Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

A Case of Tinea Incognito Mimicking Folliculitis in Atopic Dermatitis Patient / 대한의진균학회지

A 27-year-old male with underlying history of atopic dermatitis presented with skin lesion on the trunk and upper extremity, occurring a month ago. Scattered erythematous multiple tiny maculopapules and patches were noticed. The lesion was first diagnosed as aggravated atopic dermatitis with folliculitis based on the clinical manifestation, but had failed to improve with antibiotics and medications for atopic dermatitis. KOH examinations were performed on his upper arm's lesion, and with detection of hyphae and isolation of Trichophyton rubrum by fungus culture, he was successfully treated with oral itraconazole 200 mg/day and topical flutrimazole. Tinea incognito refers to dermatophyte infections with atypical clinical presentation caused by previous treatment with steroid. Nowadays, the cases of tinea incognito have been increasing due to the increased usage of steroid and other immunosuppressants. Therefore, it is essential to include fungal infection in the differential diagnosis when cutaneous lesions are noticed in patients taking steroid and other immunosuppressants. Herein, we present a tinea incognito that clinically mimicked folliculitis in atopic dermatitis patient.

Majocchi's Granuloma of the Knee Caused by Trichophyton rubrum Presented as Tinea Incognito / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous layers that is caused by fungal organism. It often presents as plaques and papules on areas where trauma is common. Majocchi's granuloma appears usually in immunocompromised patient but can also appear in immunocompetent patient. Tinea incognito appears in various forms of skin diseases, but it is rarely presented as Majocchi's granuloma. We report a case of trichophytic granuloma of the knee caused by Trichophyton(T.) rubrum in a 70-year-old male, who showed a pruritic, 7.0 × 2.0 cm sized, erythematous scaly patches with multiple papules on the right knee for 2 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain ATCC 52013 (GenBank accession number KX092384.1). Histiologic examination showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole 200 mg/day and sertaconzole cream treatment, the lesion was completely cleared.

A Clinical and Etiological Analysis of Tinea Incognito Over 10 Years: A Single-Center Experience / 대한의진균학회지

BACKGROUND: Tinea incognito is the dermatophytoses of atypical clinical appearance that is induced by topical and systemic steroid treatment or topical calcineurin inhibitor. OBJECTIVE: The purpose of this study was to investigate the clinical and etiological aspects of tinea incognito. METHODS: In the 10-year-period 2007-2017, we reviewed fifty-one patients with tinea incognito with regards to the age, gender, duration, and associated diseases. The patients with tinea incognito were further evaluated concerning the clinical manifestations and culture of organisms. RESULTS: Age of the tinea incognito was most prevalent in the fifties (23.5%). The male-to-female ratio was 1:1.3. The most common type of infection was tinea corporis (52.9%), followed by tinea faciei (35.3%), tinea manus (5.9%), tinea barbae (3.5%), and tinea cruris (2.0%). The clinical features were to some extent diverse, ranging from eczema-like, seborrheic dermatitis-like, psoriasiform, folliculitis-like, rosacea-like, pyoderma-like, and purpura-like, and discoid lupus erythematosus-like. Trichophyton(T.) rubrum was the most common etiological agent (35.3%), followed by T. mentagrophytes (11.8%), Microsporum(M.) canis (7.8%), T. verrucosum (5.9%), T. erinacei, and M. gypseum (2.0%), respectively. CONCLUSION: Because of the increase in tinea incognito, there is a need for careful mycological examination in patients with tinea incognito.

Disseminated Tinea Corporis by Trichophyton mentagrophytes / 대한의진균학회지

Trichophyton(T.) mentagrophytes is a zoophilic or anthropophylic dermatophyte causing cutaneous human fungal disease. Atypical, disseminated clinical presentations may be seen in immunocompromised patients. It is also hard to diagnose tinea corporis when patients are using corticosteroid or have other dermatologic diseases. Herein, we report on an interesting case of tinea corporis caused by T. mentagrophytes in a patient with Cushing syndrome. A 75-year-old woman presented with pruritic, scaly, erythematous patches, papules and plaques on the face, neck, trunk and extremities for 7 months. She had been diagnosed with psoriasis at the local clinic and taking steroid (prednisolone, 20 mg/day) intermittently for 17 years. Potassium hydroxide smear showed several hyphae on microscope. Fungus culture showed a growth of colonies with whitish granular colonies surface and yellowish brown colored reverse. Characteristic grape-shaped microconidia, spiral hyphae and macroconidia were shown on the lactophenol cotton blue stain identified the colony as T. mentagrophytes. Lesions showed a marked improvement with oral itraconazole 200 mg/day for 14 days and topical lanoconazole cream for 30 days. It is important that when patient has eczematous lesions which are resistant to treatment, we should consider tinea incognito.

