Case and Research Letters
Inflammatory Tinea Capitis Due to Trichophyton rubrum
Tinea capitis inflamatoria por Trichophyton rubrum
N. Martínez Campayo
, I. Meilán Sánchez, W. Martínez Gómez, E. Fonseca Capdevila
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
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Martínez Campayo, I. Meilán Sánchez, W. Martínez Gómez, E. Fonseca Capdevila" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Martínez Campayo" "email" => array:1 [ 0 => "nieves.mtnez.campayo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Meilán Sánchez" ] 2 => array:2 [ "nombre" => "W." "apellidos" => "Martínez Gómez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Fonseca Capdevila" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tinea capitis inflamatoria por <span class="elsevierStyleItalic">Trichophyton rubrum</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 429796 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Wide scarring alopecia area on the scalp with perifollicular pustules and crusts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old woman, living in an urban area, reported an approximately 3-month history of an inflammatory purulent lesion on the scalp and a 1-year history of toe nail onychomycosis and tinea pedis treated with topical ciclopirox and sertaconazole. Examination findings showed a wide scarring alopecia area on the scalp with perifollicular pustules and crusts which, after having been removed, exhibited a bleeding, erosive surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No adenopathies and no general symptoms of infection were found. There was no history of animal contact and no clinical signs of immunodeficiency.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">For diagnosis, swab samples of yellowish secretion of the pustules were obtained and <span class="elsevierStyleItalic">Trichophyton rubrum</span> was identified by culture and microscopic examination. We also took a biopsy, in which histopathological study showed perivascular infiltration by lymphocytes in the upper dermis. Septate hyphae were not revealed by periodic acid-Schiff staining (PAS). Bacterial cultures showed mixed microbiota.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Finally, a diagnosis of tinea capitis due to <span class="elsevierStyleItalic">T. rubrum</span> was made.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the matter of treatment, the patient improved her condition with a course of twelve weeks of two hundred and fifty milligrams per day of oral terbinafine and topical ketoconazole treatment (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Tinea capitis is common in children, but several studies have shown that it also can be seen in adults, particularly in postmenopausal women, a phenomenon that may be explained by the involution of sebaceous glands following decreased blood oestrogen levels,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> and immunocompromised people, as immunologic dysfunction may increased risk of infection through an impaired cell-mediated response.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our geographical area, most of the cases of tinea capitis affecting the adult population are caused by species of the genus <span class="elsevierStyleItalic">Trichophyton</span>.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However, <span class="elsevierStyleItalic">T. rubrum</span> is a very uncommon cause of tinea capitis in the general population. This particular dermatophyte led to a robust case of tinea capitis in our patient, likely due to autoinoculation from tinea pedis and onychomycosis. In contrast to other dermatophyte species, <span class="elsevierStyleItalic">T. rubrum</span> can cause both an endothrix and an ectothrix infection in the setting of hair invasion, maybe this is what allows long-term colonization.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Adult tinea capitis may have polymorphic and atypical clinical presentations, leading to difficulty in diagnosis and a delay in treatment. The differential diagnosis in our area included erosive pustular dermatosis of the scalp, folliculitis decalvans and cutaneous cryptococcosis. Erosive pustular dermatosis of the scalp is a rare inflammatory disease of unknown aetiology that usually occurs in the elderly and is a diagnosis of exclusion. Patients commonly present tiny pustules on the scalp, forehead or temples. The pustules are usually sterile, but they can become secondarily colonized by bacteria. Folliculitis decalvans is a highly inflammatory form of cicatricial alopecia where perifollicular papules and pustules complete the clinical picture. Often, <span class="elsevierStyleItalic">Staphylococcus aureus</span> can grow. Finally, cutaneous cryptococcosis is an infection caused by <span class="elsevierStyleItalic">Cryptococcus neoformans</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. The skin lesion sometimes consists of large crusted ulceration on the scalp that could resemble tinea capitis, but this usually occurs in immunocompromised hosts.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In terms of treatment, the choice of the antifungal drug depends on the characteristics of the patient, the type and extent of infection, and the possibility of drug interactions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Situations where systemic therapy is indicated include tinea involving two or more areas, tinea corporis with extensive involvement, tinea pedis such as moccasin or vesicular type, and failure of treatment with topical agents<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not only griseofulvin has been widely used as oral antifungal drug but also terbinafine. Ketoconazole, itraconazole and fluconazole are used in a lesser extent. Several and important adverse reactions have been reported with griseofulvin and some studies have shown a higher efficacy of terbinafine compared to griseofulvin in half the time in tinea capitis caused by <span class="elsevierStyleItalic">Trichophyton</span> with a better profile of tolerability.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><span id="sec0041" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0101">Funding sources</span><p id="par0181" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0041" "titulo" => "Funding sources" ] 1 => array:2 [ "identificador" => "xack562406" "titulo" => "Acknowledgement" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Campayo N, Meilán Sánchez I, Martínez Gómez W, Fonseca Capdevila E. Tinea capitis inflamatoria por <span class="elsevierStyleItalic">Trichophyton rubrum</span>. Actas Dermosifiliogr. 2021. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2020.02.009">https://doi.org/10.1016/j.ad.2020.02.009</span></p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 429796 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Wide scarring alopecia area on the scalp with perifollicular pustules and crusts.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 588 "Ancho" => 750 "Tamanyo" => 129869 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Complete healing after treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tinea capitis in adults in southern Spain. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 7 | 20 |
| 2024 October | 85 | 55 | 140 |
| 2024 September | 100 | 32 | 132 |
| 2024 August | 120 | 71 | 191 |
| 2024 July | 115 | 38 | 153 |
| 2024 June | 107 | 34 | 141 |
| 2024 May | 107 | 44 | 151 |
| 2024 April | 101 | 17 | 118 |
| 2024 March | 103 | 37 | 140 |
| 2024 February | 70 | 44 | 114 |
| 2024 January | 88 | 38 | 126 |
| 2023 December | 78 | 17 | 95 |
| 2023 November | 134 | 37 | 171 |
| 2023 October | 103 | 27 | 130 |
| 2023 September | 98 | 35 | 133 |
| 2023 August | 82 | 16 | 98 |
| 2023 July | 126 | 53 | 179 |
| 2023 June | 78 | 31 | 109 |
| 2023 May | 106 | 28 | 134 |
| 2023 April | 95 | 25 | 120 |
| 2023 March | 142 | 46 | 188 |
| 2023 February | 120 | 25 | 145 |
| 2023 January | 78 | 23 | 101 |
| 2022 December | 91 | 39 | 130 |
| 2022 November | 65 | 30 | 95 |
| 2022 October | 51 | 22 | 73 |
| 2022 September | 55 | 40 | 95 |
| 2022 August | 45 | 40 | 85 |
| 2022 July | 17 | 39 | 56 |
| 2022 June | 22 | 31 | 53 |
| 2022 May | 96 | 37 | 133 |
| 2022 April | 80 | 45 | 125 |
| 2022 March | 90 | 60 | 150 |
| 2022 February | 69 | 31 | 100 |
| 2022 January | 92 | 44 | 136 |
| 2021 December | 71 | 38 | 109 |
| 2021 November | 91 | 70 | 161 |
| 2021 October | 99 | 72 | 171 |
| 2021 September | 107 | 62 | 169 |
| 2021 August | 82 | 44 | 126 |
| 2021 July | 72 | 39 | 111 |
| 2021 June | 89 | 58 | 147 |
| 2021 May | 42 | 30 | 72 |
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