Widespread Dermatophytosis Research Articles

Widespread dermatophytosis in a healthy adolescent: the first report of multidrug-resistant Trichophyton indotineae infection in the UAE

Widespread dermatophytosis in a healthy adolescent: the first report of multidrug-resistant Trichophyton indotineae infection in the UAE

Widespread dermatophytosis after combined immunosuppressive therapy in a patient with COVID-19

Mycotic diseases of human skin are frequently diagnosed reaching 2025% of the population prevalence. The leading factor in the mycotic prevalence is the high survival rate of fungi in various environmental conditions. Up to 30 genera of fungi constantly live on human skin and mucous membranes. This constant balance of their presence on the body and interaction with it is called a mycobiome. If the balance between it and the macroorganism is disturbed, the reproduction of fungi begins and mycotic skin lesions develop.
 The study included the patient V. 75 years old, who came in with complaints of widespread rashes on the skin of the body and limbs accompanied by peeling after a COVID-19 infection. Microscopy revealed mycelium of pathogenic fungi. The patient received systemic and topical antifungal therapy until the end of hospitalization. He continued to receive terbinafine on an outpatient basis in combination with a topical antimycotic after discharge. Short review on baricitinib and levilimab is presented. According to the results of the study, a 6070% regression of the skin process was achieved after 2 weeks at discharge. One month later a complete regression of the skin process was achieved due to the therapy.
 The use of the combination of janus-kinase inhibitors with biological drugs and systemic glucocorticosteroids in COVID-19 patients has a powerful immunosuppressive effect on the body. It leads to the development of a common fungal skin lesion, which was observed in our patient.

Psychosocial and Financial Impact of Disease among Patients of Dermatophytosis, a Questionnaire-Based Observational Study.

Introduction:In the present epidemic of chronic, recalcitrant, and widespread dermatophytosis, impact of disease on quality of life (QoL) can be severe. Similarly, financial impact due to treatment cost and loss of wages needs consideration too.Aims and Objectives:Our primary aim was to evaluate the impact of dermatophytosis on QoL and the financial burden on individual and family.Materials and Methods:Adult patients having dermatophytosis were included in the study. Standard Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the psychosocial impact, and financial burden was evaluated by nine binary questions.Results:A total of completed 299 DLQI surveys and 275 financial burden surveys were taken for final analysis. Mean DLQI was 12.25 (SD = 5.56, n = 299). Significant association between total body surface area (BSA) and DLQI score was observed (rs = 0.251, P < 0.001, n = 299). Presence of tinea corporis was found to be significantly affecting the choice of clothing (P = 0.018, χ2 = 5.127, CI 95%). More numbers of male respondents reported loss of work or study hours due to their illness (P = 0.015, χ2 = 5.196, CI 95%), which was significantly associated with the BSA involved (P < 0.05, t = 5.529, CI 95%). Some difficulties in sexual activity were reported by 35.6% patients, which has significant association with tinea cruris (P = 0.001, χ2 = 10.810, CI 95%). Median household income was 10,000 INR and interquartile range (IQR) being 8,000–19,000. Mean financial burden calculated at 3.458 (SD = 1.696, n = 275), whereas mean financial worry reported by patient stood at 3.661 (SD = 1.216, n = 275). Financial burden showed significant correlation with “previous treatment approximate cost,” financial worry, and DLQI (P < 0.05, CI 95%). Financial worry (P = 0.016, rs = 0.145, CI 95%) and financial burden (P = 0.002, rs- = 0.145, CI 95%) both showed positive correlation with duration of disease.Conclusion:In present scenario of Dermatophytosis in India, the disease and its treatment causing impact on QOL as well as on personal financial burden and worry need consideration.

A Case of Widespread Dermatophytosis during Interleukin-17A Inhibitor Treatment in Psoriasis Patient with Tinea Unguium

Interleukin-17 (IL-17) is secreted by a class of helper T cells called Th17 cells, which stimulates keratinocytes to secrete proinflammatory mediator and to recruit other inflammatory cells in psoriatic skins. IL-17A inhibitor was approved for the management of psoriatic arthritis by FDA. It is the one of the biologics approved as first-line therapy for the management of psoriasis. But several studies show some side effects of IL-17A inhibitor such as upper respiratory infection and fungal infection like Candida albicans. Herein we report a widespread dermatophytosis during IL-17A inhibitor treatment. A 66-year-old male patient, with tinea unguium and chronic plaque psoriasis for several decades, presented with multiple erythematous scaly macules and patches for 2 weeks. He medicated IL-17A inhibitor for treating psoriasis total 3 times and last injection was 1 week ago. Dermatological examination revealed the involvement of 20% body surface area in the form of erythematous scaly macules and patches. KOH mount revealed the presence of numerous hyphae. The patient was started on oral terbinafine, topical isoconazole and efinaconazole. His skin lesions were improved after 1 month of anti-fungal therapy. IL-17 plays an important role in mucocutaneous microbial defense. So, fungal infection should be checked in using IL-17A inhibitor patients periodically.

