribed by non-dermatologists. Despite of topical and systemic steroid, skin lesions became worsened and spread. Repeatative KOH examination from the skin lesion have shown many hyphae. Trichophyton mentagrophytes was cultured from all three patients. Their colonial morphology and microscopic findings were very similiar each other, in spite of no direct contact. All the 3 cases developed in a month. Because one of the patients had a rabbit in her home, source of infection was suspected from rabbit

Three Cases of Tinea Faciei Misdiagnosed as Contact Dermatitis / 대한의진균학회지

Although tinea faciei has its own characteristic clinical features, its clinical features may be similar to contact dermatitis, discoid lupus erythematosus, polymorphous light eruption, and seborrheic dermatitis. So we should always considered them in differential diagnosis. Recently we have seen three patients with erythematous scaly skin lesions on their faces. Their clinical features were very similar to that of contact dermatitis. All of them have been using topical steroids prescribed by non-dermatologists. Despite of topical and systemic steroid, skin lesions became worsened and spread. Repeatative KOH examination from the skin lesion have shown many hyphae. Trichophyton mentagrophytes was cultured from all three patients. Their colonial morphology and microscopic findings were very similiar each other, in spite of no direct contact. All the 3 cases developed in a month. Because one of the patients had a rabbit in her home, source of infection was suspected from rabbit

A Case of Tinea Incognito on the Face due to Trichophyton mentagrophytes / 대한피부과학회지

Recently, we have encountered an increasing number of patients who have obtained topical steroids to self-treat various dermatosis. Tinea incognito has been used to describe a dermatophyte infection modified by corticosteroid treatment. Lesions are often atypical appearing and the diagnosis can be delayed or missed. We report a case of tinea incognito with ill-defined erythematous patch and nodules on the right upper eyelid and taken intermittently application with corticosteroid ointment over a period of l year. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton mentagrophytes. The lesion was treated with of itraconazole and cured 3 weeks later.

Two cases of tinea faciei with atypical clinical manifestation / 대한피부과학회지

Tinea faeiei is an unusual fungal infection which often is not recognized by clinieians. Because of light sensitivity, the frequent absence of typical clinical manifestation, and secondary changes due to steroid treatment, this condition is frequently misdiagnosed with other dermatoses. We described two patients who showed atypical facial lesions which were histologically diagnosed as tinea faciei. The case I was a 54 year old male who had multiple discoid plaques and nodules on the face. The other case was a 83 year old female who showed scaly plaques, nodules, pustules, and photosensitivity on the face. Histologic exarnination revealed fungus spores and mycelia within the inflamed hair follicles.