Corticosteroid-modified tinea faciei simulating rosacea

Tinea faciei simulating rosacea which developed after topical application of a corticosteroid ointment is described. Mycological examinations revealed that the causative organism was Trichophyton mentagrophytes. The tinea was cured by topical application of a cream containing tolciclate.     

73例儿童毳毛面癣病原菌分析

目的:明确儿童毳毛面癣常见致病菌种及易感因素。方法:分析2014年4月至2019年3月我院就诊的73例儿童毳毛面癣患儿的临床资料。皮损部位刮取鳞屑及毳毛接种到沙堡弱培养基,27℃恒温培养2周,对培养出的病原菌进行形态学及分子生物学鉴定。结果:共分离出皮肤癣菌62株,其中须癣毛癣菌38株(61%),犬小孢子菌12株(19%),石膏样小孢子菌10株(16%),紫色毛癣菌2株(3%)。62例患儿有动物接触史,45例患儿有外用糖皮质激素史。患儿外用特比萘芬乳膏或联苯苄唑乳膏,部分患者口服特比萘芬片,治疗4~8周后均达到临床和真菌学治愈。结论:毳毛面癣的优势致病菌是须癣毛癣菌,其次依次是犬小孢子菌和石膏样小孢子菌。发病因素与接触动物密切相关。     

Tinea capitis in infants in their first year of life

BACKGROUND: Tinea capitis is the most common type of dermatophytosis in children, but is uncommon in the first year of life. OBJECTIVES: To review clinical, mycological and epidemiological data in a series of 10 infants aged under 1 year diagnosed as having tinea capitis in three Spanish hospitals between 1998 and 2002. METHODS: A retrospective case note study. RESULTS: There were six boys and four girls with a mean of age 7 months (range 1.5-12). All the children were born in Spain, but in five cases the parents were immigrants from Africa. In these cases the isolated dermatophytes were two Trichophyton tonsurans, one T. verrucosum and two Microsporum audouinii. Four autochthonous cases were caused by M. canis and one by M. audouinii (but this one was in contact with African immigrants). In two of the five cases produced by anthropophilic dermatophytes other family members were infected by the same fungus. Most cases were treated successfully with griseofulvin. CONCLUSIONS: Although tinea capitis is rare in infants in their first year of life, the condition should be investigated if scaling and/or alopecia are present. A thorough epidemiological study of other family members is mandatory.     

Tinea capitis in two elderly women: transmission at the hairdresser

Tinea capitis is rare in the elderly. We report cases of two elderly women who presented to our dermatology clinic within 8 weeks of each other, with scalp scaling and alopecia. In both cases, Microsporum canis grew on fungal culture of their hair, and required prolonged treatment with terbinafine. Neither of them gave a history of contact with young children or any animals. Both were fairly fit and not systemically immunocompromised. However, both had been regularly visiting the same hairdresser, during the presumed period of infectivity, making this the most likely source of infection.     

Lupus miliaris disseminatus faciei successfully treated with tranilast: report of two cases

We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF.     

A case of erythromelanosis follicularis faciei with a unique distribution

A 16-year-old Japanese boy with erythromelanosis follicularis faciei (EFF) with an unusual distribution is described. The clinical features of classic EFF consist of reddish-brown discoloration of the skin with fine follicular hyperkeratosis in the preauricular areas, and occasionally on the temples and the lateral aspects of the neck. The present case is unique in that similar lesions also occurred on the auricles and eyebrows. Both light and electron microscopic findings of the lesions were consistent with the diagnosis of EFF.     

Tinea capitis in two black african adults with HIV infection

Tinea capitis is rare in adults, although a few cases have been described in HIV-infected patients. We present two cases in black African adults who were HIV positive. In one, the condition led to the diagnosis of HIV infection. It is possible that the rarity of tinea capitis in HIV-positive adults could be related to increased colonization of their scalp by Pityrosporum (Malassezia) spp. In patients well controlled with an antiviral therapy, the treatment of tinea capitis seems no more difficult than in non-immunosuppressed patients. There is possibly a relation between clinical presentation and degree of immunodeficiency.     

