Erythroderma combined with deeper dermal dermatophytosis due to Trichophyton rubrum in a patient with myasthenia gravis: first case report and literature review

BACKGROUND

Dermatophytes are the most common causative pathogens of mycoses worldwide and usually cause superficial infections. However, they can enter deep into the dermis lead to invasive dermatophytosis such as deeper dermal dermatophytosis on rare occasions. Erythroderma is a severe dermatological manifestation of various diseases resulting in generalized skin redness, but erythroderma due to fungi infections is barely reported. In this article, we reported the first case of erythroderma combined with deeper dermal dermatophytosis due to Trichophyton rubrum (T. rubrum) in a patient with myasthenia gravis.

CASE PRESENTATION

A 48-year-old man was hospitalized because of erythema with scaling and nodules covering his body for a month. The patient had a history of myasthenia gravis controlled by regularly taking prednisolone for > 10 years and accompanied by onychomycosis and tinea pedis lasting > 8 years. Based on histopathological examinations, fungal cultures, and DNA sequencing results, the patient was finally diagnosed with dermatophyte-induced erythroderma combined with deeper dermal dermatophytosis caused by T. rubrum. After 2 weeks of antifungal treatment, the patient had recovered well.

CONCLUSIONS

This case report shows that immunosuppressed patients with long histories of superficial mycoses tend to have a higher risk of developing invasive dermatophytic infections or disseminated fungal infections. Dermatologists should be alert to this condition and promptly treat the superficial dermatophytosis.

Efficacy and Safety of Eberconazole vs Sertaconazole in Localised Tinea Infection

BACKGROUND

Topical antifungals especially azole group of drugs are effective agents in the treatment of dermatophytoses producing 100% clinical and mycological cure. Each of them vary having specific characteristics to tackle several clinical challenges like high relapse rate, recurrences and quality of life.

AIMS AND OBJECTIVES

To compare the efficacy and safety of Eberconazole and Sertaconazole in tinea infection.

MATERIALS AND METHODS

This was a randomized, observer-blinded, parallel-group study conducted at a dermatology out-patient department (OPD) of tertiary care teaching hospital in Puducherry. 85 patients with tinea corporis and tinea cruris infections who visited the dermatology OPD were enrolled in this study. The treatment phase involved two groups receiving either Sertaconazole 2% cream or Eberconazole 1% applied topically twice daily for 4 weeks. At the end of treatment phase, there was a 'follow-up phase' at the end of 4 weeks, where the patients were assessed clinically and mycologically. The data were analyzed using descriptive statistics using MS Excel version 2019 and SPSS version 15 for Windows.

RESULTS

The primary efficacy variables namely change in pruritus, erythema, induration, scaling and mycological cure significantly improved in both the groups, as compared to baseline (P < 0.001), in the treatment phase and follow-up phase. Intergroup comparison with respect to pruritus and scaling showed significant difference (P < 0.001), suggestive of better reduction of pruritus and scaling scores at 4 weeks with Sertaconazole when compared to Eberconazole.

CONCLUSIONS

Sertaconazole was better than Eberconazole in relieving signs and symptoms of dermatophytoses, especially pruritus, thereby improving patients' quality of life.

Epidemiology of dermatophytic infections between 2008 and 2017 in Barcelona, Spain

OBJECTIVE

The aim of this study was to evaluate the epidemiological profile of dermatophytoses from 2008 to 2017 in the area of "Barcelonès Nord", located in north-eastern Spain.

METHODS

From 2008 to 2017, 13,419 specimens obtained from patients with suspected superficial mycosis were subjected to direct microscopy and culture. Clinical and sociodemographic data were recorded. Proportions were compared using Chi-square and Fisher's exact tests. A logistic regression model was used for multivariate analysis.

RESULTS

Trichophyton rubrum was the most frequently isolated fungus (76.1%), followed by Trichophyton mentagrophytes/Trichophyton interdigitale (11.9%) and Microsporum canis (2.9%). Among the population over 15 years of age, tinea unguium pedum (40.4%) and tinea corporis (29.1%) were the predominant dermatophyte infections. Tinea capitis was mostly prevalent (53.6%) among patients up to 15 years of age, followed by tinea corporis (21.4%). We observed an increase in non-endemic anthropophilic dermatophytes (Trichophyton soudanense, Microsporum audouinii and Trichophyton violaceum) in the last few years. These species were associated with the population up to 15 years of age (p<0.001), having tinea capitis (p=0.0017) and being of African/Hindustani origin (p<0.001).

CONCLUSIONS

We confirmed the spread of T. rubrum as the predominant dermatophyte in our area and reported an increase in non-endemic anthropophilic dermatophytes in the last few years, especially in the African and Hindustani population up to 15 years of age.