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We also took a biopsy&#44; in which histopathological study showed perivascular infiltration by lymphocytes in the upper dermis&#46; Septate hyphae were not revealed by periodic acid-Schiff staining &#40;PAS&#41;&#46; Bacterial cultures showed mixed microbiota&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Finally&#44; a diagnosis of tinea capitis due to <span class="elsevierStyleItalic">T&#46; rubrum</span> was made&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the matter of treatment&#44; 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 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Tinea capitis is common in children&#44; but several studies have shown that it also can be seen in adults&#44; particularly in postmenopausal women&#44; a phenomenon that may be explained by the involution of sebaceous glands following decreased blood oestrogen levels&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> and immunocompromised people&#44; as immunologic dysfunction may increased risk of infection through an impaired cell-mediated response&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our geographical area&#44; most of the cases of tinea capitis affecting the adult population are caused by species of the genus <span class="elsevierStyleItalic">Trichophyton</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; <span class="elsevierStyleItalic">T&#46; rubrum</span> is a very uncommon cause of tinea capitis in the general population&#46; This particular dermatophyte led to a robust case of tinea capitis in our patient&#44; likely due to autoinoculation from tinea pedis and onychomycosis&#46; In contrast to other dermatophyte species&#44; <span class="elsevierStyleItalic">T&#46; rubrum</span> can cause both an endothrix and an ectothrix infection in the setting of hair invasion&#44; maybe this is what allows long-term colonization&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Adult tinea capitis may have polymorphic and atypical clinical presentations&#44; leading to difficulty in diagnosis and a delay in treatment&#46; The differential diagnosis in our area included erosive pustular dermatosis of the scalp&#44; folliculitis decalvans and cutaneous cryptococcosis&#46; 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&#46; Patients commonly present tiny pustules on the scalp&#44; forehead or temples&#46; The pustules are usually sterile&#44; but they can become secondarily colonized by bacteria&#46; Folliculitis decalvans is a highly inflammatory form of cicatricial alopecia where perifollicular papules and pustules complete the clinical picture&#46; Often&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> can grow&#46; Finally&#44; cutaneous cryptococcosis is an infection caused by <span class="elsevierStyleItalic">Cryptococcus neoformans</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; The skin lesion sometimes consists of large crusted ulceration on the scalp that could resemble tinea capitis&#44; but this usually occurs in immunocompromised hosts&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In terms of treatment&#44; the choice of the antifungal drug depends on the characteristics of the patient&#44; the type and extent of infection&#44; and the possibility of drug interactions&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Situations where systemic therapy is indicated include tinea involving two or more areas&#44; tinea corporis with extensive involvement&#44; tinea pedis such as moccasin or vesicular type&#44; and failure of treatment with topical agents<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not only griseofulvin has been widely used as oral antifungal drug but also terbinafine&#46; Ketoconazole&#44; itraconazole and fluconazole are used in a lesser extent&#46; 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&#46;<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&#46;</p></span></span>"
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Case and Research Letters
Inflammatory Tinea Capitis Due to Trichophyton rubrum
Tinea capitis inflamatoria por Trichophyton rubrum
N. Martínez Campayo
Autor para correspondencia
nieves.mtnez.campayo@gmail.com

Corresponding author.
, I. Meilán Sánchez, W. Martínez Gómez, E. Fonseca Capdevila
Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
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    "titulo" => "Inflammatory Tinea Capitis Due to <span class="elsevierStyleItalic">Trichophyton rubrum</span>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old woman&#44; living in an urban area&#44; 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&#46; Examination findings showed a wide scarring alopecia area on the scalp with perifollicular pustules and crusts which&#44; after having been removed&#44; exhibited a bleeding&#44; erosive surface &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; No adenopathies and no general symptoms of infection were found&#46; There was no history of animal contact and no clinical signs of immunodeficiency&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">For diagnosis&#44; swab samples of yellowish secretion of the pustules were obtained and <span class="elsevierStyleItalic">Trichophyton rubrum</span> was identified by culture and microscopic examination&#46; We also took a biopsy&#44; in which histopathological study showed perivascular infiltration by lymphocytes in the upper dermis&#46; Septate hyphae were not revealed by periodic acid-Schiff staining &#40;PAS&#41;&#46; Bacterial cultures showed mixed microbiota&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Finally&#44; a diagnosis of tinea capitis due to <span class="elsevierStyleItalic">T&#46; rubrum</span> was made&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the matter of treatment&#44; 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 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Tinea capitis is common in children&#44; but several studies have shown that it also can be seen in adults&#44; particularly in postmenopausal women&#44; a phenomenon that may be explained by the involution of sebaceous glands following decreased blood oestrogen levels&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> and immunocompromised people&#44; as immunologic dysfunction may increased risk of infection through an impaired cell-mediated response&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our geographical area&#44; most of the cases of tinea capitis affecting the adult population are caused by species of the genus <span class="elsevierStyleItalic">Trichophyton</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; <span class="elsevierStyleItalic">T&#46; rubrum</span> is a very uncommon cause of tinea capitis in the general population&#46; This particular dermatophyte led to a robust case of tinea capitis in our patient&#44; likely due to autoinoculation from tinea pedis and onychomycosis&#46; In contrast to other dermatophyte species&#44; <span class="elsevierStyleItalic">T&#46; rubrum</span> can cause both an endothrix and an ectothrix infection in the setting of hair invasion&#44; maybe this is what allows long-term colonization&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Adult tinea capitis may have polymorphic and atypical clinical presentations&#44; leading to difficulty in diagnosis and a delay in treatment&#46; The differential diagnosis in our area included erosive pustular dermatosis of the scalp&#44; folliculitis decalvans and cutaneous cryptococcosis&#46; 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&#46; Patients commonly present tiny pustules on the scalp&#44; forehead or temples&#46; The pustules are usually sterile&#44; but they can become secondarily colonized by bacteria&#46; Folliculitis decalvans is a highly inflammatory form of cicatricial alopecia where perifollicular papules and pustules complete the clinical picture&#46; Often&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> can grow&#46; Finally&#44; cutaneous cryptococcosis is an infection caused by <span class="elsevierStyleItalic">Cryptococcus neoformans</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; The skin lesion sometimes consists of large crusted ulceration on the scalp that could resemble tinea capitis&#44; but this usually occurs in immunocompromised hosts&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In terms of treatment&#44; the choice of the antifungal drug depends on the characteristics of the patient&#44; the type and extent of infection&#44; and the possibility of drug interactions&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Situations where systemic therapy is indicated include tinea involving two or more areas&#44; tinea corporis with extensive involvement&#44; tinea pedis such as moccasin or vesicular type&#44; and failure of treatment with topical agents<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not only griseofulvin has been widely used as oral antifungal drug but also terbinafine&#46; Ketoconazole&#44; itraconazole and fluconazole are used in a lesser extent&#46; 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&#46;<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&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez Campayo N&#44; Meil&#225;n S&#225;nchez I&#44; Mart&#237;nez G&#243;mez W&#44; Fonseca Capdevila E&#46; Tinea capitis inflamatoria por <span class="elsevierStyleItalic">Trichophyton rubrum</span>&#46; Actas Dermosifiliogr&#46; 2021&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2020.02.009">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;ad&#46;2020&#46;02&#46;009</span></p>"
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ISSN: 15782190
Idioma original: Inglés
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