Tinea incognito due to Microsporum gypseum in three children

Tinea Incognito: Challenges in Diagnosis and Management

Tinea incognito is a dermatophyte infection with atypical features, due to the use of topical or systemic steroids or other immunosuppressive medications. Delayed diagnosis, spread of the infection to critical body surfaces, resistance to antifungal drugs, and increased costs due to prolonged hospitalization and multiple treatment regimens often complicate tinea incognito. It can affect individuals of all ages and genders, but it is more common in children. Atypical clinical appearance often necessitates differentiation from other diseases such as eczema, seborrheic dermatitis, lupus erythematosus, psoriasis, or other non-fungal skin conditions. The treatment of tinea incognito usually involves discontinuation of topical steroids or other immunosuppressive medications. Preventive measures and management of the underlying fungal infection are necessary and can be achieved with antifungal drugs. Patients should wear loose cotton clothes, use boiling water for laundry, and iron their clothing before wearing them. Additionally, they should avoid sharing bed linens, towels, clothes, and shoes. This review aims to raise awareness of tinea incognito among health practitioners, provide tips for detecting the disorder, include it in the differentials, and evaluate the available diagnostic procedures.

Dermatophytes and dermatophytosis in the eastern and southern parts of Africa

Dermatophytosis is currently a disease of global importance and a public health burden. It is caused by dermatophytes, which attack and grow on dead animal keratin. Dermatophytes belong to three genera, namely, Epidermophyton, Microsporum, and Trichophyton. The predominant clinical forms and causative agents vary from one region of the world to another. Poor socioeconomic status, high population densities, and poor sanitary conditions are some of the factors responsible for the high prevalence of dermatophytosis in many developing countries, which include countries in southern and eastern Africa, the focus of this review. To the best of our knowledge, there is currently no review article on published findings on dermatophytosis in the eastern and southern parts of Africa. This information will be of interest to the medical and research community since the world has become a global village. This review covers published research findings in eastern and southern regions of Africa until this date. The countries covered in the current review include Kenya, Ethiopia, Tanzania, South Africa, Mozambique, Madagascar, Malawi, Rwanda, Burundi, Uganda, Zambia, Zimbabwe, and Botswana. T. violaceum is the most common human etiological agent in all the countries under review with prevalence ranging from 56.7% to 95%, except for Madagascar (M. langeronii, reclassified as M. audouinii), Uganda (M. gypseum) and Malawi (M. audouinii). Tinea capitis was the most clinical type, followed by tinea corporis. Etiological agents of animal dermatophytoses were variable in the countries where they were reported. Major risk factors for dermatophytoses are age, climatic, and socioeconomic factors.

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

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.

Unusual Species of Dermatophytes: Rarely Identified or New?

Dermatophytes are causing superficial mycosis in animals and humans. Depending on the geophilic, zoophilic or anthropophilic origin of the fungus but also on the immunological status of the patient, symptomatology can widely differ. Nevertheless, each species is currently associated with typical clinical manifestations, even if atypical localizations and/or clinical pictures are sometimes also reported. Diagnostic tools applied to species identification have been changing since the last two decades with the more frequent use of molecular methods currently considered nowadays as reference methods for species identification. It becomes obvious that the algorithm used for the distinction of closely related species needs to combine phenotypic and genomic methods. All these different points are discussed, and the most recent novel species causing or involved in human dermatophytosis are reported.

Tinea incognito

Tinea incognito was first described 50 years ago. It is a dermatophytic infection with a clinical presentation modified by previous treatment with topical or systemic corticosteroids, as well as by the topical application of immunomodulators such as pimecrolimus and tacrolimus. Tinea incognito usually resembles neurodermatitis, atopic dermatitis, rosacea, seborrheic dermatitis, lupus erythematosus, or contact dermatitis, and the diagnosis is frequently missed or delayed.

Extensive neonatal dermatophytoses

We report a 25-day-old boy who was referred to our dermatology unit for evaluation of extensive annular erythematous lesions on his body. We initially considered the differential diagnoses of candidiasis and neonatal lupus erythematosus but investigations revealed the case as tinea corporis due to a relatively uncommon causative agent, Microsporum gypseum. To the best of our knowledge it is the first case of extensive neonatal dermatophytoses caused by this organism. The possible causes and the role of steroids in producing the clinical picture in our patient are discussed.

