I. Alteras

15-year survey of tinea faciei in the adult.

In a series of 100 adults with tinea faciei various dermatologic manifestations were mimicked, viz.: discoid lupus erythematosus in 52 patients, lymphocytic infiltration in 15, seborrheic dermatitis in 11, rosacea in 8, contacts dermatitis in 7, polymorphous light eruption in 4 and granuloma faciale in 3. Trichophyton rubrum was isolated in 78% of the respective cases, other isolated organisms being Microsporum canis (13 cases), Trichophyton violaceum in 6, Trichophyton mentagrophytes (asteroides) in 2 and Epidermophyton floccosum in 1 case. In 85% of these patients the nails were also involved by the same agent found in the lesions of the face. On the basis of these observations it is recommended that all adult patients with tinea faciei should undergo a comprehensive mycological investigation to find the primary focus, which may be an infected nail.

The isolation of Keratinophilic fungi from soils in Israel. A preliminary report

One hundred and fourteen soil samples collected from various areas of Israel were screened for the presence of keratinophilic fungi. Five species were isolated from the 59 positive samples, viz.: C. keratinophilum — 22 strains, C. evolceanui — 18, C. serratus Eidam — 10, M. gypseum —T. terrestre — 4. Most of the geophilic organisms were recovered from garden soil, road-side and sandy-soil specimens. The importance of these findings is briefly discussed.

A critical survey of 1000 cases of dermatophytosis in the Tel Aviv area during 1970-1975.

Clinical and mycological data on 1000 cases of dermatophytosis seen from 1970 to 1975 are reported. Tinea pedis was present in 44%, T. rubrum being the main causative agent; nail involvement was present in 41% of these cases. Tineainguinalis was present in 13%, 38% of them females, withT. rubrum isolated in 87% and the swimming-pool incriminated as the main source of contamination. There were various manifestations of tinea corporis in 128 patients, withT. rubrum responsible in 91%. Among the 21 cases of tinea capitis, there was one adult female with a kerion-type due toT. violaceum, 4 cases due toM. gypseum and 2 toM. canis. Tinea favosa was seen in 6 patients, all of them females and one with a spreading fungus on the soles and palms. Amonh the 10 cases with tinea barbae,T. rubrum was found in 4,T. tonsurans in 3,T. mentagrophytes in 2 andM. gypseum in one. There were widespread lesions ofT. rubrum located on large areas of the body and including the legs, arms, groins and nails, in 11 patients with other disorders, including diabetes, Cushings syndrome and lymphoma.It was apparent that the dermatophytic flora of Israel comprises 10 dermatophytes,T. rubrum being the predominant agent of infection (in more than 80%), with a gradually increasing incidence evident. The other agents found in our survey wereT. mentagrophytes, T. violaceum, T. schoenleinii, T. tonsurans (found sporadically),E. floccosum andMicrosporum spp.M. canis andM. gypseum, the latter being reported for the first time in this country.T. verruccosum andT. megnini, mentioned in former publications, were not found in this survey.

Saprophytic occurrence of Trichophyton mentagrophytes and Microsporum gypseum in the coats of healthy laboratory animals

A group of 199 healthy laboratory animals, comprising 63 guinea pigs, 58 white mice. 47 rats and 31 rabbits, was sampled for the presence of pathogenic dermatophytes. T. mentagrophytes, var. granulare, was isolated in 10% (5-guinea pigs, 6 mice, 6 rats and 2 rabbits) and M. gypseum was found in 7 animals (3 guinea pigs, 3 mice and one rat). No ringworm lesions were observed in the respective animals. This is the first report on such findings in Israel.

The increasing role of Microsporum canis in the variety of dermatophytic manifestations reported from Israel

During a period of 8 years 300 cases of dermatophytoses involving both hairy areas and the glabrous skin were found to be caused by M. canis. There was scalp involvement in 60%, including 8 infants and 27 adults; most of the adults presented Kerion-like lesions and presented various clinical aspects such as seborrhea capitis, folliculitis and discois lupus erythematosus. In the 21 patients showing invasion of the beard the clinical manifestations included superficial erythematosquamous patches with hyperemic slightly elevated margins, folliculitis or abscess-like lesions and Kerion-like lesions. Among the lesions found on the glabrous skin there were unusual aspects of tinea faciei in 19 adults, mimicking lymphocytic infiltration, granuloma faciale or discoid lupus erythematosus. Some of the cases of tinea corporis found in 70 patients also had lesions simulating various other dermatological entities, including erythema multiforme, psoriasiform eruption, pityriasis rosea and seborrheic dermatitis. The hands were invaded in 5 adults patients, with involvement of the finger nails in one. Repeated mycologic examinations were necessary to establish the true etiology in many of these cases.

