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Tamimi P, Fattahi M, Firooz A, Ghaderi A, Ayatollahi A, Nasiri Kashani M, Alkhen A. Recalcitrant dermatophyte infections: identification and risk factors. Int J Dermatol 2024. [PMID: 38712801 DOI: 10.1111/ijd.17145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Recalcitrant dermatophytosis is an emerging phenomenon that occurs worldwide, and Trichophyton indotineae is currently the prominent cause. MATERIALS AND METHODS Skin specimens from patients with tinea infection were obtained by scrubbing and then sectioned into three fragments. Two fragments were subjected to direct microscopic examination and culture, while the third portion was utilized in the PCR method. RESULTS Isolates were morphologically identified as Trichophyton mentagrophytes/interdigitale complex (n = 60 [83.33%]), Microsporum canis (n = 8 [11.11%]), Trichophyton rubrum (n = 3 [4.16%]), and Epidermophyton floccosum (n = 1 [1.38%]). Among 60 T. mentagrophytes complex isolates, 53 (88.33%) were classified as T. indotineae and seven as T. interdigitale genotype II. The disease duration was longer in the T. indotineae group (P = 0.035). Both Gradient PCR and skin-sampling methods yield similar results in terms of positive and negative cases (P = 1.0000). The time patients stopped their medication did not impact the positive case numbers (P = 0.803). Gender had no effects on the frequency (P = 0.699). Familial contamination, dermatologic disorder, and other underlying conditions did not differ in the two group infections (P > 0.05). Steroid usage is strongly associated with the emergence of tinea infection (P < 0.04). The duration of antifungal administration had a substantial effect on the emergence of resistant organisms (P = 0.05). CONCLUSIONS Steroid usage, T. indotineae involvement, and prolonged exposure to antifungals were the solid and influential factors in recalcitrant involvement. Regarding quick and suitable diagnosis and treatment, which is essential in preventing recalcitrant cases, we suggest that direct skin sample PCR can meet the demands.
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Affiliation(s)
- Pegah Tamimi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ghaderi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Ayatollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Nasiri Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Zhuang KW, Dai YL, Ran YP, Lama J, Fan YM. Tinea faciei on the right eyebrow caused by Trichophyton interdigitale. An Bras Dermatol 2017; 91:829-831. [PMID: 28099612 PMCID: PMC5193201 DOI: 10.1590/abd1806-4841.20165270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/22/2015] [Indexed: 02/05/2023] Open
Abstract
Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical
clinical symptoms, usually misdiagnosed and treated with corticosteroids. The
authors describe a case of tinea faciei on the right eyebrow caused by
Trichophyton interdigitale. The patient was an 18-year-old
girl, who had an inflammatory plaque with a scaly, pustular surface on the right
eyebrow and upper eyelid, which had persisted for over 1 month. She was once
misdiagnosed as having eczema and was treated using corticosteroid cream. A
diagnosis of tinea faciei was made based on direct microscopy and culture. The
sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the
isolate established its T. interdigitale lineage. The patient
was cured by treatment with systemic terbinafine in combination with topical
application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.
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Affiliation(s)
- Kai Wen Zhuang
- West China Hospital, Sichuan University - Sichuan, China
| | - Ya Ling Dai
- West China Hospital, Sichuan University - Sichuan, China
| | - Yu Ping Ran
- West China Hospital, Sichuan University - Sichuan, China
| | - Jebina Lama
- West China Hospital, Sichuan University - Sichuan, China
| | - Yi Ming Fan
- Affiliated Hospital of Guangdong Medical University - Zhanjiang, China
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Park YW, Choi JW, Paik SH, Kim DY, Jin SP, Park HS, Yoon HS, Cho S. Tinea incognito simulating herpes simplex virus infection. Ann Dermatol 2014; 26:267-9. [PMID: 24882990 PMCID: PMC4037688 DOI: 10.5021/ad.2014.26.2.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 12/02/2022] Open
Affiliation(s)
- Young Woon Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woo Choi
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung Hwan Paik
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Dong Young Kim
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seon-Pil Jin
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Kim WJ, Kim TW, Mun JH, Song M, Kim HS, Ko HC, Kim BS, Park CW, Lee SJ, Lee MH, Lee KS, Kye YC, Suh KS, Chung H, Lee AY, Kim KH, Lee SK, Park KC, Lee JY, Choi JH, Lee ES, Lee KH, Choi EH, Seo JK, Choi GS, Park HJ, Yun SK, Seo SJ, Yoon TY, Kim KH, Yu HJ, Ro YS, Kim MB. Tinea incognito in Korea and its risk factors: nine-year multicenter survey. J Korean Med Sci 2013; 28:145-51. [PMID: 23341725 PMCID: PMC3546093 DOI: 10.3346/jkms.2013.28.1.145] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/31/2012] [Indexed: 11/20/2022] Open
Abstract
Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 ± 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
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Affiliation(s)
- Won-Jeong Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae-Wook Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Je-Ho Mun
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Margaret Song
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Mu Hyoung Lee
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyu Suk Lee
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Young Chul Kye
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Hyun Chung
- Department of Dermatology, The Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Ai Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ki Ho Kim
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
| | - Sook Kyung Lee
- Department of Dermatology, Maryknoll Medical Center, Busan, Korea
| | - Kyoung Chan Park
- Department of Dermatology, Seoul National University Bundang Hostpital, Seongnam, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Keun Seo
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University College of Medicine, Incheon, Korea
| | - Hai Jin Park
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seok Kweon Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Young Yoon
- Department of Dermatology, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University College of Medicine, Anyang, Korea
| | - Hee Joon Yu
- Department of Dermatology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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