Tinea folliculorum complicating tinea of the glabrous skin: an important yet neglected entity

Abstract

Dermatophytes are capable of infecting the skin and its appendages such as nails and hairs producing a variety of clinical conditions. Hair invasion by dermatophytes is a key feature of tinea capitis and tinea barbae but not of tinea of glabrous skin. In this project, we studied the clinico-mycological aspects of follicular involvement in patients with dermatophytosis of the glabrous skin. In total, 16 patients, eight males and eight females, were included in the study. All were adults except for one girl. The disease durations ranged from one month to more than ten years. Fourteen (78.5%) had multiple lesions, and most of them had undergone treatment with antifungals, antibiotics, or steroids. Dermoscopic examination showed infected hairs in the form of broken stubs, coily, curly, or as black dots on the surface of the lesions. Pathogens were either anthropophilic (seven cases of Trichophyton rubrum) or zoophilic (six cases Microsporum canis, three cases of the T. mentagrophytes). Patients responded well to oral griseofulvin or terbinafine, and topical antifungals. No antifungal resistance developed during the treatment course. Follicular involvement of glabrous skin is not as rare as previously thought and should be considered for systemic antifungal treatments.

Combination dermoscopy highlights fungal invasion of vellus hair in tinea vellus

“…The dysbiosis may be associated with previous findings of fewer and atrophic sebaceous glands in HS and thereby a subsequent reduced sebum excretion rate in HS. 2 Taken together, these observations led us to speculate about the potential utility of probiotics in HS, which has also been described in other chronic inflammatory skin diseases. 3…”

“…1 It has been recently reported that the presence of curly and coiled hairs is a new and specific trichoscopic feature of fungal infection of the vellus hair. 2 Use of Wood lamp in a dark room can help identify Microsporum canis infection of the hair; however, this can be challenging because of the need for eye protection and the possible distressing effect of a dark room on small children.…”

A case of infantile tinea of vellus hair confirmed by dermoscopy and scanning electron microscopy and detection of infected source

“…In the last 12 years, 63 cases have been reported in the English literature. 1,[4][5][6][7][8][9][10][11][12][13][14] People of all ages (0-64 years) can be affected by tinea of vellus hair. The face and neck (37%) and upper arms (33%) have been the most involved areas, followed by the lower extremities (14%), trunk (12%), and buttocks (4%).…”

“…The SEM observation in this case showed that spores were mainly concentrated in and around the hair follicle, severely damaging its structure, which is in accord with Sun's findings on the histopathology of tinea of vellus hair. 12 The involvement of the hair follicle may result in diseases such as Majocchi's granuloma, a rare granulomatous folliculitis caused by dermatophytes. 14 Forty-seven percent of patients used topical corticosteroids before presentation, 47% had topical antifungals, and 6% had oral antifungals.…”

“…Sun et al proposed that a clinical cure cannot be considered as a treatment success, because it may endure through a treatment ended too early and recur afterward. 12 Achieving a mycological cure is the endpoint of antifungal therapy.…”