Cases reported "Tinea"

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1/21. Photolocalized tinea facialis.

    The case of a 34-year-old white woman with tinea facialis that persisted for nine months prior to diagnosis is presented. The confluent plaquelike erythematous eruption of the face with eyelid lichenification that flared outdoors was thought to represent polymorphic light eruption and was refractory to antibiotics, corticosteroids (topical and systemic), and antimalarials. A KOH preparation was positive when the dermatosis spilled onto the mandibular region, and restaining of the initial skin biopsy revealed fungal hyphae. Complete resolution was accomplished with griseofulvin and MicTin. tinea cab be added to the list of infectious agents that have a photosensitivity component. The fungus possibly "photolocalizes" to sun-damaged areas, ie, areas of increased capillary permeability. This case illustrates the importance of including tinea in considering diagnoses of sun-exposed lesions of the face.
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2/21. Deep dermatophytosis: report of 2 cases and review of the literature.

    skin infections due to dermatophytes are common and generally associated with a low degree of morbidity in normal hosts. Rare cases have been reported in which the dermatophyte invaded the deep dermis, subcutis, or even internal organs. Two patients, each of whom had clinical and histological findings of a deep or locally invasive dermatophyte infection, are described. This condition typically presents as a nodular eruption that is characterized histologically by suppurative granulomatous inflammation and deposition of organisms in the reticular dermis. Recognition of the potential of dermatophytes for local invasion in susceptible hosts will help ensure proper diagnosis and timely intervention in these cases.
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3/21. trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients.

    trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. amphotericin b did not appear effective in treating these dermatophyte infections.
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4/21. tinea barbae due to trichophyton verrucosum.

    A 25 year-old male, a dairy farmer, had noticed an annular scaly erythema on the left cheek since 3 weeks, and visited a dermatological clinic for the eruption. diagnosis of tinea faciei was made and he was treated with oral anti-histamine medicine and by topical application of anti-fungal ointment. However, the eruption worsened and enlarged so that he visited the department of dermatology of Kumiai Hospital on October 19, 1997. He was in good general health. physical examination disclosed papules and pustules with swelling and erythema on the chin and cheeks. The results of routine laboratory investigations were within normal limits except for white blood cell (9,800/mm(3)) and C reactive protein (2 ). A small white-yellowish colony was grown on brain heart infusion agar culture of the biopsied specimen of the lower jaw. Histopathological features showed epidermal hyperplasia with elongation of rate ridges and granulomatous changes around hair follicles in the dermis with many mononuclear cells and giant cells, where many positive spores and fine filamentous structures with PAS and Grocott stains were seen. Based on clinical, histopathological and mycological findings, a diagnosis of trichophyton verrucosum was made. The patient was treated with oral itraconazole (100 mg/day) for two months. There was a good clinical response and no recurrence during three years and six months.
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5/21. Recalcitrant tinea corporis as the presenting manifestation of patch-stage mycosis fungoides.

    mycosis fungoides is a cutaneous T-cell lymphoma. Its presence, which denotes an altered immune system, may make treatment of otherwise simple cutaneous infections difficult. In the case presented here, a patient with widespread tinea corporis poorly responsive to several oral antifungals was noted as having a background poikilodermatous slightly scaly eruption. Results of a skin biopsy during therapy with oral antifungal medications showed evidence of tinea corporis; atrophy of the epidermis; a superficial, perivascular, and interstitial lymphocytic infiltrate with numerous atypical lymphocytes; and exocytosis of atypical lymphocytes into the epidermis with formation of microabscesses-findings consistent with the diagnosis of mycosis fungoides. Treatment with PUVA (oral psoralen and UVA light) and oral itraconazole led to long-term remission of the mycosis fungoides and the associated tinea corporis. Immune suppression may have contributed to the recalcitrant nature of our patient's dermatophyte infection. Underlying cutaneous, systemic, or iatrogenic disorders associated with immune dysfunction should be considered in patients with recalcitrant dermatophyte infections.
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6/21. tinea faciei mimicking cutaneous lupus erythematosus: a histopathologic case report.

    tinea faciei is an uncommon dermatophyte infection. Clinically, it may resemble other dermatoses such as cutaneous lupus erythematosus (CLE), polymorphous light eruption, and contact dermatitis. Histopathology is highly variable, demonstrating a spectrum from mild focal spongiosis to a chronic spongiotic psoriasiform dermatitis with a mixed dermal inflammatory infiltrate and fungi in the cornified layer. We report a case of tinea faciei with histopathology that is characteristic of CLE.
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7/21. Acute fungal pustulosis on a bedridden patient's back.

    We report a particular dermatophytosis due to trichophyton rubrum. A 61-year-old woman presented an eruption which quickly evolved within 48 h, consisting of papular annular patches surrounded by creamy white pustules, which sometimes coalesced. The eruption was exclusively located on the back. The rest of the body and skin examination was normal, and the patient had no temperature. The mycological sample revealed mycelial filaments in the direct microscopic examination and T. rubrum in the mycological culture. Only a few cases of pustular lesions due to T. rubrum are reported in the literature. The extensive character, the site and the inflammatory aspect of the lesions were very surprising. This clinical presentation is more frequent with geophilic and zoophilic organisms than with anthropophilic dermatophytes such as T. rubrum.
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8/21. Bizarre annular lesion emerging as tinea incognito.

    tinea incognito has first been described in 1968. The term describes a tinea infection whose clinical morphology has been modified by the application of topical corticosteroids. The clinical manifestation can masquerade a number of other dermatoses and leads to misdiagnosis of annular eruptions. We describe a patient who showed a bizarre appearance of annular, inflammatory skin lesions at the umbilical region. Mycological culture yielded microsporum canis.
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9/21. Pimecrolimus-induced tinea incognito.

    A 6-year-old boy was brought to his primary care provider by his mother, who complained of a pruritic rash near his right eye. The eruption was described as a small, erythematous, slightly scaly plaque at the lateral margin of the right eyelid. The child was in good health and took no medications. The diagnosis of eczema was made; the patient was treated with pimecrolimus cream b.i.d. to the affected area. After 2-3 days of treatment, the itching and erythema completely resolved; however, a rough and scaly plaque persisted. After 1-2 weeks of treatment, the itching gradually returned, and the lesion began to increase in size. Multiple, similar lesions appeared several centimeters from the initially affected area.Pimecrolimus was discontinued; topical nystatin/triamcinolone ointment was prescribed. The eruption continued to spread, and the patient was referred to dermatology for further evaluation. The patient presented to the dermatology clinic with multiple annular, scaly papules and plaques with central clearing. Excoriations and mild inflammation were noted around all affected areas (Figure). A potassium hydroxide examination of the lesions revealed numerous hyphae. The nystatin/triamcinolone ointment was discontinued; oral griseofulvin was prescribed. The eruption improved dramatically after 3 weeks and eventually cleared completely after 5 weeks of treatment. Topical 2% ketoconazole cream was applied b.i.d. for the final 2 weeks of treatment.
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10/21. Seborrheic dermatitis-like tinea faciei.

    We report a 10-year-old Caucasian child who had erythema and abundant scaling on the nasolabial folds, the upper lip, and on the nose. Both the abundant scaling and the localization on the central part of the face led us to suspect seborrheic dermatitis. Direct microscopic examination of some scales removed from the lesions showed septate and ramified ectothrix hyphae. Cultural examination on Sabouraud medium led to the identification of the trichophyton mentagrophytes species. We described this patient to highlight the importance of considering tinea faciei in the differential diagnosis of all facial eruptions and the value of mycologic examination.
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