Tinea corporis by Nannizia gypsea: delayed diagnosis due to unusual presentation

Abstract Fungal infections by dermatophytes can present with unusual clinical manifestations, which can cause diagnostic difficulties. The authors present the case of a patient with cutaneous infection by Nanizzia gypsea, initially treated erroneously with topical corticosteroids due to a wrong diagnosis. It was cured after antifungal treatment.

A comparative clinical study on efficacy of terbinafine and griseofulvin in patients with tinea corporis

Background: The objective of the present study was to compare the efficacy of terbinafine and griseofulvin in patients with tinea corporis in a tertiary care hospital, Madurai.Methods: About 60 patients are selected from the outpatient department of Dermatology according to inclusion and exclusion criteria. They were divided into 2 groups of 30 patients each. Group 1 received tab. terbinafine 250 mg OD and group 2 received 250 mg BD for 4 weeks. All patients were investigated at baseline, end of 2nd week and at end of 4 weeks. Effectiveness of both the drugs were determined by achieving clinical as well as mycological cure. The results were recorded, tabulated and analysed using student抯 t test.Results: Patients in group 1 showed higher clinical and mycological cure rate when compared with group 2.Conclusions: Oral terbinafine is the effective antifungal agent in the treatment of extensive tinea corporis infection.

A study to assess the quality of life (QOL) of patients suffering from tinea corporis attending dermatology OPD of a tertiary care centre of Eastern India

Background: A huge number of patients in our country are affected by Tinea Corporis (TC). The number of patients affected by dermatophytosis has increased by a large extent in the last 4 to 5 years. The quality of life in TC patients can be affected by various factors including the disease morbidity, duration of disease, social & demographic factors. Aims and Objectives: The aim of the study is to find out the effect of TC on the quality of life of the affected patients & along with that to assess whether there is some association of this effect on quality of life with some demographic & clinical factors. Methods: The effect on quality of life of 328 patients affected by TC who attended the Dermatology outpatient’s department of NRS Medical College was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Results: 12 (3.658 %) of the patients had an extremely large effect on quality of life. There was a very large effect on the QOL of 121 (36.890 %) patients. There was moderate effect on 134 (40.853 %) of the patients. There was a small effect on 59 (17.987 %) of the patients. 2 (0.609 %) patients had no effect on their QOL. Duration of disease & body surface area involved have significant impacts on QOL. Conclusion: The quality of life is adversely affected by TC. Early detection & treatment of the disease is very important. Steps must be taken to increase awareness about the disease among the general population.

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.

A randomized, double-blind trial of amorolfine 0.25% cream and sertaconazole 2% cream in limited dermatophytosis

Background: Dermatophytosis is becoming increasingly unresponsive to conventional antifungals. Newer topical antifungals may be more effective in these patients. Aims: To evaluate and compare the efficacy and safety of amorolfine 0.25% cream and sertaconazole 2% cream in limited tinea cruris/corporis. Methods: A single-center, randomized (1:1), double-blind, parallel group, active-controlled trial (CTRI/2014/12/005246) was performed. Sixty-six untreated adults with acutely symptomatic tinea cruris/corporis were included in the study. All patients had limited cutaneous involvement and were KOH mount positive. Group A received amorolfine 0.25% cream, and group B received sertaconazole 2% cream twice daily application to the lesions for 4 weeks. After the baseline visit, four follow-up visits were carried out. The outcome measures for effectiveness were clinical and mycological cure. Safety parameters studied were treatment-emergent adverse events and changes in routine laboratory parameters. Results: Both sertaconazole and amorolfine significantly reduced symptoms (P < 0.001) in both groups. However, improvement in symptoms (pruritus, burning sensation, erythema, scaling and crusting) was significantly greater in the sertaconazole group at every follow-up visit. Sertaconazole cream was also more effective than amorolfine cream in reducing the number of lesions (P = 0.002 at 12 weeks) and improving the Dermatology Life Quality Index (P < 0.001) at all the follow-up visits. Adverse events were similar in the two groups (P = 0.117). Fungal cultures became negative in 92.3% of the sertaconazole group as compared to 80% in the amorolfine group (P = 0.010). Limitations: Antifungal susceptibility testing could not be done. Conclusion: Sertaconazole 2% is superior to amorolfine 0.25%, both in terms of effectiveness and tolerability. Improvement can be appreciated from second week onwards.