Itraconazole: What clinicians should know?

Our purpose in assembling this paper is 2-fold. First, we hope to review in-depth the properties on itraconazole pellet-capsules and what clinicians should know when considering oral itraconazole and discuss the potential value of treating superficial dermatophyte infections with oral antifungal therapy. Second, we hope to address some of the concerns of the recent epidemic of chronic recalcitrant widespread dermatophytosis in India, with emphasis on better treatment but also considering some of the necessary prophylaxis hygiene measures. An in-depth review of itraconazole (as pellet-capsules), a triazole antifungal will be presented with focus on the pharmacokinetic properties which lead to the development of the 1-week pulse dosing for skin and nail infections. Finally, recommendations for best usage of itraconazole pellet-capsules for management of dermatophytosis will be summarized in this paper.

Chronic widespread dermatophytosis due to Trichophyton rubrum: a syndrome associated with a Trichophyton-specific functional defect of phagocytes.

Dermatophytes are agents of typically benign superficial infections. However, an increasing number of severe infections in immunocompromised hosts has been reported. We aimed to understand the factors underlying the existence of a cohort of patients presenting with chronic widespread dermatophytosis (CWD) due to Trichophyton rubrum, but with no signs of immunodeficiency. Their disease is usually recurrent and difficult to manage. Fourteen patients meeting the following criteria for CWD were studied: T. rubrum culture-proven skin lesions of ≥10 cm in at least one dimension; the involvement of at least three non-contiguous localizations of >1 year’s duration; and no predisposing conditions. For comparison, we also studied 13 acute Tinea pedis patients. Macrophages and neutrophils were isolated and tested for T. rubrum conidia phagocytic and killing activity. H2O2, NO, and pro- and anti-inflammatory cytokine release were measured. All experiments were run with age- and sex-matched healthy donors’ cells in parallel. CWD patients’ macrophages and neutrophils presented with reduced T. rubrum–phagocytic and killing abilities, and reduced H2O2 and NO release when compared with those of healthy donors. CWD patients’ macrophages secreted lower levels of the proinflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α, but enhanced levels of the anti-inflammatory cytokine IL-10. Neutrophil secretion closely followed this unbalanced pattern. In contrast, responses to the positive controls zymosan, lipopolysaccharide, and phorbol myristate acetate were comparable with those of healthy donors. The same experiments were performed with macrophages and neutrophils from the acute Tinea pedis patients and showed no differences when compared with the matched healthy donors. Patients with CWD have a T. rubrum-related functional deficiency of phagocytes and may represent a distinct clinical entity in the complex spectrum of the Trichophyton–host interaction.

Trichophyton species of Arthroderma benhamiae - a new infectious agent in dermatology.

In Germany, infections due to the zoophilic dermatophyte Trichophyton (T.) species of Arthroderma benhamiae are being more frequently diagnosed. The source of infection of this emerging pathogen overlaps with that of the zoophilic species T. interdigitale. The most common source are guinea pigs. T. species of Arthroderma benhamiae causes inflammatory dermatophytosis in children and adolescents. In addition to tinea capitis, it may cause both tinea corporis, tinea manus and frequently tinea faciei. In Germany, T. species of Arthroderma benhamiae is a frequent zoophilic dermatophyte, which in regions is probably more frequent than Microsporum canis. The mycological identification of the isolates with their yellow stained colonies is based on their macroscopic and microscopic features. However, some exhibit colony features consistent with those of T. interdigitale. These strains only can be identified unambiguously by means of molecular techniques. Using detection methods such as PCR-ELISA or real-time PCR, the dermatophyte can be identified directly from clinical material. Sequencing of the internal transcribed spacer region (ITS) of the ribosomal DNA has been approved as culture confirmation test for T. species of Arthroderma benhamiae. In addition, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) is useful. Widespread dermatophytosis due to T. species of Arthroderma benhamiae, in particular of tinea capitis, requires oral antifungal agents. Terbinafine is most effective, alternatives are fluconazole and itraconazole.

