Paolo Pontini

A case of tinea imbricata in an Italian woman.

© 2015 The Authors. doi: 10.2340/00015555-1887 Journal Compilation

Tinea Imbricata in an Italian Child and Review of the Literature

Tinea imbricata is a chronic superficial mycosis caused by Trichophyton concentricum. It is characterized by widespread, annular, concentric, squamous lesions. Tinea imbricata is endemic in three geographical areas: Southwest Pacific, Southeast Asia, and Central and South America. Tinea imbricata in travelers returning from endemic areas is exceptionally rare. We report a case of tinea imbricata in an Italian child who acquired the infection during a trip to Solomon Islands. Three cultures were positive for T. concentricum. The patient was successfully treated with griseofulvin and terbinafine cream.

Where to look for the scabies mite

Common locations of scabies are axillae, wrists, interdigital folds of the hands, breasts, penis, scrotum and buttocks.[1–3] Literature data about nail involvement are poor and limited to anecdotical cases.[4–8] We observed that subungual skin of the fingers is much more frequently involved than previously thought. Eighty-nine Caucasian immunocompetent patients (51 males and 38 females, aged 18–74 years), with a clinical diagnosis of scabies, were subjected to microscopical examinations in order to confirm the diagnosis. In all patients, at least fourteen locations (chest, breasts, axillae, elbows, wrists, interdigital folds of the hands, subungual skin of fingers, abdomen, pubis, penis, scrotum, vulva, back and buttocks) were evaluated. Microscopical examination was considered positive when mites and/or eggs and/or faeces were observed. In males, more frequently involved area was penis (34/511⁄4 66.7%), followed by scrotum (26/511⁄4 51%), subungual skin of fingers (21/511⁄4 41.2%), interdigital folds of the hands (16/511⁄4 31.4%), wrists and abdomen (13/511⁄4 25.5%), respectively. In females, microscopical examination was positive in breasts (23/381⁄4 60.5%), followed by axillae (15/381⁄4 39.5%), subungual skin of fingers (14/381⁄4 36.8%), abdomen (13/381⁄4 34.2%), buttocks (12/381⁄4 31.6%), interdigital folds of the hands (11/381⁄4 28.9%) and wrists (10/381⁄4 26.3%). Results are reported in Table 1. The results of our study confirm that in males common locations of scabies are penis, scrotum, interdigital folds of the hands, wrists and abdomen, while in females they are breasts, axillae, abdomen, buttocks, interdigital folds of the hands and wrists. However, in both genders, the subungual skin of fingers was very commonly involved (third location both in males and females). It is interesting to emphasize that, in all patients, we observed neither burrows nor other lesions (i.e. papules, nodules, vesicles, pustules, excoriations) in subungual skin of fingers. In 5/21 males and 2/15 females, we only observed very mild subungual scales. In addition, no patient complained of itching in periand subungual skin of the fingernails. Nail involvement is well-known in crusted scabies.[9] It is characterized clinically by yellow pigmentation of the nail plate and nail bed hyperkeratosis.[9] However, as previously mentioned, nail involvement was very rarely reported in classic scabies.[4–8] In conclusion, in our group of patients, subungual skin of fingernails was a frequent location of scabies, although no typical lesions, except for rare thin scales in some patients, were observed in these areas, and no symptoms, in particular itching, were reported by patients. It is possible that scabies mites find a favourable environment beneath the free edge of nail plates.[6] Our observations strongly suggest to treat carefully also periand subungual skin of fingers in all patients with scabies. The fingernails should be trimmed very short, scrubbed with a brush and treated with the specific therapy.[5–7] This procedure can reduce the incidence of relapse after therapy.

Nasal polyps : A predisposing factor for cutaneous leishmaniasis of the lips?

Cutaneous leishmaniasis (CL) of the lips is rare. This study was conducted to investigate findings in patients with this condition.

The association of isoconazole–diflucortolone in the treatment of pediatric tinea corporis

Abstract Background: Tinea corporis is a common mycotic infection in children. Staphylococcus aureus superinfections may be observed in atopic children with tinea corporis suffering from severe pruritus and consequent scratching. Objective: From 2006 to 2011, we observed 288 children with mycologically proven tinea corporis. In 39 of them (13.5%) tinea corporis was superinfected by S. aureus: all these children were affected by atopic dermatitis. We interpreted these bacterial superinfections as the clinical result of scratching due to pruritus. Methods: In 2012, we decided to treat all children with a single lesion of tinea corporis with a combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate cream (one application/day for 5–7 days), followed by a treatment with isoconazole or clotrimazole or ciclopirox cream (two applications/day for two weeks). Results: From 2012 to 2014, we observed 108 children with tinea corporis confirmed by mycological examinations. Clinical and mycological recovery was observed in 93 of them (86.1%). Only four of these children (3.7%) developed S. aureus superinfections. Conclusions: Our study in atopic children with tinea corporis superinfected by S. aureus confirms that a topical therapy with the association isoconazole–diflucortolone is useful and safe.

Is This Melanoma?: A Quiz

A 46-year-old man was referred to our department by his general practitioner with a clinical diagnosis of melanoma on the fifth left toe. The patient reported that he was in good general health and not on any systemic drug therapy. The slightly painful lesion had appeared approximately 6 weeks earlier, during a trip to Fortaleza (Brazil). Dermatological examination revealed a pigmented, slightly infiltrated lesion, approximately oval in shape, 0.8 × 0.5 cm, brownish-black in colour, with poorly defined borders (Fig. 1). Dermoscopy of the lesion is shown in Fig. 2.