Comparative Efficacy of Terbinafine and Itraconazole on Fluconazole Resistant Tinea Corporis and Tinea Cruris Handling

Objectives: The study aimed at comparing the therapeuticefficacy of Terbinafine and Itraconazole in terms of clinical curein the treatment of Fluconazole resistant Tinea corporis andTinea cruris.Materials and Methods: A clinical trial with 154 patients’having Tinea corporis and Tinea cruris was performed. All thepatients were treated with fluconazole. The resistant patientswere randomly divided into two groups. The first group wastreated with Terbinafine 250mg daily for 4 weeks, whereassecond group was treated by Itraconazole for 4 weeks. Theparticipants were followed up till the end of treatment and onemonth after treatment.Results: At the end of the trial, terbinafine group developed78.84% clinical response, while Itraconazole treated groupdeveloped only 39.13%.Conclusion: Based on the marked observed difference, it maybe concluded that Terbinafine is more effective in treatingfluconazole resistant Tinea corporis and Tinea cruris.

Difference in expression of lymphatic markers D2-40 and Prox1 between angiokeratoma corporis diffusum and angioma serpiginosum / 中华皮肤科杂志

Objective@#To investigate the significance of lymphatic markers in the differential diagnosis of angiokeratoma corporis diffusum (ACD) and angioma serpiginosum (AS) .@*Methods@#Totally, 9 patients with ACD and 6 with AS were enrolled from Department of Dermatology, Xijing Hospital between 2006 and 2017, and their clinical and histopathological features were retrospectively analyzed. Skin sections from all the patients were stained for CD31, D2-40 and Prox1.@*Results@#In the 9 patients with ACD, abnormal vessels were weakly positive or negative for CD31, and positive for Prox1. Endothelial cells in abnormal vessels were locally positive for D2-40 in 4 patients with ACD, but negative for D2-40 in the other 5 patients. In the 6 patients with AS, the endothelia of hyperplastic small vessels were positive for CD31, but negative for D2-40 and Prox1.@*Conclusion@#The clinical features of a few patients with ACD are similar to those of patients with AS, and lymphatic markers have definite significance in the differential diagnosis of the two diseases.

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.

A Study of Prevalence of Etiological Agents of Dermatophytosis in a Tertiary Care Hospital.

Background: Dermatophytoses are commonly encountered fungal diseases prevalent in most parts of the world especially in tropical countries. It is a superficial mycotic infection affecting hair, skin and nails. The present study was carried out to determine the incidence of dermatophytoses and their etiological agent in different age groups attending the Dermatology department. Methods: A total of 200 samples were taken from skin department and processed by direct KOH preparation & fungal culture methods. Identification of the species was done by Lactophenol Cotton Blue mount from colony. Results: Our study shows that males 60 (68.41%) are more infected than females 40 (31.59%) Tinea corporis was the commonest clinical type 59 (55.75%). The commonest fungal isolate is Trichophyton species (51.72%), followed by Micro-sporum 38 (36.92%) and Epidermophyton species 11(9.31 %). Conclusion: Male have higher fungal infection rate than females. Trichophyton rubrum is the common isolate in our geographical area. KOH preparation has higher positivity rate than culture.

Tinea corporis due to Trichophyton violaceum: A report of two cases.

Dermatophytes are Fungi which infect keratinized tissues, that is, skin epidermis, hair and nails. Trichophyton violaceum is an anthropophilic, cosmopolitan dermatophyte. It primarily causes tinea capitis and less commonly tinea corporis and tinea unguium. We present a report of two cases of tinea corporis due to T. violaceum in children. Infections due to T. violaceum are important because of its transmissibility within families and community and its potential to spread and establish in new geographical areas.

Comparison of efficacy, safety and cost-effectiveness of clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from of mild to moderate tinea corporis, attending tertiary care hospital out-patient department: a randomized, open-labeled, comparative, parallel group trial.

