Chronic Trichophyton indotineae Infections Mimicking Adult-Onset Atopic Dermatitis
Main Article Content
Keywords
Trichophyton indotineae, dermatophytosis, tinea cruris, adult-onset atopic dermatitis , tinea corporis
Abstract
Tricophyton indotineae is a dermatophyte endemic to South Asia that has been increasingly prevalent in the United States. Its atypical appearance and resemblance to atopic dermatitis (AD), clinically and histologically, has resulted in misdiagnosis and mismanagement. It is associated with multidrug resistance which complicates treatment when mismanaged. We were presented with two cases of chronic T.indotineae infections that were being treated as adult-onset AD with topical steroids and immune modulators without resolution. A punch biopsy and fungal culture confirmed T.indotineae and antifungal therapy was initiated. The clinical similarity between AD and T. Indotineae can lead to mistreatment, a prolonged infection course with the potential to spread, and hardship on the patient. To be thorough in a treatment-resistant AD profile, a skin biopsy, targeted laboratory tests, microscopic examination, and a KOH preparation may be indicated. Additionally, social history including travel to endemic areas is important. These measures may decrease inappropriate treatment as AD treatments are ineffective for T. Indotineae and often make it worse. Clinicians should consider T. indotineae in cases of presumed adult-onset or refractory AD that lacks personal or family history of atopy or fail improvement after adequate trials of standard AD therapies. Early performance of a punch biopsy combined with fungal culture is the gold standard for diagnosis. These cases highlight the importance of understanding dermatophyte epidemiology with increasing travel.
References
2. Bylund S, Kobyletzki L, Svalstedt M, Svensson. Prevalence and incidence of atopic dermatitis: A systematic review. Acta Dermato Venereologica. 2020;100(12). doi:10.2340/00015555-3510
3. Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. Journal of the American Academy of Dermatology. 2019;80(6). doi:10.1016/j.jaad.2018.05.1241
4. Silvestre Salvador J, Romero-Pérez D, Encabo-Durán B. Atopic dermatitis in adults: A diagnostic challenge. Journal of Investigational Allergology and Clinical Immunology. 2017;27(2):78-88. doi:10.18176/jiaci.0138
5. Uhrlaß S, Verma SB, Gräser Y, et al. Trichophyton indotineae—an emerging pathogen causing recalcitrant dermatophytoses in India and worldwide—a multidimensional perspective. Journal of Fungi. 2022;8(7):757. doi:10.3390/jof8070757
6. Elston DM, Ferringer T, Ko CJ, Peckham S, High WA, DiCaudo DJ. Dermatopathology. 3rd ed. Elsevier; 2018.
7. Lakhani S, Bilimoria F, Lakhani J. Adverse effects of steroid use in dermatophytic infections: A cross sectional study. Journal of Integrated Health Sciences. 2017;5(2):63. doi:10.4103/2347-6486.240248
8. Cather J, Young M, DiRuggiero DC, Tofte S, Williams L, Gonzalez T. A review of phase 3 trials of dupilumab for the treatment of atopic dermatitis in adults, adolescents, and children aged 6 and up. Dermatology and Therapy. 2022;12(9):2013-2038. doi:10.1007/s13555-022-00778-y
9. Gooderham MJ, Hong HC, Eshtiaghi P, Papp KA. Dupilumab: A review of its use in the treatment of atopic dermatitis. Journal of the American Academy of Dermatology. 2018;78(3). doi:10.1016/j.jaad.2017.12.022
10. dos Santos AR, Uhrlaß S, Nenoff P, et al. Global emergence of antifungal‐resistant dermatophytosis caused by trichophyton indotineae (formerly T. mentagrophytesits genotype viii): A Genomic investigation involving 14 countries. Mycoses. 2025;68(8). doi:10.1111/myc.70101
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.
Authors retain copyright in their work and license the publisher to publish the content. The publisher is the National Society for Cutaneous Medicine, with production and publishing support provided by OJS, Open Journal Systems,see https://pkp.sfu.
Prior to January 2022, authors transferred copyright to the National Society for Cutaneous Medicine. However, all articles are freely available to anyone in the world. There are no subscription fees, page charges, or article processing charges.