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.

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.

In Vitro additive effect on griseofulvin and terbinafine combinations against multidrug-resistant dermatophytes

ABSTRACT Griseofulvin (GF) and terbinafine (TF) are commonly used drugs to treat dermatophytosis, a fungal infection of the skin. Today there is an increase in drug resistance to these antifungals which highlight the need for alternative synergistic therapies. Minimum Inhibitory Concentration (MIC) of GF and TF were determined against fungi clinical isolates from local hospitals with values ranging 0.03-2.0 µg mL-1 and 0.24-4.0 µg mL-1, respectively. A checkboard test was used to determine the combination of GF:TF which could induce an additive effect against the fungi isolates Multidrug-resistant isolates showed susceptibility after treatment with 16:2 µg mL-1 GF:TF. An MTT assay further verified that GF and TF combinations have greater additive effect against pathological and multidrug-resistant isolates than antifungals alone. Herein we disclose GF:TF combinations that could constitute as a possible new anti-dermatophyte therapy.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

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.

Dermatophytosis caused by Microsporum gypseum in infants: report of four cases and review of the literature

Abstract Dermatophytosis caused by Microsporum gypseum is rare, especially in infants, with few published cases. Diagnosis in this age group is frequently delayed. We review the literature and report 4 new cases of tinea of glabrous skin caused by M. gypseum mimicking eczema in infants. Considering new and previously reported cases, half of patients were exposed to sand, emphasizing the importance of this transmission vehicle in this age group. In conclusion, although rare, dermatophytosis by M. gypseum should be part of the differential diagnosis of inflammatory dermatosis in infants. A clinical suspicion and the availability of culture are keys to the diagnosis.

Scanning electron microscopy of superficial white onychomycosis

AbstractSuperficial white onychomycosis is characterized by opaque, friable, whitish superficial spots on the nail plate. We examined an affected halux nail of a 20-year-old male patient with scanning electron microscopy. The mycological examination isolated Trichophyton mentagrophytes. Abundant hyphae with the formation of arthrospores were found on the nail's surface, forming small fungal colonies. These findings showed the great capacity for dissemination of this form of onychomycosis.

Majocchi's granuloma - Case report

We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.

Toll-like recepoors (tlr) 2 and 4 expression ofkeratinocytes from patients witth localized and disseminated dermatopyytosis / Expressão de receptores do tipo Toll 2 e 4 nos queratinócitos de pacientes com dermatofitose localizada e disseminada

There are few studies on the role of innate immune response in dermatophytosis. An investigation was conducted to define the involvement of Toll-Like Receptors (TLRs) 2 and 4 in localized (LD) and disseminated (DD) dermatophytosis due to T. rubrum. Fifteen newly diagnosed patients, eight patients with LD and seven with DD, defined by involvement of at least three body segments were used in this study. Controls comprised twenty skin samples from healthy individuals undergoing plastic surgery. TLR2 and TLR4 were quantified in skin lesions by immunohistochemistry. A reduced expression of TLR4 in the lower and upper epidermis of both LD and DD patients was found compared to controls; TLR2 expression was preserved in the upper and lower epidermis of all three groups. As TLR4 signaling induces the production of inflammatory cytokines and neutrophils recruitment, its reduced expression likely contributed to the lack of resolution of the infection and the consequent chronic nature of the dermatophytosis. As TLR2 expression acts to limit the inflammatory process and preserves the epidermal structure, its preserved expression may also contribute to the persistent infection and limited inflammation that are characteristic of dermatophytic infections.

A literatura sobre o papel da resposta imune inata em dermatofitose é escassa. Este estudo se propôs a investigar a participação dos receptores do tipo Toll 2 e 4 (TLRs) 2 e 4 em pacientes com dermatofitose localizada (LD) e disseminada (DD, definida como lesões em pelo menos três segmentos corpóreos distintos), causadas por Trichophyton rubrum. Foram analisados cortes histológicos de 15 pacientes recém-diagnosticados, oito com LD e sete com DD. O grupo controle foi composto por 20 amostras de pele de indivíduos saudáveis submetidos a cirurgia plástica. TLR-2 e TLR-4 foram quantificados em lesões cutâneas por imunohistoquímica. Encontramos uma expressão reduzida de TLR-4 na epiderme superior e inferior nos dois grupos, LD e DD, quando comparados com o grupo controle; a expressão de TLR-2 foi preservada na epiderme superior e inferior de todos os três grupos. Como a sinalização por TLR-4 induz produção de citocinas inflamatórias e recrutamento de neutrófilos, a menor expressão desta molécula provavelmente contribui para a não resolução da infecção e conseqüente natureza persistente da dermatofitose. Como a sinalização via TLR-2 tem sido descrita como fator de regulação do processo inflamatório e de preservação da estrutura epidérmica, a sua expressão inalterada nas lesões dos pacientes com DD e DL pode contribuir também para a persistência da infecção e do reduzido processo inflamatório que são característicos das infecções por dermatófitos.