利拉萘酯乳膏治疗手足癣和体股癣40例疗效观察

目的：评价2％利拉萘酯乳膏手足癣与体股癣的临床疗效及安全性，并与l％联苯苄唑乳膏进行比较。方法：对74例浅部真菌病患者进行治疗，其中治疗组40例，外用2％利拉萘酯乳膏，每日1次；对照组34例，外用1％联苯苄唑乳膏，每日1次。手足癣疗程4周，体股癣疗程2周。分别于停药及停药后2周观察患者的临床表现及治疗效果。结果：2％利拉萘酯乳膏和1％联苯苄唑乳膏临床疗效相似，停药时临床总有效率分别为87．50％和85．29％；停药后2周临床总有效率分别为97．50％和91．17％，两组总有效率比较差异均无统计学意义（P均〉0．05），无不良反应。结论：2％利拉萘酯乳膏治疗手足癣和体股癣使用方便，依从性好，安全，有效，是值得推广的一种新型外用抗真菌药。     

The Rise and Fall of Fluorescent Tinea Capitis

The epidemiology of tinea capitis has had a remarkable change in the past 20 years. It is important for physicians to realize that most tinea capitis in the United States is caused by Trichophyton tonsurans and that these lesions cannot be diagnosed by the Wood's lamp. Trichophyton tonsurans tinea capitis is frequently misdiagnosed because the lesions mimic such common scalp conditions as dandruff and seborrhea. Further, this organism can cause chronic tinea capitis in women that may become a infectious reservoir for other family members. A negative potassium hydroxide preparation will not rule out infection with T tonsurans and cultures are necessary. Scalp lesions in children should be considered tinea capitis until culturally proved otherwise.     

Case report: A successful combined treatment of severe lupus miliaris disseminatus faciei with oral isotretinoin and methylprednisolone

Lupus miliaris disseminates faciei (LMDF) is a rare inflammatory dermatosis characterized by an asymptomatic papular eruption in the central face, of which the etiology and pathogenesis are not clear. There is a lack of standard treatment recommendations, especially for severe cases. Here we report a new case of successful treatment of severe LMDF by the combination therapy of oral isotretinoin and methylprednisolone.     

Human cases of cattle ringworm due to Trichophyton verrucosum in Victoria, Australia

Between 1962 and 1994, 32 isolates of Trichophyton verrucosum from cases of tinea corporis, tinea faciei and tinea capitis were referred to the Mycology Reference Laboratory of the Microbiological Diagnostic Unit at The University of Melbourne, Victoria, Australia. Patients had presented at clinics in metropolitan Melbourne and country towns in the State of Victoria, Australia. They included dairy and cattle farmers, a slaughterman who worked in an abattoir, a veterinary tutor and children who lived on farms. Many patients lived in one of the three dairy farming areas of Victoria. A few lived in the outer suburbs of Melbourne. One cattle farmer came from south-east New South Wales. Specimens were not received for examination from animal contacts of the patients. The only patient from overseas was a boy from Lebanon. The literature recording human infections due to T. verrucosum in Australia is reviewed.     

Scarring of lupus miliaris disseminatus faciei: treatment with a combination of trichloroacetic acid and carbon dioxide laser

We present a case of a 35‐year‐old man having a 12‐month history of multiple reddish‐brown papules on the chin, forehead, cheeks, and eyelids. Histopathologic findings revealed epithelioid cell granulomas with central necrosis consistent with a diagnosis of lupus miliaris disseminatus faciei. After 9 months of combined treatment with ethambutol, rifampin, and pyrazinamide, most lesions gradually resolved but remained as severe disfiguring scars. After 10 sessions of treatments with 100% trichloroacetic acid and CO₂ laser, the lupus miliaris disseminatus faciei scars have been much improved and the patient has never experienced a recurrence of disease during subsequent years of follow‐up.     

A case of lupus miliaris disseminatus faciei that was successfully treated with 595 nm pulsed‐dye laser combined with drugs

Lupus miliaris disseminatus faciei (LMDF) is a rare chronic inflammatory and granulomatous skin disease characterized by reddish‐brown papules and nodules on the central face. Although this disease can spontaneously resolve, disfiguring scars can often remain. This disease responds poorly to general treatments. Except for systemic hormones, the efficacy of other drugs is unclear. There are few reports on the use of laser treatment for LMDF. Here, we report a case of LMDF that was successfully treated with a 595 nm pulsed‐dye laser combined with glucocorticoids and isotretinoin. The treatment outcome shows less scar formation and fewer side effects when this regimen was employed.     

家兔饲养者两侧面颌部的难辨认癣1例

患者女,33岁。两侧面颌红斑瘙痒1年余。曾外用多种糖皮质激素霜治疗无效。刮取皮屑镜检见大量真菌菌丝,培养见棒形分隔大分生孢子、葡萄串状小分生孢子。尿素酶实验阳性、毛发穿孔实验阳性,鉴定为须癣毛癣菌。经内服特比萘芬胶囊和外用萘替芬酮康唑乳膏治疗28天后皮损消退。复查真菌阴性。     

红色毛癣菌致股癣合并龟头癣1例

报道1例红色毛癣茵引起的股癣合并龟头癣。患者男,16岁。因双侧腹股沟及龟头红斑、鳞屑伴痒2周就诊。经真菌培养确诊为红色毛癣茵感染所致的股癣合并龟头癣,予伊曲康唑口服及联苯苄唑乳膏外用治疗2周后痊愈。     

Tinea of the scrotum--report of a case presenting as lichenified plaques

A 57-year-old Japanese man with tinea of the scrotum was described. His lesions on the scrotum were unusual; they appeared as lichenified plaques.     

