L. Massai

Prevalence of dermatophytic skin and nail infections in diabetic patients.

Summary. To determine whether there is a higher frequency of mycotic infections due to dermatophytes in diabetics, 171 diabetic outpatients and 276 controls were recruited in the period 1997–98. Patients with suspicious lesions underwent mycological examination which was positive in seven diabetics and 17 controls. In diabetics the most frequent infection was tinea pedis, followed by distal subungual onychomycosis; the most frequently isolated fungus was Trichophyton mentagrophytes. The results of the study did not show a prevalence of dermatophyte infections in diabetics. No correlation was found between dermatophytosis and duration or type of diabetes and its complications, blood sugar levels or levels of glycosylated haemoglobin. None of the diabetic patients with dermatophytosis had complications related to diabetes and basal blood sugar and glycosylated haemoglobin levels indicated good metabolic control.

Tinea Incognito due to Microsporum gypseum in Three Children

Abstract: Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical steroids, sometimes prescribed as a result of incorrect diagnosis. The cases reported in the literature have different clinical presentations and have generally been in adults. We report three children with tinea incognito in whom the lesions were psoriasis‐like, eczema‐like, and lichenoid, respectively. Diagnosis was confirmed by mycologic examination, which led to the identification of Microsporum gypseum, a geophilic dermatophyte which is an infrequent agent of mycotic infection in humans.

Eighty-four consecutive cases of tinea faciei in Siena, a retrospective study (1989-2003)

Consecutive cases of tinea faciei diagnosed in Siena between 1989 and 2003 were studied retrospectively for differences in clinical form, demographic data and species of dermatophyte isolated. The series consisted of 84 cases (59 females, 25 males) with a mean age of 27 years. Mean age of females (32.4 years) was significantly greater than that of males (14.2 years). The dermatophytes most frequently isolated were Microsporum canis (38 cases) and Trichophyton rubrum (31 cases). Clinical form was typical of tinea in 54 subjects (64.3%) and was tinea incognito because of inappropriate therapy in the other 30 (35.7%) subjects. The mean age of patients with the typical form (19.2 years) was significantly lower than that of those with tinea incognito (41.1 years). All cases in the age range 6–15 years had typical tinea, whereas the maximum frequency of cases with tinea incognito was 46–50 years. In the group with tinea incognito there was a majority of women and the dermatophytes isolated differed with gender. No such difference was observed in the group with typical tinea.

Case Reports. Six cases of infection due to Trichophyton verrucosum

Summary. Dermatophyte infections due to Trichophyton verrucosum are not frequent in Europe. Six cases observed in Italy in the period 1995–99 are reported. Two were cases of tinea barbae, two of tinea corporis and two of tinea capitis, one of which had been preceded by tinea faciei. In three cases the source of contagion was horses, in two it was cattle and in one case it was another person. The two cases of tinea barbae were initially interpreted and treated as bacterial infections, a diagnostic error reported with increasing frequency in the literature regarding dermatophytosis due to T. verrucosum.

Case Report. Primary cutaneous histoplasmosis in an immunosuppressed patient

A case of cutaneous histoplasmosis is reported in an 80‐year‐old man with rheumatoid arthritis who had been treated with steroid therapy for 15 years. The patient developed a large ulcerative lesion on the back of the left hand and on the distal third of the left dorsal forearm after a slight trauma. Diagnosis was based on histological and mycological examination. Systemic involvement was not found. The lesions healed after 2 months of therapy with 100 mg day−1 fluconazole, confirmed at follow‐up 1 year later.

Microsporum gypseum infection in the Siena area in 2005–2006

Fourteen cases of dermatophytosis caused by Microsporum gypseum, representing 6.8% of all dermatophytic infections reported, were diagnosed in Siena, Italy, between 2005 and 2006. There were as follows: six cases of tinea corporis, one case of tinea corporis associated with tinea capitis, one case of tinea corporis associated with tinea barbae, one kerion on the head, one tinea cruris, one tinea faciei, one tinea barbae, two onychomycosis. In the three subjects with tinea corporis, the clinical appearance was impetigo‐like, psoriasis‐like and pityriasis rosea‐like respectively. In another case, the lesion was indicative of tinea imbricata. The diagnosis was based on mycological examination. In six cases, the source of infection was a cat, whereas in the others it was contact with soil.

Tinea capitis due to Trichophyton soudanense mimicking bacterial folliculitis.

We report the case of a 36‐year‐old Senegalese male with non‐scarring alopecia of the scalp, including nodules and pustules, diagnosed as tinea capitis caused by Trichophyton soudanense. This dermatophyte is endemic in Central Africa and is becoming more frequent in Europe because of immigration. It has seldom been isolated in Italy. Tinea capitis is common in childhood and it is rare in adults, in which female sex is preferred. In adults, alopecic patches have to be distinguished from those due to other dermatoses inducing alopecia.

Primary subcutaneous zygomycosis due to Rhizopus oryzae in a 71-year-old man with normal immune status

A case of primary subcutaneous zygomycosis due to Rhizopus oryzae is described in a 71‐year‐old man with normal immune status. Diagnosis was based on histological examination and culture of biopsy fragments from skin lesions. The patient recovered after itraconazole therapy (200 mg day−1 for 60 days followed by 100 mg day−1 for 45 days).

Proximal subungual hyperkeratosis of the big toe due to Microsporum gypseum.

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Tinea corporis purpurica and onychomycosis caused by Trichophyton violaceum

We report two cases of tinea corporis purpurica of the legs, presumably caused by self‐inoculation of the mycete from the toenails, in two elderly women (80 and 78 years). Trichophyton violaceum was isolated from the skin and nails. Histological examination of a biopsy specimen from the leg lesions confirmed the diagnosis. The source of infection was an Ethiopian carer who had tinea capitis in the first case, and was undiagnosed in the second patient. Cases of purpuric variants of tinea corporis are rare and this is the first report of probable self‐inoculation of T. violaceum from onychomycosis.