Case Report and Literature Review of Impetigo-Like Tinea Faciei

Abstract

Impetigo, commonly caused by bacteria, is characterized by lesions of pustules, bullae or golden yellow crusts; it is seldom caused by fungi. Here, we report one case of a 17-year-old female patient with a 1-month history of erythematous pustules on her left cheek. She was clinically diagnosed with “impetigo”, but did not respond to 1 week of treatment with topical mupirocin cream (antibacterial agent). We then saw that a fungal colony grew on the culture, which was identified as T. mentagrophytes based on the morphological and molecular characteristics. The patient was then diagnosed with tinea faciei and was topically treated with 0.2% ketoconazole cream twice per day for 7 days. Through a literature review, we found another 18 cases of impetigo-like tinea faciei with similar clinical manifestations and pathogenic characteristics. Among these, the most common causative agent was T. mentagrophytes complex, which frequently occurs in children and adolescents and exhibits no gender preferences. Systemic and topical antifungals such as terbinafine or itraconazole are effective for impetigo-like tinea faciei caused by T. mentagrophytes complex. However, prolonged course of impetigo in more than 50% cases highlights the importance of mycological examination when dealing with apparent antibiotic-resistant impetigo cases in clinical settings.

Tinea faciei clinical characteristics, causative agents, treatments and outcomes; a retrospective study in Thailand

“…Seventy percent of lesions are initially misdiagnosed and treated as other diseases such as discoid lupus erythematosus, light polymorphous eruption, seborrheic dermatitis, atopic dermatitis, rosacea and granuloma annulare. 8 Sometimes, the clinical presentation of the infection is modified when treated with corticosteroids, resulting in the loss of its characteristics. This condition is termed 'tinea incognito' due to its resemblance to other diseases.…”