Background: Tinea corporis is a common dermatophytic infection of the body involving keratin layer of skin. This lesion presents as an annular plaque with an advancing border along with central clearing. Clotrimazole is topical, conventional imidazole antifungal drug and has given good efficacy in tinea corporis. Sertaconazole is new topical imidazole antifungal claimed to be superior to old topical imidazoles in tinea corporis. The aim of this study was to compare efficacy, safety and cost effectiveness of topical antifungals, clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from mild to moderate tinea corporis attending out-patient department of tertiary care hospital in Vidarbha region of Maharashtra. Methods: This was a prospective, comparative, randomized trial with 2 parallel treatment arms of 4 weeks duration. Patients were diagnosed on the basis of clinical evaluation and microscopic findings of KOH mount. Hundred patients were randomly assigned into two groups of clotrimazole 1% cream, and sertaconazole 2% cream with 50 patients in each group. Evaluation was carried out at baseline, 1st week, 2nd week and 4th week for efficacy parameters viz. itching, erythema and scaling, physician’s global assessment (PGA), safety and cost effectiveness. Results: Topical sertaconazole 2% cream was highly efficacious and superior to clotrimazole 1% cream in improvement of clinical parameters, PGA and mycological cure at the end of the treatment phase. At end of the follow-up phase both the trial drugs were effective with no recurrence or relapse of tinea corporis. However, clotrimazole 1% cream was safe and cheaper. Conclusions: Topical clotrimazole 1% cream and sertaconazole 2% were effective and well tolerated in patients of tinea corporis. Effectiveness of sertaconazole was early and superior with tolerable side-effects. However, clotrimazole was costeffective.

Familial angiokeratoma corporis diffusum without identified enzyme defect.

Angiokeratoma corporis diffusum is the cutaneous hallmark of several rare inherited lysosomal diseases associated with specific enzyme deficiencies in the metabolism of glycoproteins, most notably Fabry disease. These defects result in many systemic manifestations. Here, we report a rare familial case of angiokeratoma corporis diffusum that developed at puberty with no major systemic manifestations and no underlying enzyme defect or gene mutation. Familial angiokeratoma corporis diffusum without identified enzyme defect appears to be a distinct clinical entity with a benign course.

Simultaneous Occurrence of Tinea corporis Caused by Microsporum canis in a Grandmother and a Granddaughter / 대한의진균학회지

Microsporum (M.) canis is one of the zoophilic dermatophytes which can cause ringworm in cats and dogs and is responsible for 3~30% of tinea corporis and tinea capitis in human. It is most likely transmitted by contact with infected animals, but rare cases of person-to-person transmission and an outbreak among school girls have also been reported. Herein we report on interesting cases of tinea corporis caused by M. canis in a grandmother and a granddaughter. A 63-year-old woman presented with pruritic, scaly, erythematous plaques on the post. neck and trunk which had started 2 months ago. Also her 9-year-old granddaughter presented with pruritic, annular, erythematous plaques on chest and back for 7 days. They denied contact with animals. KOH smear showed several hyphaes on microscope. Fungus culture on potato dextrose agar showed growth of colonies with whitish fluffy surface and radial folds, the dorsal surface of the colonies showed golden-brown color which were identified as M. canis in both patients. As for the grandmother the lesions improved with oral itraconazole 200 mg/day for 7 days and topical antifungal cream for 5 weeks which resulted in marked improvement of the lesions.

Clinical Efficacy of Topical Terbinafine Versus Topical Luliconazole in Treatment of Tinea Corporis/Tinea Cruris Patients.

Aims: Tinea corporis & cruris of skin respond well to topical antifungal therapy, but there is a need to apply cream 2- 3 times daily for up to four weeks will impair compliance & lead to treatment failure. Luliconazole is one of those drugs offering good efficacy & tolerability with a short duration of treatment. Terbinafine, an allylamine antifungal agent, acts by selective inhibition of fungal squalene epoxidase. Luliconazole, an imidazole antifungal agent is considered to be more effective in inhibition of ergosterol biosynthesis and its reservoir property in stratum corneum is greater than that of terbinafine. As there are lack of studies between terbinafine & luliconazole, the present study was undertaken to compare the clinical efficacy in tinea corporis/tinea cruris patients. Study Design: Prospective parallel study. Place and Duration of Study: Study was conducted on 60 patients presenting to the Dermatology out-patient department of RL Jalapa Hospital, Kolar, from 1st December 30th April 2012. Methodology: Patients alternatively assigned to either terbinafine or luliconazole & advised to apply test drugs topically for 14 days. Clinical symptoms & signs were assessed using 4-point (pruritus, erythema, scaling) scale & 10% KOH mount at base line, end of treatment visit (15th day) & later 30th day. The data was analysed based on age, gender distribution, duration of lesion, clinical score & KOH mount. Results: Of the 60 patients recruited, all came for 1st follow up (14th day) & 51 patients for 2nd follow-up (30th day). Mean age of the patients was 33.80± 9.58 years in terbinafine & 33.90 ± 9.58 years luliconazole group. Majority of patients were in 12- 40 years aged in both group. Sixty patients and 51 patients were negative for KOH mount preparation on 15th & 30th day respectively. At the end of first follow-up, the clinical score was reduced from 3 to zero (P=0.0001) in both the treatment groups. Mycological cure was 100% in both the drug groups. There was no relapse in 51 patients who came for 2nd follow-up. Four in terbinafine and 5 in luliconazole group were lost to follow up. Conclusion: Only mild forms of tinea infections were included as compared to other studies where moderate to severe (pustules, incrustations, vesiculation). Hence the onset of illness, treatment duration and severity of illness were favorable in this study for two weeks. In both the treatment arms, clinical & mycological cure was comparable, hence once a day application for two weeks of terbinafine & luliconazole were equally effective for treatment of tinea corporis/cruris infection.

