Generalized tinea corporis due to Trichophyton rubrum in ichthyosis vulgaris

Exploring the Co-occurrence of dermatophyte infection and ichthyosis: A report of 3 cases

Dermatophyte infections frequently pose diagnostic challenges, especially when occurring alongside ichthyosis, a genetic skin disorder characterized by dry, thickened, scaly skin. This case series outlines three cases where dermatophyte infections overlapped with ichthyosis, emphasizing the complexities in clinical identification and differential diagnosis. Atypical clinical presentations in these cases led to initial misdiagnoses. Ichthyosis, a genetic skin disorder characterized by thickened and scaly skin, creates an environment conducive to dermatophyte settlement, complicating the diagnostic process. The cases highlight the importance of considering fungal infections, even when clinical features deviate from the expected course. A vigilant diagnostic approach, including mycological examinations, is crucial for accurate identification and timely management.

Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases

In medical mycology, the main context of disease is iatrogenic-based disease. However, historically, and occasionally, even today, fungal diseases affect humans with no obvious risk factors, sometimes in a spectacular fashion. The field of “inborn errors of immunity” (IEI) has deduced at least some of these previously enigmatic cases; accordingly, the discovery of single-gene disorders with penetrant clinical effects and their immunologic dissection have provided a framework with which to understand some of the key pathways mediating human susceptibility to mycoses. By extension, they have also enabled the identification of naturally occurring auto-antibodies to cytokines that phenocopy such susceptibility. This review provides a comprehensive update of IEI and autoantibodies that inherently predispose humans to various fungal diseases.

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report

BACKGROUND

Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.

CASE SUMMARY

We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.

CONCLUSION

A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.

Randbetonte erythematöse Plaques bei einem Patienten mit kongenitaler Ichthyose: von häufigen und seltenen Dermatosen

Nicht-syndromale autosomal-rezessive kongenitale Ichthyosen (ARCI) sind seltene hereditäre Verhornungsstörungen mit einem heterogenen Spektrum an Phänotypen von einer nahezu erscheinungsfreien Haut über eine milde bis schwere Erythrodermie bis hin zu Panzer-artigen Schuppen. Zu den Hauptvertretern zählen die lamelläre Ichthyose, die kongenitale ichthyosiforme Erythrodermie, die Harlekin-Ichythose, die „bathing suit ichthyosis“ und die „self-improving congenital ichthyosis“ (SICI), die sich im Laufe des ersten Lebensjahres bessert und im späteren Leben nur noch durch eine Xerosis cutis mit diskreten, feinen weißen Schuppen äußert.

Wir berichten über einen 38-jährigen Patienten, der sich mit einer milden kongenitalen Ichthyose unbekannter genetischer Ursache und einem seit einem Monat erheblich verschlechterten Hautbefund vorstellte. Anhand des klinischen Befundes mit anulären, randbetonten, schuppenden erythematösen Plaques, der Histologie und einer Schuppenpilzkultur konnte eine durch Trichophyton rubrum hervorgerufene Tinea corporis als Ursache für die Exazerbation identifiziert werden. Diese heilte nach 4-wöchiger systemischer Therapie mit Terbinafin komplett ab. Zurück blieb nur eine Xerosis cutis mit einer feinen weißen Schuppung. Passend zur klinischen Verdachtsdiagnose einer SICI erbrachte die molekulargenetische Untersuchung zwei mutmaßlich compound-heterozygote, wahrscheinlich pathogene Varianten im ALOXE3-Gen, eine Spleiß-Variante (c.1392+2T>A;p.?) und ein komplexes Rearrangement. ALOXE3 kodiert für die Lipooxygenase E3, die für die epidermale Differenzierung und für den Aufbau des „cornified envelope“ bedeutsam ist. Varianten in diesem Gen sind eine der Hauptursachen für SICI.

Patienten mit Ichthyosen weisen aufgrund des verdickten Stratum corneum, einer verzögerten Desquamation, einer gestörten epidermalen Barrierefunktion und einer Störung der Talg- und Schweißproduktion ein erhöhtes Risiko für Dermatophytosen auf. Diese präsentieren sich oft atypisch und können daher leicht verkannt werden. Insbesondere bei schweren kongenitalen Ichthyosen sind chronische Verläufe und Rezidive häufig. Unser Fall zeigt, dass auch und gerade bei Patienten mit seltenen Verhornungsstörungen an häufige infektiöse Dermatosen wie Tinea corporis gedacht werden muss.

Inherited ichthyosis and fungal infection: an update on pathogenesis and treatment strategies

Inherited ichthyoses are a group of genodermatoses classified as either nonsyndromic or syndromic. Nonsyndromic ichthyoses and keratitis, ichthyosis and deafness (KID) syndrome predispose to fungal infection. The diagnosis and treatment of fungal infections underlying ichthyoses are challenging. In this review, we summarize reported cases of ichthyosis with fungal infection over the past 50 years. Atypical manifestations such as alopecia, papules and brittle nails occurred in patients with ichthyosis combined with fungal infection. Various pathogenic mechanisms have been implicated, including mutations of ichthyosis-related genes leading to disruption of the skin barrier via multiple pathways. Host immune disorders, including atopy and abnormal innate immunity also contribute to susceptibility. Specific fungi may escape the immune response. Extensive and recurrent fungal infections are not uncommon in patients with ichthyosis, making a cure more difficult and increasing the need for systemic antifungal therapy. Traditional and new ichthyosis treatments aiming to improve skin barrier function could help prevent fungal infection. In conclusion, the close relationship between ichthyosis and fungal infection is of vital importance in clinical practice and requires more attention from physicians. More studies are required to investigate the mechanisms and explore useful treatment strategies.

