Ichthyosis associated with widespread tinea corporis: report of three cases.
Bottom Line: All of these favor fungal proliferation.They have the ability to obtain nutrients from keratinized material.One of its most prevalent genera is Trichophyton rubrum.
Affiliation: Curitiba(PR), Brazil.
Ichthyoses are a common group of keratinization disorders. A non-inflammatory generalized persistent skin desquamation is observed. It is characterized by increased cell turnover, thickening of the stratum corneum and functional changes of sebaceous and sweat glands. All of these favor fungal proliferation. Dermatophytes may infect skin, hair and nails causing ringworm or tinea. They have the ability to obtain nutrients from keratinized material. One of its most prevalent genera is Trichophyton rubrum. Although tineas and ichthyoses are quite common, the association of the two entities is rarely reported in the literature. Three cases of ichthyosis associated with widespread infection by T. rubrum are presented. Resistance to several antifungal treatments was responsible for worsening of ichthyosis signs and symptoms.
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Mentions: An 87-year-old female patient with congenital ichthyosiform erythroderma had beenfollowed since 1976. Over the years she presented with erythematous-scaling patches,with peripheral activity and central clearing. The diagnosis of chronicdermatophytosis had been established for more than 30 years. The patient underwentseveral treatments with systemic antifungal agents, including griseofulvin and azolesfor periods of 3 to 12 weeks. In addition, topical creams were used with temporaryimprovement. In 2006 she accepted treatment with Acitretin. Partial improvement oferythema and desquamation was seen within 2 months; however, arciform lesions wereoccasionally seen. In September 2011, she showed signs of clinical deterioration withwidespread lamellar scaling on the limbs and trunk, ectropion and multiple bilateralerythematous round patches on the lower limbs (Figure1A). Direct examination demonstrated hyaline septate hyphae with a positiveculture for T. rubrum. Association with dermatophytosis wasdiagnosed. Thirty days after prescription of terbinafine 250 mg qd the patient showeddramatic improvement of the lesions (Figure1B).