Bullous tinea pedis in two children. Bullose Tinea pedis bei zwei Kindern

Cutaneous Fungal Infections in Older Adults

The population of older adults continues to increase in the United States, leading to a concomitant increase in cutaneous disease. Fungal disease, specifically, commonly affects this population but often goes undiagnosed for too long. It is therefore important that providers be aware of common fungal pathogens, recognizable symptoms of disease, and treatment options. This article discusses 3 groups of pathogens: dermatophytes, Candida species, and Pityrosporum species, all of which cause a host of conditions that can be debilitating for older adults.

Annular bullous diseases

Annular bullous dermatoses represent an etiologically diverse group of cutaneous phenomena that present with a figurate morphology in association with vesicles and bullae. This group of diverse conditions consists of bullous pemphigoid; pemphigoid gestationis; epidermolysis bullosa simplex, Dowling-Meara type; linear immunoglobulin A bullous dermatosis; chronic bullous disease of childhood; anti-p200 pemphigoid; subcorneal pustular dermatosis; and immunoglobulin A pemphigus. Astute examination of clinical, histopathologic, and serologic features is crucial in distinguishing these bullous dermatoses. We review the clinical presentation, pathophysiology, histopathology, and treatments for each bullous annular disease to aid physicians in their recognition, diagnosis, and management.

Histopathology of Cutaneous Inflammatory Disorders in Children

Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.

Bullous tinea pedis with direct immunofluorescence positivity: when is a positive result not autoimmune bullous disease?

Skin biopsy for direct immunofluorescence (DIF) testing is an essential tool in the diagnosis of blistering diseases. In the majority of cases, positive epidermal immunofluorescent staining is indicative of an autoimmune bullous disease (AIBD). We identified 2 patients with bullous dermatophyte infection diagnosed on hematoxylin- and eosin-stained sections who had positive DIF findings on biopsy of perilesional skin. We subsequently reviewed the literature regarding positive DIF findings in conditions other than AIBD. Other infections, including herpesviridae, scabies, and orf, have rarely been reported to yield positive DIF findings, with positive staining at the dermoepidermal junction. Some genodermatoses and many inflammatory skin diseases, including lichen planus, psoriasis, graft-versus-host disease, among others, may also have DIF findings mimicking those of both intra- and subepidermal AIBD. Although rare, positive DIF results occur in conditions other than AIBD. In many instances, the pathophysiological mechanisms behind immunoreactant deposition in these conditions are poorly understood. Misleading DIF results may lead to delay in correct diagnosis and treatment. Clinicians should be aware of potential alternate sources of positivity when there is lack of clinical correlation with immunofluorescence findings.

Cutaneous fungal infections in the elderly

This article summarizes the common, superficial, cutaneous, fungal infections that are found in older adults. The epidemiology, classic appearance, and current treatments of these fungal infections are discussed. These common skin pathogens occur in many older adults.

Tinea pedis and tinea unguium in a 7-year-old child

This report documents tinea pedis and tinea unguium in a 7-year-old child. In all cultures Trichophyton rubrum was present. As tinea pedis and tinea unguium affect adults more often than children, they might be overlooked and misdiagnosed in the latter.