Tinea profunda of the genital area. Successful treatment of a rare skin disease

Abstract

We present a rare case of 36-year-old female patient, who developed a severe Majocchi granuloma in the pubis after waxing, with isolated causative agent Trichophyton mentagrophytes. The condition was initially misdiagnosed as a bacterial folliculitis and treated unsuccessfully with topical corticosteroids and antibiotics. After the adequate diagnose was confirmed by mycological examination, followed by histopathological verification, complete remission of the symptoms was achieved at the 4th week after initiating 6 weeks course of antifungal therapy with Terbinafine 250 mg/daily dose, while good therapeutic response was observed even in the 10th day. The etiopathogenesis of the disease, as well as its current treatment options are considered, in respect to the rare occurrence of this condition in the pubic area and its frequent misdiagnosis.

Trichophyton mentagrophytes – a new genotype of zoophilic dermatophyte causes sexually transmitted infections

“…Patients in this study were treated systemically with antimycotics for an average of seven weeks. This is comparable to the therapy duration indicated in other studies for the treatment of tinea pubogenitalis due to T. mentagrophytes .…”

“…It is a rather rare cause of tinea genitalis, and was mentioned as such for the first time in two studies in 2001. The species was isolated from female prostitutes in Spain and from a 19‐year‐old girl in Germany and has occasionally been found since then in individual cases with a slight increase since 2015 .…”

Tinea im Genitalbereich

“…Anthropophilic fungi were T. rubrum (6) and T. tonsurans (1). Anamnestic questions should include contact with pets, physical activities, and travel.…”

Granuloma de Majocchi: una forma de infección dermatofítica invasiva

“…Sólo han sido reportados tres casos de granuloma de Majochi en genitales: una paciente que utilizó esteroides tópicos por cinco días, causando perifoliculitis en vulva por T. mentagrophytes; otro en escroto por T. rubrum de un paciente sano y, por últi-mo, en el pubis femenino de una paciente por T. mentagrophytes luego de depilarse (16,18,19 Se han reportado dos variantes clínicas: la forma papular perifolicular o superficial que afecta a personas inmunocompetentes y a mujeres que se depilan las piernas, y la forma nodular subcutánea o profunda, más común en pacientes inmunosupri midos y que se caracteriza por nódulos firmes o fluctuantes en la cabeza y brazos.…”

“…El granuloma de Majochi que afecta la piel cabelluda debe diferenciarse de piodermias (foliculitis), tiña capitis y querión de Celso (19). Cuando se ubica en la barba, debe ser distinguida de tiña de la barba y del bigote, mientras que en extremidades inferiores, debe diferenciarse de tiña corporis, eritema nodoso y micobacteriosis atípica (23).…”