Indian Journal of Dermatology
CASE REPORT
Year
: 2009  |  Volume : 54  |  Issue : 5  |  Page : 57--59

Extensive Tinea corporis with photosensivity


Kamran Balighi, Vahide Lajevardi, Mohamad Reza Barzegar, Majid Sadri 
 Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran

Correspondence Address:
Kamran Balighi
Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran
Iran

Abstract

Tinea corporis is a superficial fungal infection of the keratinized epithelial layer, presenting as erythematous scaling patches with central clearing. Sometimes it can resemble other skin disorders, so its misdiagnosis constitutes a problem of considerable practical importance. We describe a patient who presented with widespread Tinea corporis that morphology and distribution of the lesions mimicked lupus erythematosus and/or photodermatosis.



How to cite this article:
Balighi K, Lajevardi V, Barzegar MR, Sadri M. Extensive Tinea corporis with photosensivity.Indian J Dermatol 2009;54:57-59


How to cite this URL:
Balighi K, Lajevardi V, Barzegar MR, Sadri M. Extensive Tinea corporis with photosensivity. Indian J Dermatol [serial online] 2009 [cited 2019 Nov 14 ];54:57-59
Available from: http://www.e-ijd.org/text.asp?2009/54/5/57/45458


Full Text

 Introduction



Tinea corporis is a superficial fungal infection of the keratinized epithelial layer, presenting as erythematous scaling patches with central clearing. Sometimes it can resemble other skin disorders, so its misdiagnosis constitutes a problem of considerable practical importance. We describe a patient who presented with widespread Tinea corporis that morphology and distribution of the lesions mimicked lupus erythematosus (LE) and/or photodermatosis.

 Case History



A 34-year-old man presented with a one-year history of an extensive eruption constituted by ill-defined erythematous patches and plaques witch covered in a symmetrical pattern his face, hands and forearms. There was a sharp upper border on the middle of the arms [Figure 1],[Figure 2]. There was diffuse erythema with telangiectasia on the face extending to the neck and exposed area of the chest. Additionally, there were some purplish nodules on the neck and forearms. He complained of itching and burning sensation and lesions aggravated with sun exposure. Further physical examinations, including the feet and nails, were unremarkable. No systemic signs or symptoms were present. The personal history was not relevant. He received several course of topical and systemic steroids with the suspicious to the collagen vascular diseases and/or photodermatosis. All the laboratory investigations were normal. KOH examination of a skin scraping taken from the face, hands, neck and forearms revealed abundant branching hyphae. Mycological native preparation was positive; culture resulted in Trichophyton verrucousum. There was no known underlying disease or immunosuppression that could favor a dermatophyte infection. We started his treatment with 250mg/day Terbinafin for one month. After one month he improved greatly and photosensivity reduced but because of the remaining of some nodules and erythema we changed the treatment to Itraconazol 200mg/day for one month during witch time the lesions were cured [Figure 3],[Figure 4]. Acontrol KOH smear and fungal culture were negative.

 Discussion



Tinea corporis refers to all superficial fungal infections of glabrous skin except the palms, soles, and groin. It is caused by members of the genera including: Epidermophyton, Trichophyton and Microsporum. Tinea corporis is found worldwide and affects all ages and races backgrounds. [1],[2] In patients with disseminated dermatophytosis, immunosupression due to HIV infection, atopy and long-term treatment with steroids must always be kept in mind. [3],[4],[5] However, there are few reports of widespread T8inea corporis in immunocompetent patients. [6] In our case no underlying disease was found in clinical and laboratory investigations. It has been postulated that local impaired immune responses in only some parts of the skin may explain the extensive dermatophyte infection in patients with normal immune status. [7] Occupational and environmental risk factors of Tinea corporis include contact with animals and outdoor occupations. [8],[9] In addition, chronic dermatophytosis of the foot, nail, scalp and hands can behave like a reservoir of fungus for the development of Tinea corporis . [8],[9] We did not observe dermatophyte infestation in cutaneous examination of the scalp, nails and feet in this patient. Tinea corporis classically presents as an erythematous annular plaque with a scaly, centrifugally advancing border. Uncommonly, dermatophyte infections may also demonstrate an atypical pattern or stimulate other dermatological diseases in immunocompetent patients. Further fungal infections may mimic many inflammatory skin diseases such as lupus erythematosus (LE), polymorphic light eruption (PLE), psoriasis, nummular eczema, erythema multiformis, granoloma annularis, lymphocytic infiltration of the skin, pytiriasis rosea, sebborheic dermatitis and secondary annular syphilis. [1],[2],[10],[11] The majority of cases of Tinea corporis which resemble to LE are those of tinea facei and involvement of trunk is exceptional. Most of the cases are discoid LE and systemic LE-like eruptions and rarely resemble to subacute cutaneous lupus erythematosus (SCLE). [12],[13],[14],[15]

The dermatophyte responsible for such infections are varied and include Trichophyton rubrum, Trichophyton tonsorans, Trichophyton verrocosum and mycrosporum canis. [12],[13],[14],[15] In this case, fungal cultures of skin scrapings were positive for Trichophyton verrocosum. The application of topical corticosteroids can modify clinical picture still further and some patients considered as having LE, erroneously. [12],[13],[14],[15] In some cases there is concomitant dermatophytosis and LE, although in our case physical or laboratory findings was not in favor of SLE. [12],[13],[14],[15] In our case, the clinical morphology and the photoaggravation of the lesions led to consider the diagnosis of LE and photosensitive disorders. The photoexacerbation of the eruption and the presence of the lesions mainly confined to sun-exposed areas are events that have been rarely reported. [12],[13],[14],[15] Furthermore, it had been suggested that tinea can be added to the list of dermatomes that have a photosensitivity component. [16] The great variations in clinical presentations are related to the spices and strains of the fungus, the size of the inoculum, the body area, and the immune status of the host. [17]

 Conclusion



Clinically atypical varieties of Tinea corporis are being increasingly reported in the literatures. In many cases the patient may be treated with the initial diagnose of collagen vascular diseases or photodermatoses and this can alters the clinical pictures and adds to the ambiguity and causes tinea incognita. Thus, it is recommended that in any patient with erythematosquamous lesions of the face and trunk, fungal infections should be consider in the differential diagnosis.

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