Microsporum gypseum dermatophytosis in a patient of acquired immunodeficiency syndrome: A rare case report.

Microsporum gypseum, a geophillic dermatophyte is rarely isolated from patients with acquired immunodeficiency syndrome. We report tinea corporis due to Microsporum gypseum, an uncommon aetiological agent, in a patient with acquired immunodeficiency syndrome from our region. The clinical presentation resembled psoriasis characterised by atypical, scaly and hyperkeratotic lesions.

Isolation, Identification and Prevelance of Dermatophytes in Tertairy Care Hospital in Gulbarga District.

Dermatophytosis is one of the most commonly encountered cutaneous fungal infections worldwide. The higher prevalence in tropical and subtropical areas is supposedly due to the hot and humid climatic condition. Other factors like personal hygiene and habits, prevalence of virulent species in the soil are also known to influence the infection. A high prevalence of dermatophytoses has been reported from India. Hence, this study was undertaken to identify, speciate and study the sensitivity pattern of dermatophytosis from clinical samples received at Basveshwar Teaching & General Hospital, Gulbarga. A total of two hundred clinically diagnosed randomly selected patients of dermatophytosis attending the out patient department of Dermatology and Venereology, Basveshwar Teaching & General Hospital & M.R. Medical College, Gulbarga were studied. Skin, nail and hair specimens taken from the patients were processed by potassium hydroxide preparation (KOH) for direct microscopy and culture. Dermatophytosis was more common in the age group of 21-30 years (36%) and in males (73%). Fungi was demonstrated in 130 cases by KOH and in 96 cases by culture; 78 cases were positive by both direct examination and culture. Tinea corporis was the commonest clinical type encountered (54.5%) followed by tinea cruris (25.5%). Tricophyton rubrum (46.87%) was the commonest aetiological agent in majority of clinical types followed by Trichophyton mentagrophytes (36.46%), Microsporum gypseum (4.16%), Trichophyton tonsurans (1.04%) , Epidemophyton floccosum (8.33%). Microsporum audouinii (2.08%) and Trichophyton violecium (1.04%). Dermatophyte infections are very common in our country where hot and humid climate along with poor hygienic conditions play an important role in the growth of these fungi. By and large, Trichophyton species forms the commonest etiological agent of dermatophytosis. Tinea rubrum was the commonest isolate in tinea corporis, tinea cruris and Onychomycosis. Microporium audouinii was isolated from 1 case of tinea capitis.

Tuberculoid-type Leprosy Mimicking Tinea Corporis / 대한피부과학회지

A 59 year-old man developed a large, reddish, well-defined, scaly patch on his submental area 37 years before visiting our department; the patch showed central atrophy and was enlarged. He was erroneously treated for tinea corporis at private clinics for 5 years before the correct clinicopathological diagnosis of tuberculoid-type leprosy was made. We report this case to suggest that dermatologists should play an important role in the diagnosis and treatment of leprosy, and that they should pay careful attention while diagnosing new cases of leprosy.