Case for diagnosis

Majocchi's granuloma is a persistent supurative folliculitis, associated with a deep granulomatous reaction induced by dermatophytes. There are two clinical forms of Majocchi's granuloma: the superficial form that appears in healthy individuals after localized trauma; and the nodular form, which occurs in inmunocompromised patients. We present a case of nodular Majocchi's granuloma on the forearm of an immunocompetent patient. Microbiological culture and examination of a deep aspiration sample identified Trichophyton rubrum. Collecting a deep sample of tissue is essential in achieving a good diagnostic performance.

Scanning electron microscopy of tinea nigra

Tinea nigra is a rare superficial mycosis caused by Hortaea werneckii. This infection presents as asymptomatic brown to black maculae mostly in palmo-plantar regions. We performed scanning electron microscopy of a superficial shaving of a tinea nigra lesion. The examination of the outer surface of the sample showed the epidermis with corneocytes and hyphae and elimination of fungal filaments. The inner surface of the sample showed important aggregation of hyphae among keratinocytes, which formed small fungal colonies. The ultrastructural findings correlated with those of dermoscopic examination - the small fungal aggregations may be the dark spicules seen on dermoscopy - and also allowed to document the mode of dissemination of tinea nigra, showing how hyphae are eliminated on the surface of the lesion.

Clinical, epidemiological, and therapeutic profile of dermatophytosis

BACKGROUND: The cutaneous mycoses, mainly caused by dermatophyte fungi, are among the most common fungal infections worldwide. It is estimated that 10% to 15% of the population will be infected by a dermatophyte at some point in their lives, thus making this a group of diseases with great public health importance. OBJECTIVE: To analyze the clinical, epidemiological, and therapeutic profile of dermatophytosis in patients enrolled at the Dermatology service of Universidade do Estado do Pará, Brazil, from July 2010 to September 2012. METHOD: A total of 145 medical records of patients diagnosed with dermatophytosis were surveyed. Data were collected and subsequently recorded according to a protocol developed by the researchers. This protocol consisted of information regarding epidemiological and clinical aspects of the disease and the therapy employed. RESULTS: The main clinical form of dermatophyte infection was onychomycosis, followed by tinea corporis, tinea pedis, and tinea capitis. Furthermore, the female population and the age group of 51 to 60 years were the most affected. Regarding therapy, there was a preference for treatments that combine topical and systemic drugs, and the most widely used drugs were fluconazole (systemic) and ciclopirox olamine (topical). CONCLUSION: This study showed the importance of recurrent analysis of the epidemiological profile of dermatophytosis to enable correct therapeutic and preventive management of these conditions, which have significant clinical consequences, with chronic, difficult-totreat lesions that can decrease patient quality of life and cause disfigurement. .

Ichthyosis associated with widespread tinea corporis: report of three cases / Ictiose associada a dermatofitose disseminada: relato de tres casos

Ichthyoses are a common group of keratinization disorders. A non-inflammatory generalized persistent skin desquamation is observed. It is characterized by increased cell turnover, thickening of the stratum corneum and functional changes of sebaceous and sweat glands. All of these favor fungal proliferation. Dermatophytes may infect skin, hair and nails causing ringworm or tinea. They have the ability to obtain nutrients from keratinized material. One of its most prevalent genera is Trichophyton rubrum. Although tineas and ichthyoses are quite common, the association of the two entities is rarely reported in the literature. Three cases of ichthyosis associated with widespread infection by T. rubrum are presented. Resistance to several antifungal treatments was responsible for worsening of ichthyosis signs and symptoms.

Ictioses são distúrbios da queratinização que se expressam com descamação cutânea generalizada persistente não inflamatória. Os pacientes que apresentam essa doença possuem aumentada renovação celular, maior espessura da camada córnea e alterações funcionais de glândulas sebáceas e sudoríparas, aspectos que parecem favorecer a infecção por dermatófitos. Dermatofitoses são infecções causadas por fungos ceratinofílicos, que acometem pele, pelos e unhas. Um dos gêneros mais prevalentes é o Trichophyton rubrum. Apesar das infecções fúngicas por dermatófitos e os quadros clínicos de ictiose serem muito comuns, são raros em literatura os relatos de associações dessas duas entidades. Apresentamos os relatos de três casos de ictiose associada a dermatofitose por T. rubrum. A ausência de resposta aos antifúngicos leva à piora clínica da ictiose.

