Fungal infections of the skin are a common condition, usually easy to diagnose and treat. When the infection is clinically mimicking another cutaneous disorder or when the clinical presentation is modified by the use of inappropriate treatment, it is referred to as tinea atypica or tinea incognito.We report a series of nine cases of patients with tinea atypica, imitating and diagnosed initially as different skin diseases. Two patients were defined as pyoderma in the facial and pubic regions (caused respectively by Trichophyton mentagrophytes var. mentagrophytes and Microsporum canis) and one as herpes zoster ophthalmicus (caused by Trichophyton rubrum). Six additional patients were initially misdiagnosed: (1) Plaque-like formation of the skin misdiagnosed as an impetiginized eczema (with isolated agent Trichophyton verrucosum). (2) A rare form of skin infection of the hand caused by T. rubrum, imitating clinically cutaneous infection with tuberculum mulgentium. (3) Rosacea-like dermatitis with an isolated agent Fusarium. (4) A patient with the typical clinical symptoms of seborrheic dermatitis of the face (and with isolated T. rubrum as a causative agent). (5) Another patient presented with a widespread folliculitis by Trichophyton mentagrophytes. (6) In a patient with bullous pemphigoid and immunosuppression pemphigoid-like eruptions were caused by Malassezia pachydermatis and T. rubrum. The diagnosis in the presented cases was based on direct microscopic examination with KOH and a culture on Sabouraud agar.After the diagnosis of tinea, treatment with topical and systemic antifungal agents was administrated, followed by complete clinical remissions in all cases.The clinical manifestations of tinea atypica can mimic a large number of other dermatoses, which often leads to misdiagnosing, and as a consequence--to serious difficulties in the management of clinical symptoms and in offering appropriate therapy.
Kindler syndrome (KS), the fourth major type of hereditary epidermolysis bullosa (HEB), is a rare, autosomal recessive disorder characterized by skin fragility and blistering at birth followed by development o f m a r k e d p h o t o s e n s i t i v i t y a n d p r o g r e s s i v e poikilodermatous skin changes in later years. After the first description by Theresa Kindler in 1954, more than 250 cases have been reported to date (1-4). In Bulgaria, about 100 patients suffered from HEB were currently registered. Among them only one case with KS is described (5). We report here a new case of KS putting accent on the nailfold capillaroscopic changes.A 54-year-old woman presented with history of recurrent blistering after minor friction or trauma started after birth. The changes were more prominent on the extremities and tend to regress with age. Subsequently, photosensitivity, discoloration and atrophy of the skin developed. In addition, occasionally gingival and urethral bleeding, and surgically treated squamous cell carcinoma on the dorsum of the right hand 7 years ago were reported. The family history was negative. On examination, diffuse poikiloderma (atrophy, telangiectases, and reticular pigmentation), mainly on the face and dorsal surfaces of the hands and feet, was observed. The dorsum of the hands and feet had atrophic skin with cigarette paper-like wrinkling. There were also skin erosions, atrophic scars, ectropion, gingivitis and periodontitis with missing teeth, and nail changes (prolonged eponychium, transverse and longitudinal ridges, onycholysis, yellow discoloration) (Figure 1). Routine blood tests, including immunological tests, were within normal range. The result from the nerve conduction study indicated the presence of sensory polyneuropathy. The histopathologic examination of skin lesion, performed 20 years ago, revealed an atrophic epidermis, subepidermal cracks, flattened dermis with thin collagen fibers, edema, dilated capillaries, pigmentary incontinence, and scarce perivascular infiltrate. A diagnosis KS type of HEB was made and symptomatic treatment was applied.In order to explore the changes in microcirculation we performed nailfold videocapillaroscopy at varied magnifications (×60, ×200, and ×500) using digital dermatoscope DinoLite (AnMo, Taipei, Taiwan). The following capillaroscopy findings were found: skin transparency: good; number: 4-6/mm, reduction in capillary density; morphology: shape heterogeneity and marked tortuosity with varied appearance; dimensions: regularly and irregularly enlarged (width 30-50 SummaryKindler syndrome (KS), the fourth major type of hereditary epidermolysis bullosa (HEB), is a rare, autosomal recessive disorder characterized by skin fragility and blistering at birth followed by development of marked photosensitivity and progressive poikilodermatous skin changes in later years. We reported here the case of a 54-year-old woman, who fulfills the diagnostic criteria of KS type of HEB, putting accent on the nailfold capillaroscopic changes. Using videocapill...
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