A Case of Majocchi Granuloma Caused by Microsporum canis Presented as Tinea Incognito / 대한피부과학회지

No abstract available.

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 due to Trichophyton rubrum in Atopic Dermatitis Patient / 대한의진균학회지

Tinea incognito is a dermatophytic infection with an atypical clinical presentation caused by previous treatment with topical or systemic steroids, as well as by the topical application of calcineurin inhibitors such as pimecrolimus and tacrolimus. The diagnosis of tinea incognito is frequently delayed or missed due to loss of typical appearance. Nowadays, as the use of steroid and topical calcineurin inhibitor has been increasing, the incidence of tinea incognito has also increased. Here we report a case of tinea incognito in a 19-year-old girl initially misdiagnosed as irritant contact dermatitis who also had atopic dermatitis and onychomycosis on the left 3rd finger nail. On the basis of the detection of hyphae on KOH examinations and isolation of Trichophyton rubrum by fungus culture, she was successfully treated with oral terbinafine 250 mg/day and topical terbinafine for 12 weeks.

Tinea Incognito on the Face and Neck / 대한의진균학회지

Tinea incognito is a dermatophytosis modified by previous treatments such as prolonged use of corticosteroids. Because the lesions often atypical appearing without classic features of ringworm, the diagnosis can be delayed or missed especially when tinea incognito is on the face and neck. A 75-year-old male patient who had been treated with topical steroids at the local dermatologic clinic for 10 years for the eczematous lesion on the scalp and face and recently the lesions spread throughout his neck and back. Physical examination showed ill-defined erythematous scaly patches on the face, neck and back and reddish crusted papules on the scalp. Potassium hydroxide (KOH) preparation on the left face and right neck showed hyphae and fungus cultures were positive for colonies of Trichophyton rubrum (T. ruburum). The result of DNA sequencing from the colony was identical to that of T. rubrum. The lesions were treated by oral terbinafine and topical isoconazole.

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.

Tinea Incognito in Korea and Its Risk Factors: Nine-Year Multicenter Survey

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.

Two Cases of Tinea Incognito Misdiagnosed as Eczema / 대한의진균학회지

Tinea incognito is a dermatophytosis of atypical clinical manifestation due to improper use of topical or systemic corticosteroids. We report two cases of tinea incognito misdiagnosed as eczema by non-dermatologist physicians. First, the lesions were manifested by pruritic, scaly localized erythematous macules and patches on the left ankle in a 61-year-old woman. She had been treated with topical steroids for 1 month without improvement. KOH smear revealed multiple fungal hyphae and histopathologic examination revealed the presence of fungal hyphae in the stratum corneum. Second, the lesions were manifested by localized scaly erythematous patches with pruritus on the face in a 76-year-old woman. She had been also treated with topical steroids for 2 months. KOH mount was positive for hyphae. All two patients were treated with 250 mg of terbinafine daily for 2 weeks and topical flutrimazole application. The lesions improved one month after treatment and no recurrence was observed.

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.

Eczema-Like Tinea Incognito Occurring Leg / 대한의진균학회지

Tinea incognito is the dermatophytosis of atypical clinical presentation that induced by topical and systemic corticosteroid treatment or new class of topical non-steroidal agent such as tacrolimus or pimecrolimus. We report a case of eczema-like tinea incognito in a 15-year-old girl. The lesions were manifested by pruritic to tender, scaly well-demarcated erythematous macules and patches with pustules on the lateral side of right shin. She had been treated with topical corticosteroid and pimecrolimus for 6 months. Direct microscopic examination of the lesion was positive for hyphae and fungal culture revealed colonies of Trichophyton(T.) rubrum. Histopathologic examination of the skin lesion showed mild perivascular inflammation with presence of fungal hyphae in the horney layer of the epidermis. 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 no recurrence was 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.