Initial Evidence of Distinguishable Bacterial and Fungal Dysbiosis in the Skin of Patients with Atopic Dermatitis or Netherton Syndrome

Atopic dermatitis (AD) is an inflammatory skin disease in which epidermal barrier impairment, often owing to FLG null mutations, precedes immune hyperresponsiveness. Ichthyosis vulgaris is characterized by FLG null mutations and noninflamed dry skin. Netherton syndrome (NS), caused by SPINK5 null mutations, is characterized by generalized erythroderma with scaling and atopic manifestations. The goal of this work was to evaluate associations between specific skin disease features, such as ichthyotic and/or atopic manifestations, and the skin bacterial and fungal microbiota. Taxon diversity showed greater variation in the bacterial microbiota than in the fungal microbiota in the skin diseases. The relative abundances of Firmicutes (Staphylococcus) and Actinobacteria (Corynebacterium) were augmented in ichthyosis vulgaris, AD, and NS, whereas those of Proteobacteria/Enhydrobacter and Bacteroidetes were reduced, regardless of body site. Furthermore, proportions of Staphylococcus were correlated with transepidermal water loss and serum IgE levels. Nevertheless, the skin of patients with low to mild AD was overcolonized with Staphylococcus epidermidis and not with Staphylococcus aureus. Ascomycota were increased in both AD and NS, but from expansion of different fungal species. Finally, the expansion of pathologic bacteria in AD and NS might be supported by surrounding fungi. Thus, distinguishable bacterial and fungal skin dysbiosis in AD, NS, and ichthyosis vulgaris emphasizes disease-specific pathomechanisms.

Congenital ichthyosis associated with Trichophyton rubrum tinea, imitating drug hypersensitivity reaction

Tinea corporis and congenital ichthyoses are common dermatological diseases. The association of the two disorders is plausible due to the immunological and barrier defects of ichthyoses; however, relatively limited literature is available in this field. Since superficial fungal infections possess atypical morphology in keratinization disorders, and could imitate other dermatological conditions, the correct diagnosis can be challenging. We present the case of a 54-year-old woman with ichthyosis, who was initially treated for drug-hypersensitivity reaction.

3D-Organotypic Cultures to Unravel Molecular and Cellular Abnormalities in Atopic Dermatitis and Ichthyosis Vulgaris

Atopic dermatitis (AD) is characterized by dry and itchy skin evolving into disseminated skin lesions. AD is believed to result from a primary acquired or a genetically-induced epidermal barrier defect leading to immune hyper-responsiveness. Filaggrin (FLG) is a protein found in the cornified envelope of fully differentiated keratinocytes, referred to as corneocytes. Although FLG null mutations are strongly associated with AD, they are not sufficient to induce the disease. Moreover, most patients with ichthyosis vulgaris (IV), a monogenetic skin disease characterized by FLG homozygous, heterozygous, or compound heterozygous null mutations, display non-inflamed dry and scaly skin. Thus, all causes of epidermal barrier impairment in AD have not yet been identified, including those leading to the Th2-predominant inflammation observed in AD. Three dimensional organotypic cultures have emerged as valuable tools in skin research, replacing animal experimentation in many cases and precluding the need for repeated patient biopsies. Here, we review the results on IV and AD obtained with epidermal or skin equivalents and consider these findings in the context of human in vivo data. Further research utilizing complex models including immune cells and cutaneous innervation will enable finer dissection of the pathogenesis of AD and deepen our knowledge of epidermal biology.

Ichthyosis associated with widespread tinea corporis: report of three cases

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.

Refractory Trichophyton rubrum infection in lamellar ichthyosis

A 10-month-old boy with congenital lamellar ichthyosis presented with a chronic Trichophyton rubrum infection. There was no history of atopy or immunosuppression, and examination revealed high total immunoglobulin E (IgE) with a positive specific IgE for T. rubrum. Multiple treatments with fluconazole were necessary to control the infection. T. rubrum is present worldwide and is responsible for the vast majority of chronic dermatophytosis. Lamellar ichthyosis is a risk factor for chronic dermatophytosis because of excessive keratin and the barrier defect. A delayed-type hypersensitivity reaction to T. rubrum is associated with cure, whereas immediate hypersensitivity and IgE are not protective and may lead to chronic infection. Atopy and the Th2 profile therefore seem to be associated with chronic dermatophytosis. The association between ichthyosis and atopy is well documented. T. rubrum also has an interesting ability to evade immunity, which helps explain the chronic infection. Finally, in ichthyosis, it is likely that fluconazole has difficulty penetrating the acanthotic stratum corneum, which explains treatment failure. We report this case to alert clinicians to the possible association between lamellar ichthyosis and chronic dermatophytosis and to report the difficulties of management.

Trichophyton Schoenleinii-induced widespread tinea corporis mimicking parapsoriasis

We report a case of extensive tinea corporis in an 80-year-old woman on her forearms, thighs, legs, buttocks and trunk, mimicking parapsoriasis due to Trichophyton schoenleinii, without scalp involvement. Diagnosis of Trichophyton schoenleinii was confirmed by microscopy and mycological culture specimens.