Common Features of Periocular Tinea

Abstract

To present the common features of periocular tinea to aid physicians in future diagnosis and therapy of this condition, because superficial fungal infections on the face are often misdiagnosed owing to the diverse morphologies that they manifest. This is especially true of dermatophytoses involving the periocular region.Methods: A retrospective review was performed of patients with a diagnosis of periocular tinea who were seen between January 2003 and September 2009 in the pediatric dermatology clinic at St. Louis Children's Hospital.Results: Ten cases of periocular tinea were identified (6 male patients and 4 female patients). Common features included prolonged misdiagnosis (all 10 cases), a normal ophthalmologic examination (all 10 cases), and inappropriate corticosteroid application (7 cases). Loss of the eyelashes occurred in all 10 patients. No cases had evidence of other tinea infections on examination. Only 2 cases had the central clearing classically associated with tinea corporis. Seven patients had a potassium hydroxide preparation and/or culture positive for fungal elements. Lesions improved with topical and oral antifungal treatment in all cases, and patients were able to regrow their eyelashes. Conclusion:Periocular tinea should be considered in the differential diagnosis for periocular inflammation, especially in those patients refractory to therapy for more common conditions. Loss of the eyelashes is characteristic of these fungal infections, similar to the hair loss that occurs in kerions associated with tinea capitis.

Answer to: Acquired causes of eyebrow and eyelash loss: A review and approach to diagnosis and treatment

“…In light of cases such as the one presented, it is crucial to include the diagnosis of tinea faciei involving the eyelids as a possible aetiology of alopecia affecting the eyebrows, eyelashes and vellus hairs on face, particularly among school-aged children and elder population, who are more susceptible to such fungal infections. 3 A number of case series have demonstrated an association between tinea faciei affecting the eyelids and zoonoses transmitted by rabbits, cats and dogs, highlighting the importance of inquiring about direct exposure to these animals, 2,4 although in this case we were not able to demonstrate such contact.…”

“…Such a delay can last up to 24 weeks, with a median of 6 weeks, prolonging patients' discomfort. 2,[4][5][6][7] Therefore, early recognition and prompt treatment of this condition are essential for better outcomes.…”

Support of the Laboratory in the Diagnosis of Fungal Ocular Infections

“…For its hairy condition, the eyelids and eyebrows are some time involved in fungal infections in children [12] and adults. The dermatophytes described in eyelid infections are the same kind that affects the head skin (Tinea capitis), or in other skin locations (Tinea corporis), or even the intertriginous skin in hands like Microsporum or Trichophyton.…”

Periocular dermatoses

“…The most probable complication is the development of tinea incognita secondary to the topical administration of steroid medications because of a misdiagnosis of the disease, which further distorts the clinical picture and delays an adequate diagnosis. The key features to a correct diagnosis are the scale in the lesion, loss of eyelashes or eyebrows, and a history of exacerbation with the administration of steroid medications ( Finger Basak et al, 2011 ). Subcutaneous mycosis such as micetoma, chromoblastomycosis, and sporotrichosis ( Fig.…”