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Disseminated tinea incognito due to Trichophyton violaceum in a healthy child

  • Xiang-Dong Wang
    Affiliations
    Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Rd 38, Hangzhou, 310009, China
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  • Ze-Hu Liu
    Correspondence
    Correspondence to: Ze-Hu Liu Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine West Lake Rd 38, Hangzhou, China, Tel: 86-571-87827181, Fax: 86-571-87814481
    Affiliations
    Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Rd 38, Hangzhou, 310009, China
    Search for articles by this author
Open AccessPublished:June 15, 2022DOI:https://doi.org/10.1016/j.ijid.2022.06.018

      Keywords

      A 13-year-old boy living in a village presented to our clinic with a 1-year history of pruritus involving the face, scalp, trunk, and extremities with nonresponse to topical corticosteroid, including triamcinolone acetonide cream and lotion. Physical examination revealed wide-spread erythematosus, sharply demarcated plaques with scales, and central clearing on the face (Figure 1, 2a), scalp (Figure 3), trunk (Figure 1b and c), and extremities (Figure 1d, e, and f). Posterior cervical and postauricular lymphadenopathy could not be found. There are multiple scattered, irregularly shaped patches of partial alopecia with black dots (Figure 3). Direct microscopy examination of skin lesions revealed abundant dermatophytic hyphae (Figure 4a). Direct microscopy examination of hair also revealed endothrix dermatophytic hyphae and arthrospores (Figure 4b). Fungal culture isolated from different inoculations showed the same dermatophyte. Colonies were waxy, heaped, folded, and deep violet in color. Numerous chlamydospores with no conidia could be detected under slide culture on potato dextrose agar at 28°C. The fungus was defined as Trichophyton violaceum by morphology. The general condition of the child was good. No abnormalities were found during pulmonary and abdominal clinical examinations. The diagnosis of disseminated tinea incognito was confirmed. Tinea incognito is a term used to describe a tinea infection modified by topical corticosteroids (
      • Ive FA
      • Marks R.
      Tinea incognito.
      ). Topical corticosteroids suppress the local immune response and allow the fungus to grow easily (
      • Ive FA
      • Marks R.
      Tinea incognito.
      ). As a result, the fungal infection may take on a bizarre appearance in the patient (
      • Marks R
      Tinea incognito.
      ). Tinea capitis is not usual in tinea incognito (
      • Romano C
      • Maritati E
      • Gianni C.
      Tinea incognito in Italy: a 15-year survey.
      ). Oral terbinafine (250mg daily) and topical bifonazole was started. The mycological examination was negative after four weeks of treatment. A follow-up examination six months later showed no recurrence of symptoms. Tinea incognito, especially disseminated tinea incognito, is a great pitfall for physicians (
      • Nowowiejska J
      • Baran A
      • Flisiak I.
      Tinea incognito-a great physician pitfall.
      ). Therefore, if it's red and scaly, always look for fungus (
      • Marks R
      Tinea incognito.
      ,
      • Liu ZH.
      If it's red and scaly look for fungus: remember cutaneous protothecosis.
      ).
      Figure 1
      Figure 1Erythematous, sharply demarcated plaques with scales and central clearing on the face.
      Figure 2
      Figure 2Multiple lesions on the face (a), trunk (b, c), and extremities (d, e, and f).
      Figure 4
      Figure 4a: Abundant septate mycelium from skin scrapings (x400). b: Arthroconidia and hyphae invasion of the hair (x400).

      Declaration of Competing Interest

      The authors have no competing interests to declare.

      Funding

      This work was supported by the Hangzhou Science and Technology Bureau, China (grant no. 202004A17).

      Ethical approval

      Written informed consent was obtained from the patient for publication of this case report and accompanying images.

      Author contributions

      Drs. Wang and Liu: Study design. Drs. Wang and Liu: Data collection. Drs. Wang and Liu: Data analysis. Dr. Liu: Writing.

      References

        • Ive FA
        • Marks R.
        Tinea incognito.
        Br Med J. 1968; 3: 149-152
        • Liu ZH.
        If it's red and scaly look for fungus: remember cutaneous protothecosis.
        J Eur Acad Dermatol Venereol. 2018; 32: e327
        • Marks R
        Tinea incognito.
        Int J Dermatol. 1978; 17: 301-302
        • Nowowiejska J
        • Baran A
        • Flisiak I.
        Tinea incognito-a great physician pitfall.
        J Fungi (Basel). 2022; 8
        • Romano C
        • Maritati E
        • Gianni C.
        Tinea incognito in Italy: a 15-year survey.
        Mycoses. 2006; 49: 383-387