Rapid Response of Transient Acantholytic Dermatosis to Selenium Sulfide Treatment for Pityriasis Versicolor

The observation of a 51-year-old male patient with transient acantholytic dermatosis (TAD) is briefly reported. The discrete eruption, composed of erythematous escoriated papules and papulovesicles, moderately itching, was located on the back and chest, more permanent during the summer season. The biopsy revealed suprabasal acantholysis and Darier-like elements. Lesions of pityriasis versicolor, confirmed by microscopic examination and fluorescence in Woods light, were intermingled with TAD in the same patient. A topical treatment with selenium sulfide brought TAD lesions to the disappearance in 1 week. Comments are made in relation with the possibility of Malassezia furfur to induce acantholytic phenomena.

Two Years of Follow-up of Oral Ketoconazole Therapy in 60 Cases of Pityriasis versicolor

In a series of 60 patients (42 males, 18 females) with widespread lesions of pityriasis versicolor, 200 mg of oral ketoconazole was administered daily for a period of 24 days. Routine laboratory examinations, including microscopic and Woods light examinations, were performed prior to initiation of treatment and twice during the treatment period as well as 3 and 6 months, and 1 and 2 years after completion of treatment. In 95% of the patients the clinical cure was maintained after 3 months but after 6 months it was still present in only 80% and after one year in only 57%. At the end of two years 60% showed relapse of the disorder. In 75% hypopigmented macules persisted after 6 months but without microscopic evidence of the fungus. No side effects were reported. It is evident that oral ketoconazole is effective in maintaining a clinical cure mainly during the first 3 months after treatment. The question as to whether side effects might appear with a more prolonged course of the drug should be given serious consideration before continuation of treatment is contemplated.

The prevalence of pathogentic and potentially pathogenic fungi on the apparently healthy skin of patients with neoplastic diseases

A group of 83 patients (45 females, 38 males) suffering from various cancerous diseases were investigated for the presence of fungi, specimens being obtained from the intertriginous areas of the body and toe and fingernails as well as areas of apparently healthy skin at sites less prone to fungal infection, including the abdomen, thorax and interscapular area. A group of 25 patients with non-cancerous disease served as controls Examination of the KOH-treated scrapings and cultures revealed that the nails were affected in 85 % of the neoplastic patients, the toe-webs and soles in 79 %, the groin in 72 % and the inframmammary fold in 33 %. T. rubrum was the predominant organism found in the nails and soles, C. albicans in the groin and breast T. mentagrophytes (interdigitale) was second in order of frequency and E. floccosum was found in only a few cases. Of note was the finding of these fungi in areas with no visible changes, particularly on the abdomen (in 23 patients), the back (in 17 cases) and thorax (in 11 cases). The latter areas also were found to harbour the blastospores of Pityrosporum spp. in 22 patients. There was a negative response to trichophytin and candidin antigens in all the patients. The tests for cell-mediated immunity performed in 22 patients provided no significant data. In the control group of non-cancerous patients there was no evidence for any of the above fungi on the back, abdomen or thorax area. The findings of this study indicate that the apparently healthy skin of cancerous patients shows a higher incidence of fungal invasion in both areas usually affected by fungi as well as those usually found not to be affected in non-cancerous individuals.

Tinea capitis due to Microsporum canis in infants

Three cases of scalp involvement by M. canis in infants are briefly reported. The first was a 2-month-old female with a few erythematous spots on the scalp, the second an 8-month-old male with lesions resembling seborrhoeic dermatitis and the third an 11-month-old male having areas of folliculitis of a kerion type. The father of the second case was found to have a tinea barbae infection due to the same fungus. Stray kittens were the most probable source of infection in all these cases.

The incidence of skin manifestations by dermatophytes in patients with psoriasis.

Thirty-four psoriatic patients (23 males, 11 females) were found to have skin manifestations of dermatophyte infection. Tinea pedis was observed in 20 cases, tinea cruris in 6 and tinea mannum in 2. T. rubrum was the causative agent in all of these with the exception of 2 cases caused by E. floccosum. Lesions of tinea corporis were found intermingled with psoriatic plaques in various areas of the body skin in 6 patients (4 males, 2 females); T. rubrum was isolated from 5 of these and M. canis from one. Twenty-one of these psoriatic patients also had lesions caused by C. albicans in the toe-webs and interdigital aspects of the fingers, the latter being associated with paronychia in 9 cases. These findings indicate that we should remain aware of the possibility of fungus manifestations in patients with psoriasis, which would not appear to be an exceptional occurrence.