Trichophyton rubrumsyndrome: the tip of the iceberg and a preventable outcome

Abstract

Infections of the skin, nails and hair caused by Trichophyton (T.) rubrum are currently the most prevalent dermatophytoses (Foster KW et al., J Am Acad Dermatol 2004; 50: 748-52). This fungus can colonise the plantar foot from childhood and can remain active for years (Zaias N et al., Int J Dermatol 1996; 35: 614-7). The infection can propagate from this primary location through autoinoculation and secondary lesions can subsequently appear anywhere on the body. These lesions may be concurrent or intermittent, or can occur after an interval, and their severity varies according to their location and the hostÕs cellular immune response (Jones HE. J Am Acad Dermatol 1993; 28: S12-S18). The possibility of inheriting a greater susceptibility for acquiring and developing these infections through an autosomal dominant pattern has been described (Zaias N et al., J Am Acad Dermatol 1996; 34: 302-4). Several authors have reported the chronification of this dermatophyte infection (Zaias N et al., Int J Dermatol 1996; 35: 614-7; Zaias N et al., J Am Acad Dermatol 1996; 35: S17-20; Kick G et al., Mycoses 2001; 44: 167-71; Böhmer U et al., Hautarzt 1999; 50: 292-4) and some authors have even suggested a definition of T. rubrum syndrome with three essential criteria (Kick G et al., Mycoses 2001; 44: 167-71): (i) lesions in the feet, hands and nails and at least one lesion in another part of the body (except the groin); (ii) positive potassium hydroxide (KOH) in samples from the four distinct locations; and (iv) identification of T. rubrum by culture from at least three of the four locations.In a prospective study on dermatophytosis performed in our service to identify lesions in locations other than that motivating the consultation, four patients fulfilled all the diagnostic criteria (Larruskain J et al., Enferm Infecc Microbiol Clin 2005; 23: 191-3). All four patients had at least one risk factor predisposing them to fungal spread (Table 1): a 38-year-old man with Down syndrome and lesions in the leg; a 47-year-old man with HIV with lesions in the leg and buttock; a 56-year-old man with diabetes and lesions on the trunk; and a 43-year-old man with lesions on the eyelid, who had received topical corticosteroid treatment for dorsoplantar lesions on both feet. All the patients also had lesions on the feet, hands and nails and showed positive results both in direct KOH test and cultures from all the samples. In the first three patients, the reason for consulting was the secondary lesion, or lesions, while the primary lesion went unnoticed. In the fourth patient, the secondary lesions were initially overlooked.In our experience, the diagnosis of T. rubrum syndrome represented only 7% (4 ⁄ 57) of patients who had dermatophytosis with concurrent lesions at a distance caused by this fungus, which is often under-diagnosed and incorrectly treated. The treatment of the T. rubrum syndrome should associate systemic and topical therapy. Detection of secondary lesions in other locations and identification of the primary lesion, almost alway...

Tinea Capitis in Adults

“…Tinea capitis caused by infection of T. rubrum is described to be extremely rare [4,17]; however we observed two patients affected by this pathogen, and one of them suffered from T. rubrum syndrome (skin ringworm all over the body [12]). …”

“…In one case the patient displayed lesions on the whole body (T. rubrum Syndrome [12]) 11 patients suffered from itch ( Table 1).…”

Mycology – an update Part 2: Dermatomycoses: Clinical picture and diagnostics

“…Moreover, previously administered topical or systemic corticosteroid therapy also has to be considered a predisposing factor. Piñeiro et al pointed towards secondary tinea as a result of autoinoculation from primary tinea pedis, as they found T. rubrum syndrome in 7 % of these secondary infections. Four male patients (age: 38–56) with T .…”

Mykologie – ein Update Teil 2: Dermatomykosen: Klinisches Bild und Diagnostik

“…Als disponierender Faktor muss zudem eine zuvor erfolgte lokale oder auch systemische Steroidbehandlung angesehen werden. Piñeiro et al wiesen auf die sekundäre Tinea infolge einer Autoinokulation von einer Primärinfektion der Füße hin, bei 7 % dieser sekundären Infektionen würde ein T.‐rubrum ‐Syndrom vorliegen. Vier 38 bis 56 Jahre alte männliche Patienten mit T .‐ rubrum ‐Syndrom wiesen disponierende Faktoren auf.…”