Superficial fungal infection among patients with immune bullous diseases

Abstract

Background/Objectives: Since no previous reported studies on superficial fungal infection (SFI) among patient with an immune bullous dermatosis exist in Libya, this study aimed to determine clinical and mycological aspects of SFI among those patients. Patients and Methods: This study was carried out in a Bullous clinic at Tripoli Central Hospital from May 2010 to October 2010. Patients were examined clinically for evidence of SFI, and scrapings were obtained from suspicious lesions for mycological investigation. Results: Clinical diagnosis of SFI was made in 31/79 (39.2%) female patient cases with immune bullous diseases. Their age ranged from 28 to 80 years (40 ± 13.3 years; mean ± standard deviation) and the main age group affected was 31–40 years (51.6%). A total of 20 (64.5%) of patients had pemphigus foliaceus, 4 (12.90%) pemphigus vulgaris, 3 (9.68%) herpetiform pemphigus, 2 (6.45%) bullous pemphigoid, 1 (3.2%) pemphigus vegetans, and 1 (3.23%) had IgA pemphigus. The majority (87.1%) were living in rural area, 90% of them were homemakers, and 19.4% had a diabetes mellitus. Fingernail involvement was seen in 38.9%, and toenail and tinea pedis were seen in 25% of cases equally. Distal subungual onychomycosis was the predominant clinical entity. Direct microscopic examination was positive in 51.4% and positive culture was obtained in 54.1%. Candida species were the main isolated organism from fingernails and dermatophytes from toenails. Conclusion: This study revealed that SFI was more frequent among female patients with pemphigus foliaceus and Candida species was the main isolated organism from the fingernails.