佛山市禅城区糖尿病患者足癣流行病学调查

目的：了解佛山市禅城区糖尿病人群足癣流行情况。方法：对2005年8年至2007年8月到我院内分泌科及社区医院就诊20岁以上1082例糖尿病患者足癣流行病学情况进行统计分析。结果：糖尿病患者足癣的患病率37．7％，病原菌主要为红色毛癣菌，白念珠菌也有相当大比例；临床表现以鳞屑型为主，其次糜烂型及水疱型；年龄分布以中青年为主，20～40岁占55．9％；农民患者比例高于其他人群，足癣患病率随糖尿病病程延长而增加。结论：根据佛山禅城区糖尿病患者足癣流行病学特征，加强城市人群的糖尿病及其并发症的防治宣传工作，积极控制血糖，合理使用抗生素，预防和减少足癣感染。     

Tinea of vellus hair: an indication for systemic antifungal therapy

Background Topical antifungal treatment is indicated in tinea of glabrous skin, except in cases of extensive, multiple or recurrent lesions, or immunocompromised patients. However, in daily practice there are cases resistant to topical treatment despite these indications. Parasitism of the hair could be the cause behind the majority of isolated lesions of ringworm of hairless skin with a poor outcome with topical antifungal treatment. Objectives To present a prospective observational study of 13 cases of tinea of glabrous skin with topical antifungal resistance during the period 2007–2009. Methods Cases were analysed from a clinical, mycological and therapeutic standpoint. Results The mean age was 7 years. Eight (62%) patients reported prior contact with an animal and 10 (77%) patients had received topical corticosteroids before visiting the dermatologist. Excoriation was observed in eight (62%) patients, and follicular micropustules were seen in 11 (85%). In all patients, some short thin hairs fell easily on to the slide during the skin scraping. In all patients all the few vellus hairs identified in direct examination were affected. All identified species were zoophilic or geophilic. All cases resolved after oral antifungal treatment. Conclusions In tinea of glabrous skin with low response to topical antifungal treatment we must rule out tinea of the vellus hair. Infection by nonanthropophilic dermatophytes, previous corticosteroid therapy and excoriation might be predisposing factors. Parasitism of the vellus hair, observed by direct microscopy, should be another criterion for establishing systemic treatment from the onset, as is the case in tinea capitis.     

特比萘芬联合中药复方透骨草溶液治疗角化过度型足癣临床疗效观察

目的观察盐酸特比萘芬(兰美抒)口服联合中药复方透骨草浸泡治疗角化过度型足癣的临床疗效。方法采用随机对照法观察口服兰美抒联合中药浸泡(联合组)及单用兰美抒口服(兰美抒组)或中药浸泡(中药组)治疗角化过度型足癣的临床疗效。结果用药后2周联合组、兰美抒组的痊愈率、有效率均明显优于中药组(P<0.05);联合组的痊愈率、有效率略高于兰美抒组,但两者差异无显著性(P>0.05)。真菌学评价:用药后2周联合组真菌清除率80.00%,兰美抒组70.00%,中药组50.00%。联合组真菌清除率显著高于中药组(P<0.05)。除中药组1例患者出现接触性皮炎外,其余患者均未见显著不良反应。结论中西医结合治疗角化过度型足癣的临床效果好,且具有良好的安全性。     

Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases

Background Keratosis pilaris rubra (KPR) and keratosis pilaris atrophicans faciei (KPAF) are both keratinization disorders characterized by erythema and keratotic follicular papules usually located on cheeks, forehead, chin and eyebrows. Topical keratolytics, vitamin D3 analogues, antibiotics, topical and oral retinoids have been used with limited results. As this condition can be socially very limiting, the need for an effective treatment has led to the use of other technologies such as pulsed dye laser (PDL) or intense pulsed light. Objective The aim of this study was to assess the efficacy and safety of PDL in patients with KPR or KPAF. Methods Ten patients with KPR or KPAF were treated with two to seven sessions of PDL at 595‐nm wavelength. Laser therapy was performed using a spot size of 7 or 10 mm, a pulse duration of 0.5 or 1.5 ms and a fluence from 5 to 9 J/cm². Two dermatologists evaluated treatment effectiveness by means of photographs of the patients before starting and after finishing the therapy. Results Complete resolution of erythema was achieved in three patients; clearance of erythema was > 75% in the other seven patients. Transient purpura was present in all patients for about 2 weeks and one patient presented postinflammatory hyperpigmentation for 7 months. Conclusion We consider that PDL is a good option for the treatment of KPR and KPAF. A marked reduction in erythema is achieved in all patients with a low incidence of side effects.