Tinea manuum bullosa

Comparison of Samples of Blister Fluid and Scales in the diagnosis of dermatomycosis

BACKGROUND

The successful diagnosis of dermatomycosis depends on specimen collection. Dermatomycosis is sampled mainly for scales, but there is a lack of research on specimens of blister fluid.

OBJECTIVES

To explore whether blister fluid can diagnose dermatomycosis and compare blister fluid and scale specimens for dermatomycosis diagnosis.

METHODS

From April to July 2021, we prospectively gathered 34 patients who needed to meet all inclusion criteria simultaneously and collected their blister fluid and scales as specimens. The two samples were tested by fluorescent stain microscopy, fungal culture, and PCR, and the diagnosis results were compared.

RESULTS

The blister fluid sample's sensitivity, specificity, and accuracy were 90%, 100%, and 94.1%, respectively, whereas the scales sample were 60%, 100%, and 76.5%, respectively. The positive likelihood ratios were>10 for both blister fluid and scales specimen, and the negative likelihood ratios were not < 0.1. On the Youden's index, the blister fluid specimen was 90%, and the scales specimen was 60%. As for the diagnostic odds ratio, both of them were >1. By fungal culture, we detected 14 cases of fungi in blister fluid and eight in scales. On PCR, 22 cases of fungi in blister fluid and ten in scales were identified.

CONCLUSIONS

This study demonstrated that a sample of blister fluid had better sensitivity, accuracy, and Youden's index in diagnosing dermatomycosis with blister fluid. Collection of blister fluid might compensate for the inadequacy of collecting only scales specimens for mycological testing.

[Report of the first case of tinea corporis bullosa by Trichophyton tonsurans]

Blister formation in tinea corporis is rare. Bullous tinea is usually evoked by zoophilic dermatophytes. A 20-year-old woman presented in our out-patient department with a painful pruritic bullous skin eruption at the left forearm. Clinically, a 4 × 3 cm symmetrical plaque with sharp borders and peripheral versiculation and serous crusts was seen. Histologically there was a marked spongiotic dermatitis with fungal elements in periodic acid stain (PAS). By fungal culture, PCR and gene sequencing Trichophyton (T.) tonsurans was identified. To the best of our knowledge, this is the first published case of T. tonsurans as the causative agent of bullous tinea corporis.

Tinea manuum: A report of 18 cases observed in the metropolitan area of Milan and review of the literature

OBJECTIVE

Tinea manuum is considered in Italy as an uncommon infection, although no recent epidemiological data are available.

METHODS

In the period 2000-2018, we observed in the metropolitan area of Milan 18 patients with mycologically tinea manuum.

RESULTS

The infection was monolateral in all patients and characterised by erythema and scaling; in two patients, each vesicles and pustules were present. Two patients had also onychomycosis of one fingernail. No cases of simultaneous tinea pedis were observed. As far as the job of these patients is concerned, seven of them were masseurs, three barbers, two cattlemen, two masons, one car mechanic, one florist, one maid and one veterinarian. Trichophyton rubrum was isolated in 6 patients, Microsporum canis in 4, Trichophyton gypseum in 3, Trichophyton verrucosum in 3 and Trichophyton violaceum in 2 patients.

CONCLUSION

Masseurs were the most affected. Trichophyton rubrum and Microsporum canis were the most frequent isolated dermatophytes.

Acral manifestations of fungal infections

Fungal infections, which are named according to the body site involved, can affect any skin area, the fingernails, or the toenails. Numerous fungal agents are responsible for both superficial and deep fungal diseases. Dermatophytes and Candida spp are the most common causative organisms on the surface of the hands, feet, and nails of patients with superficial fungal diseases; however, although deep fungal infections of the skin are less common compared with superficial fungal diseases, their incidence is increasing worldwide due to cross-border travel. Most superficial fungal diseases are diagnosed clinically, but sometimes direct microscopic examination with potassium hydroxide and fungal culture may be necessary for diagnosis, especially in patients suspected of having tinea incognito. In cases of superficial fungal infections except for onychomycosis and tinea incognito, topical treatments are usually sufficient and effective, but systemic treatments may be required in recalcitrant cases. Deep fungal diseases may resemble each other clinically; therefore, the organism must be identified with laboratory methods and should be treated for a long period. We review the most important clinical, diagnostic, and therapeutic aspects of fungal diseases. This paper covers fungal problems encountered both in hospitals and in general practice.

Tinea corporis bullosa due to Trichophyton schoenleinii: case report

We report the first case of tinea corporis bullosa due to Trichophyton schoenleinii in a 41-year-old Romanian woman, without any involvement of the scalp and hair. The species identification was performed using macroscopic and microscopic features of the dermatophyte and its physiological abilities. Epidemiological aspects of the case are also discussed. The general treatment with terbinafine and topical applications of ciclopiroxolamine cream have led to complete healing, with the lesions disappearing in 2 weeks.