Trichophyton schoenleinii causing tinea corporis without involvement of

hair and nail.

Case report

S. Thakur (MD)**, A. Sood (MD)##

Corresponding Author

**Senior Resident,

##

Assistant Professor,

Department of Microbiology, Dr. RPGMC Kangra at Tanda, HP, India.

Address for correspondence:

G-41, Type 5, Dr. RPGMC Kangra at Tanda, HP, India 176001
Email: suman_thakur13@yahoo.com
Mobile: +919418341201

Source of support: None

Conflict of interest: None

Introduction
Dermatophytoses are considered one of the most prevalent public health problems
in economically underdeveloped and developing countries seen in man and animals
affecting skin, hair and nails. The lifestyle in societies, contact with animals and
prolonged use of broad-spectrum antibiotics, corticosteroids, and antineoplastic
drugs are some of the factors that contribute to the increase in the risk of infection
by fungi, especially by dermatophytes.(1)( Akram Ansar) dermatophytes are hyaline
septate moulds with more than 100 species described divided into three main
anamorhic genera i.e. Trivhophyton, Microsporum, and Epidermophyton depending
on their morphological characteristics (JagdishChandra). For identification of
dermatophytes microscopic morphology of the micro and/or macroconidia is the
most reliable identification character whereas culture characteristics such as
surface texture, topography and pigmentation are variable and are therefore the
least reliable criteria for identification. Clinical information such as the site,
appearance of the lesion, geographic location, travel history, animal contacts and

race is also important, especially in identifying rare non-sporulation species like M.

audouini, T. concentricum and T schoenleinii etc.(David Ellis notes on dermatophyte
identification)
Trichophyton schoenleinii an anthropophilic fungi generally causes tinea capitis
favosa, a chronic inflammatory dermatophyte infection of the scalp and is
transmitted by contact between humans. Favus is typically a childhood disease, yet
adult cases are not uncommon. Interestingly, favus is less contagious than other
dermatophytoses, although intrafamilial infections are reported and have been
widely discussed in the literature. Although in the past T. schoenleinii was the
dominant fungus recovered from dermatophytic lesions, worldwide the incidence
has decreased due to improvements in living conditions and hygiene as well as
early appropriate diagnosis and availability of antifungals.(2)( A. Khaled) . Clinical
presentation of T. schoenleinii infections is variable: generally isolated from tinea
capitis lesions that appear as gray patches, but symptom-free colonization of the
scalp may also occurs. Favus of the glabrous skin and nails are reported less
frequently than favus of the scalp.(3)(Update --Macit Ilkit). We are presenting a rare
case report which shows involvement of glabrous skin with T. schoenleinii.
Case report
A 49 years old male presented to the out patient department of Dermatology,
DRPGMC Tanda. His chief complaints were erythematous lesions on the dorsum of
left arm since past two and a half months. The lesions were intensely itchy and
gradually increased in size and number. There was no history of diabetes mellitus
and hypertension. On examination the lesions were scaly, erythematous and
varying from 2-8cm in diameter. Two of the lesions were ulcerated and showed
secondary suppuration. History of use of ointments for treatment from local
practitioner were obtained. Skin scrapings from the lesions were taken and sent for
fungal culture and KOH examination. No involvement of nails and hair was seen in
the patient. On 10% potassium hydroxide revealed the presence of septate hyaline
hyphae. The culture on Sabouraud glucose agar at 25 0C yielded in three weeks
white limited colonies producing ramifications that submerged into agar (Fig. 1).
Microscopic examination revealed the presence of multiple branched hyphae known
as favic chandeliers, terminal dilation of hyphae giving a nail head shape known as
favic nails and some chlamydoconidia (Fig. 2a and b). it showed colour change on
dermatophyte test medium(Fig 3) and was urease positive(Fig 4). Based on the
clinical and mycological data, the diagnosis of tinea corporis by T. schoenleinii was
made. Patient didnt collected the report so treatment history and follow up could
not be traced.
Discussion
Tinea corporis are the infection in the glaborous skin and is the most common type
of dermatophytosis in India caused by T. rubrum and other speces. Trichophyton
schoenleinii.causes chronic fungal infection of the scalp, glabrous skin, and/or nails.

Occasionally Trichophyton violaceum or Microsporum gypseum may cause similar

lesions. Trichophyton schoenleinii.causes favus and the classical favus lesion is the
scutulum, a concave cup shaped yellow crust on the scalp that is associated with
severe alopecia. These keratotic crusts contain fungal hyphae and can be highly
infectious. Ninety five percent of the individuals infected with favus have overt
clinical symptoms e.g. scutula, pale hairs, atrophy and scarring. Matted hair, tissue
debris and scutula may be present with serous exudate, secondary bacterial
involvement, pus and general filth. The scalp has an unpleasant and mousy odor.
Rest five percent can present as atypical tinea favosa e.g. pityroides, psoraisiform,
follicular and impetiginous forms has been observed both on scalp and glabrous
skin.(3)(Update --Macit Ilkit) Because of its non-inflammatory appearance, the
disorder may persist un diagnosed for many years with an ultimate evolution into
scarring alopecia.(2)( A. Khaled). When scarring is present the differntial diagnosis
include lupus erythmatosus,lichen planoplaris, pseudopalade and radiation
dermatitis. .(3)Update --Macit Ilkit)
Studies
Treatment
Resistance

Conclusion
Patient can present with atypical presentation of favus and thus leading to wrong
diagnosis and persistence and thus transfer of infection to the near ones. So correct
diagnosis is required at an early stage with proper treatment.