Predictive value of seborrheic dermatitis and other common dermatoses for HIV infection in Bamako, Mali

In Africa where there are limited laboratory resources for human immunodeficiency virus (HIV) testing the presence of seborrheic dermatitis--common in early stages of infection--may have potential as a clinical marker for HIV. To assess the predictive value of this skin disease a prospective study was conducted at the Institut Marchoux in Bamako Mali in 1992-94. The 305 study participants whose HIV status was unknown at study entry were grouped by dermatologic condition; in 21 cases two or more dermatoses were present. 159 of these patients were found to be HIV-positive. The HIV rates by condition were as follows: seborrheic dermatitis (28/58 patients or 48%) psoriasis (10/48 patients 21%) widespread dermatophytosis (11/33 patients 33%) molluscum contagiosum (8/17 patients 47%) herpes zoster (64/81 patients 79%) Kaposis sarcoma (31/31 patients 100%) prurigo (27/59 patients 46%) and associations of several dermatoses (19/21 patients 90%). The proportions of seropositive patients with two or more clinical signs of acquired immunodeficiency syndrome (AIDS) were 18% 10% 9% 75% 27% 74% and 52% respectively. Thus Kaposis sarcoma prurigo and molluscum contagiosum were the dermatologic conditions most frequently associated with clinical indicators of a poor prognosis. Seborrheic dermatitis on the other hand has a high prevalence in HIV-infected persons but a relatively early occurrence in HIV natural history (evidenced by its low association with full-blown AIDS) making it a useful indicator of HIV infection in African populations.

An Immunosuppressive Serum Factor in Widespread Cutaneous Dermatophytosis

A patient had a widespread dermatophytosis and a serum factor that specifically suppressed his T-cell rosette formation and the phytohemagglutinin responsiveness of his lymphocytes. The patient was also unable to mount a delayed hypersensitivity reaction to a standard anergy panel, although he did exhibit an immediate type hypersensitivity reaction to the trichophytin skin test antigen. Although many immunosuppressed patients succumb to severe bacterial and fungal infections, it is our contention that in certain cases the infectious process itself may generate a serum factor that is capable of inducing immunosuppression, thereby rendering the patient susceptible to further spread of the infection.

CANDIDA GRANULOMA WITH EPIDERMOPHYTOSIS. REPORT OF A CASE AND REVIEW OF THE LITERATURE.

Granulomatous skin lesions associated with chronic infection byCandida albicansare manifestations of a rare and severe form of generalized mucocutaneous candidiasis. This syndrome is characterized by the appearance, in early childhood of extensive superficial candidiasis which runs a course of many years and tends to recur following treatment. The mouth, face, scalp, and fingernails are most commonly involved. Late in the disease granulomatous plaques develop on the skin—resembling those seen in the deep mycoses; however, no visceral involvement withCandidais present. Intravenous amphotericin B is the only effective form of therapy and has greatly improved the prognosis in this potentially fatal disease. The case reported presents typicalCandidagranulomas with associated widespread dermatophytosis due toEpidermophyton floccosum. In addition, this patient developed carcinoma of the esophagus, possibly as a result of long-standing esophageal candidiasis. The recent literature is reviewed and the cases reported to date summarized.

TRICHOPHYTOSIS, INCLUDING ONYCHOMYCOSIS UNIVERSALIS, SIMULATING TINEA IMBRICATA

Realizing the greater luxuriance of all forms of plant life in the tropics, it is not difficult to understand an analogy between the tinea imbricata of those regions and widespread dermatophytosis (of tropical origin) in the north. As early as 1855 Barensprung1insisted that tinea circinata was etiologically identical with eczema marginatum, and in 1878 Tillbury Fox2stated that some and more medical men. practising in tropical parts, . . . entirely concur in the view that eczema marginatum and the oriental phase of ringworm known as Indian, Chinese, etc., that is, tinea imbricata, are one and the same disease. That Barensprung and Fox did not have the advantage of the later clarifying mycologic work of Castellani and Sabouraud on the epidermophytons and of Castellani on the endodermophytons is beside the mark: it does not detract from the significance of the view of the forty and more medical