Actividad antifúngica y perfil de seguridad del producto natural derivado del aceite de maravilla ozonizado (AMO3) en dermatofitos / In vitro antifungal susceptibility, in vivo antifungal activity and security from a natural product obtained from sunrise oil (AMO3) against dermatophytes

This work studied safety and antifungal activity of ozonized sunflower oil (AMO3) against dermatophytes. AMO3 was prepared through a new original process that modifies the oil before ozonation by alcoholic catalytic esterification. Susceptibility was studied in 41 dermatophytes by agar diffusion and broth microdilution tests. The experimental model to assess the topical safety of the oil included 60 CF1 mice divided in three groups that were treated with vaseline (control), 1 percent AMO3 and 50 percent AMO3 (overdose), respectively. Then, experimental dermatophytosis was induced in CF1 mice. Seventy-five individuals were selected and divided in 5 groups that were treated once a day with placebo, cream with 1 percent, 2 percent and 3 percent AMO3 plus an untreated control group. This new natural product showed antifungal activity against all strains studied. The MIC ranged between was 0,125 and 1 percent, while minimum fungicidal concentration (MFC) was 2 percent. The application of vaseline and AMO3 1 percent and 50 percent did not produce clinical or histopathological lesions. The mice with dermatophytosis that were treated with 1 percent, 2 percent and 3 percent AMO3 showed 100 percent clinical cure and 94 percent average mycological cure, exceeding placebo and control groups (p < 0,05). This product exhibits high antifungal activity and could be a safe alternative for ringworm topical treatment.

Se evaluó la seguridad y actividad antifúngica del aceite de maravilla ozonizado (AMO3) frente a dermatofitos. AMO3 se generó a través de un proceso original que implica modificación del aceite previa ozonización por esterificación catalítica con alcohol. La sensibilidad fue estudiada en 41 dermatofitos por difusión en agar y microdilución en caldo. El modelo experimental para evaluar tópicamente la seguridad del aceite, incluyó 60 ratones CF1, formando tres grupos a los cuales se les aplicó respectivamente vaselina (control), AMO3 1 por ciento y AMO3 50 por ciento (sobredosis). Luego, se indujo derma-tofitosis experimental en ratones CF1, seleccionando 75 individuos divididos en cinco grupos tratados una vez al día con placebo, crema con AMO3 al 1 por ciento, 2 por ciento y 3 por ciento, más un grupo control sin tratamiento. Este nuevo producto natural presentó actividad antifúngica frente a todas las cepas estudiadas. La CIM fluctuó entre 0,125 y 1 por ciento mientras la concentración fungicida mínima (CFM) fue de 2 por ciento. La aplicación de AMO3 no generó lesiones clínicas ni histopatológicas. Los ratones con dermatofitosis tratados con AMO3 presentaron 100 por ciento de cura clínica y 94 por ciento de promedio en cura micológica, siendo superior al grupo control y placebo (P < 0,05). Este producto muestra elevada actividad antimicótica y podría ser una alternativa segura para tratamiento tópico de dermatofitosis.

Tinea granulomatosa de Majocchi / Majocchi's granuloma

Relata-se o caso de um homem de 45 anos com dermatofitose superficial de longa data, tratado, inadvertidamente, com corticoide e antibiótico, com progressão subsequente para a forma profunda, conhecida como granuloma de Majocchi. O tratamento com terbinafina VO foi curativo.

We report the case of a man of 45 with superficial dermatophytosis longtime inadvertently treated with antibiotics and corticosteroids with subsequent progression to the deep form, known as granuloma Majocchi. Treatment with orally terbinafine was successful.

Tinea nigra nas formas geográficas em "coração" e "bico do papagaio" / Tinea nigra in geographical forms of "heart" and "parrot beak"

Através de ensaios fotográficos foram evidenciadas semelhanças entre máculas hipercrômicas de dois casos de Tinea nigra com imagens do manguezal denominado "Coeur de Voh", localizado na Ilha Francesa da Nova Caledônia (Oceania) e com a formação rochosa, denominada "Bico do Papagaio", localizada na Praia de Cabeçudas, Itajaí, Estado de Santa Catarina (Brasil).

Through a photographic essay, we identified similarities between hyperchromic maculas of two cases of Tinea Nigra with images of a heart-shaped mangrove called "Coeur de Voh", located on the French island of New Caledonia (Oceania) and of a rock formation called "Parrot Beak" located on Cabeçudas Beach, Itajaí, Santa Catarina State (Brazil).

Tiña corporis y tiña capitis / Tinea corporis and tinea capitis

La tiña es una infección de la piel, piel cabelluda, uñas o pelo causada por hongos dermatofíticos que invaden el estrato corneo y usan la queratina como nutriente. Existen tres géneros de dermatofitos: Trichophyton, Epidermophyton y Microspurum.