Tinea faciei incognito due to Trichophyton rubrum as a result of autoinoculation from onychomycosis

The localisation of a dermatophytosis on the face is rare. Differential diagnoses include a broad range of dermatological disorders, e. g. contact dermatitis, psoriasis vulgaris, seborrhoeic dermatitis, demodicosis, and polymorphic photo eruptions. Two patients suffering from tinea faciei incognito caused by Trichophyton rubrum are presented. Diagnosis was based on mycological diagnostics of skin scrapings using Calcofluor preparation and cultivation of the causative dermatophyte. Both patients were suffering from tinea pedis and tinea unguium caused by the same dermatophyte species. An infection caused by Trichophyton rubrum of the face always occurs following autoinoculation from a pre-existing tinea pedis and tinea unguium of feet and toenails, sometimes of the fingernails.

Tinea incognito in Italy: a 15-year survey

Tinea incognito or steroid modified tinea is a dermatophytic infection in which topical or systemic steroids, administered as a result of dermatological misdiagnosis or preexisting pathologies, have modified the clinical appearance of the fungal infection, transforming the typical ringworm and mimicking other skin diseases. This is a retrospective study of the agents, clinical aspects, sources of infection of 200 cases (98 males, 102 females, mean age 42 years) of tinea incognito, observed in Siena and Milan, Italy, in the period 1987-2002. In order of decreasing frequency, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum and Trichophyton erinacei were isolated. The clinical appearance of the infection was lupus erythematosus discoid-like, eczema-like, rosacea-like, especially on the face, impetigo-like and eczema-like on trunk and limbs. Less often the dermatophytosis resembled psoriasis, purpura, seborrhoic dermatitis and lichen planus. There was folliculitis in 9% of cases and dermatophytid in 3% of cases. Antimycotic therapy brought about clinical and mycological recovery in all patients except one, who had iatrogenic immunodepression.

Incidence of Tinea capitis in São Paulo, Brazil

To determine the incidence of tinea capitis in São Paulo, Brazil, an investigation was performed in Private and Public Pediatrics Service involving 4,500 children from 0 to 15 years old during 5 years (1996-2000). Samples were taken from 132 children with suspected fungal infection of the scalp, for direct microscopy and culture. Tinea of scalp was mycologically confirmed in 112 patients (85%). Males were more affected than females in all age groups. Children below 8 years old accounted for more than 75% of the occurrences. Only three cases of tinea capitis were diagnosed in children from 12 to 15 years of age. Tinea capitis was prevalent in 103 cases (91.96%); inflammatory kerion type lesions were diagnosed in 9 patients (8.04%). Microsporum canis (70.5%) and Trichophyton tonsurans (23.2%) were the most common agents followed by T. mentagrophytes (3.6%), M. gypseum (1.8%) and T. rubrum (0.9%).

Concentric rings: an unusual presentation of tinea corporis caused by Microsporum gypseum

A case of tinea corporis with the unusual presentation of concentric erythematous rings on the abdomen is reported. The pathogen was identified as Microsporum gypseum. While a number of unusual lesions have been described in M. gypseum infections, we are unaware of any reports on concentric rings.

Tinea faciei in an infant caused by Microsporum gypseum simulating a dry impetigo

We report a 14-month-old White boy who was referred to our dermatology unit for evaluation of a skin eruption on his nose. The initial examination led us to the clinical diagnosis of impetigo. The mycologic studies found an uncommon dermatophyte agent, Microsporum gypseum. The main differential diagnosis of tinea faciei is discussed.

Dermatophytosis on the eyelid caused by Microsporum gypseum

We report a case of tinea on the eyelid in a woman with psoriasis. Due to the history of psoriasis and clinical aspect of the lesion the diagnosis of psoriasis was suggested in the first place; however, laboratory examination revealed Microsporum gypseum. The patient was treated with oral itraconazole resulting in clinical and mycological cure. We emphasize the uncommon location of tinea caused by M. gypseum and the importance of searching for fungal infection on scaly lesions.

Inhibition of human pathogenic fungi by ethnobotanically selected plant extracts

In this study, 36 extracts derived from 29 plant species selected using an ethnobotanical approach were tested for antifungal activity against a taxonomically diverse group of 13 human pathogenic fungi. We compared the inhibitory characteristics of these plant extracts with those of the commonly used antifungals, amphotericin B and ketoconazole, and the plant-derived antifungal, berberine. Several plant extracts, notably those from Zingiber officinale (ginger) and Juglans cinerea (butternut), had pronounced antifungal activity against a wide variety of fungi, including strains that were highly resistant to amphotericin B and ketoconazole. Further exploration of Z. officinale as an antifungal is warranted as this species is generally regarded as safe for human consumption.