Tiña corporis en pacientes venezolanos atendidos en la consulta de Dermatología de un Centro de Diagnóstico Integral / Tinea corporis in Venezuelan patients attended in the Dermatology Department from the Comprehensive Diagnosis Center

Se realizó un estudio longitudinal y prospectivo de 2 340 pacientes con Tinea corporis que acudieron a la consulta de Dermatología del Centro de Diagnóstico Integral "El Bajo" del municipio de San Francisco (Venezuela), de enero a diciembre del 2010, con vistas a determinar las características de la enfermedad en estos, la cual constituyó la segunda causa de morbilidad dermatológica en la serie. Predominaron el sexo masculino, el grupo etario de 20-29 años, las caderas como la región anatómica más afectada, las lesiones únicas y las de bordes definidos. A pesar de las diferentes medidas higienicoepidemiológicas llevadas a cabo, la tiña corporis todavía resulta un problema de salud, por lo que se deben efectuar intervenciones educativas en toda la población venezolana, de modo que sean modificados los factores de riesgos de la infección.

A longitudinal and prospective study was conducted in 2 340 patients with Tinea corporis that went to the Dermatology Department from "El Bajo" Comprehensive Diagnosis Center of San Francisco municipality (Venezuela), from January to December 2010, with the purpose of determining the characteristics of the disease in these patients, which was the second leading cause of dermatological morbidity in the series. Male sex, the age group of 20-29 years, the hips as the most affected anatomical site, single lesions and lesions of defined edges prevailed. Despite the different epidemiological health measures undertaken, tinea corporis is still a health problem, therefore educational interventions must be implemented in all Venezuelan population, so that the risk factors for infection are modified.

A study of superficial mycoses in tertiary care hospital.

Background & Objectives: Fungal infections are extremely common in the tropical regions and some of them are serious .Fungi produce diverse human infections ranging from superficial skin infections to systemic disease .The study of superficial mycosis is important due to the frequent occurrence in dermatology clinics. The present study was undertaken with a view to find out the clinical pattern of dermatophytic and non – dermatophytic fungi (superficial mycosis) and most common fungal pathogens in tertiary care hospital affiliated with medical college in Western India from August 2007 to July 2008. Methods: A clinical and mycological study of superficial mycosis was conducted on 215 cases (138 males and 77 females). Direct microscopy by KOH (potassium hydroxide) mount and culture was undertaken to isolate the fungal pathogen in each case. Results: Commonest age group involved was adults of 19-59 years age. Tinea corporis was the most common clinical presentation and Trichopyton rubrum was the most common fungal pathogen isolated. Dermatophytosis was the commonest superficial fungal infection and found in 147/215 cases (68.4%). Non dermatophytic fungus like pityriasis versicolor and yeast like candida species were isolated in 48/215(22.3%) cases and 20/215 (9.3%) cases respectively. The KOH positivity rate was 72.4% and total culture positivity rate was 62.8%.Interpretation & conclusion: Along with dermatophytes, nondermatophytic fungi are also emerging as important causes of superficial mycosis. Direct microscopy and culture both are important tools for diagnosis of the fungal infections.

A Clinical Study on Tinea Corporis / 대한의진균학회지

BACKGROUND: Tinea corporis includes all superficial dermatophyte infections of the skin other than those involving the scalp, beard, hands, feet, and groin. OBJECTIVE: The purpose of this study is to evaluate the clinical features of tinea corporis. METHOD: Clinical findings of tinea corporis diagnosed at Boramae Medical Center in the last 10 years were analyzed retrospectively. RESULTS: For the 10-year study, a total of 422 patients were analyzed. Male-to-female ratio was 0.8:1, and patients were diagnosed most often in their twenties (26.5%). Average duration of the lesions before visiting our clinic was 4.9 months. Skin lesions appeared most frequently in the summer (45.3%). Clinical appearance was most often annular (83.9%), followed by eczematous annular (13.7%) and plaque type (2.4%). Average number of lesions was 4. Lesions over 5 cm in longest diameter accounted for 47.2%; however, when occurring in the face they were significantly less frequent (4.9%). Lesions developed in unexposed areas in 60.4%, most commonly on the chest, followed by back and buttock. In 60% of patients, concurrent dermatophytosis of other regions were present, most commonly tinea pedis (58%), followed by tinea unguium (31.2%). History of prior contact with animal was in 12.3% of total but significantly higher in facial lesions (54.7%). CONCLUSION: Dermatologists should always examine the feet and toenails of patients with suspected tinea corporis since over half of these patients harbor fungal infection in the feet.