The Clinical, Histopathologic and Mycologic Characteristics of Dermatophytosis Which were Initially Diagnosed by Skin Biopsies / 대한피부과학회지

BACKGROUND: Dermatophytosis is sometimes difficult to definitively diagnose if it has atypical clinical characteristics or the mycological tests are negative. For these cases, skin biopsy will be helpful to diagnose a fungal infection. OBJECTIVE: The purpose of the present study was to evaluate the clinical, histopathologic and mycologic characteristics of dermatophytosis patients who were initially diagnosed by skin biopsies. METHODS: We performed a retrospective study of the clinical characteristics and the histopathologic and mycologic features of 16 patients with dermatophytosis and who were initially diagnosed by skin biopsy. RESULTS: The final diagnosis of dermatophytic infections were tinea incognito (7 cases) and Majocchi's granuloma (9 cases). The main symptoms were pruritus (4 cases) and pain (2 cases). The skin lesions of tinea incognito and Majocchi's granuloma mimicked inflammatory skin disease, lupus vulgaris or deep mycosis. The most common site of involvement was the face. The possible predisposing factors causing tinea incognito and Majocchi's granulomas appeared to be application of steroid ointment (6 cases), physical trauma (2 cases) and diabetes mellitus (1 case). The histopathologic features of tinea incognito revealed the sandwich sign (100%) and neutrophils in the epidermis (71.5%) and dermis (71.5%). Majocchi's granuloma showed rupture of hair follicles (88.9%) and suppurative folliculitis (66.7%). With Periodic acid Schiff and methenamine silver staining, hyphae and spores could be identified on the horny layers, within the hair follicles and/or on the dermis in the biopsy specimens of all the cases. Culture of the causative organisms using dermal fragments and skin scales on Sabouraud media demonstrated Trichophyton rubrum (4 cases), T. mentagrophytes (3 cases) and Microsporum canis (3 cases). Systemic treatment with itraconazole or terbinafine for 2~10 weeks was effective, except for two cases. CONCLUSION: We consider that the histopatholgic findings may be of great help to diagnose a dermatophytosis that has atypical clinical characteristics or negative mycological tests. Fungal culture is also important for making an accurate diagnosis of dermatophytosis.

A Case of Tinea Incognito Presented like Furunculosis / 대한의진균학회지

Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical or systemic corticosteroids, sometimes prescribed as a result of incorrect diagnosis. We report a case of tinea incognito presented like furunculosis on the chin. The patient had been treated with topical and oral corticosteroid under the impression of atopic dermatitis for 3 years for the eczematous lesion on the face and trunk. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton rubrum. Skin biopsy showed fungal hyphae in follicular keratinous plug and diffuse dermal and perifollicular inflammation. The lesion was treated with terbinafine systemically and cured 3 months later.

A Case of Tinea Incognito Induced by 1% Pimecrolimus (Elidel(R)) Cream / 대한피부과학회지

Tacrolimus and pimecrolimus represent a new class of topical non-steroidal medication currently used in the treatment of a variety of inflammatory skin lesions. We report a case of a patient in whom topical pimecrolimus therapy resulted in tinea incognito. Mycologic examination, including a KOH smear and fungal culture, was positive for hyphae and colonies of trichophyton mentagrophytes. The lesion was treated with oral griseofulvin and topical clotrimazole.

A Case of Tinea Incognito Presented as Folliculitis / 대한피부과학회지

Tinea incognito has been used to describe a dermatophyte infection modified by topical or systemic corticosteroid treatment. Lesions are often atypical appearing and the diagnosis is frequently delayed or missed even though by skilled dermatologists. We present here a 70-year-old female patient who had been treated with topical steroid ointment for the erythematous papules on the face and scalp under the diagnosis of contact dermatitis. Initially the lesions were regarded as a folliculitis, but a potassium hydroxide (KOH) preparation showed many fungal hyphae. A fungal culture grew Trichophyton rubrum.

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.