Journal Reading 1

JOURNAL READING
ICHTYOSIS ASSOCIATED WITH

WIDESPREAD TINEA CORPORIS :
REPORT OF THREE CASES
Camila Fernanda Novak Pinheiro de Freitas1
Hanae Rafaela Fontana3
Mariana Hammerschmidt1
Fabiane Mulinari-Brenner2
Arthur Conelian Gentili4
DOI: http://dx.doi.org/10.1590/abd1806-4841.20131854
Pembimbing :
Dr. Bowo Wahyudi, Sp.KK
Disusun Oleh :
Vicca Selsiana 2010730109
INTRODUCTION
Ichthyoses are a common group of

keratinization disorders
INTRODUCTION
Several forms of ichthyosis are

classified according to inheritance,
clinical appearance, pathological
features and systemic disorders
INTRODUCTION
Patients with ichthyosis demonstrate
increased cell turnover, stratum
corneum thickening and sebaceous
and sweat glands functional
changes, which seem to favor
dermatophyte infectio
INTRODUCTION
One of the most prevalent

dermatophytes is Trichophyton
rubrum, with universal occurrence.
Case Report Patient 1
An 87-year-old female patient

diagnosis of chronic
Tahun 2006
dermatophytosis had been

established for more than 30
years, with erythematous-scaling
patches, with peripheral activity
and central clearing.
Had been followed since 1976
accepted treatment with

Acitretin.
Partial improvement of
erythema and
desquamation was seen
within 2 months;
however, arciform lesions
The patient underwent several

treatments with systemic antifungal
agents, including griseofulvin and
azoles for periods of 3 to 12 weeks
were occasionally seen

In addition, topical creams were
used with temporary improvement.

she showed signs of clinical deterioration
with widespread lamellar scaling on the
limbs and trunk, ectropion and multiple
bilateral erythematous round patches on the
lower limbs. (Figure 1A)
Sept 2011
Direct examination demonstrated hyaline septate

hyphae with a positive culture for T. rubrum.
Association with dermatophytosis was diagnosed.
Thirty days after prescription of terbinafine 250

mg qd the patient showed dramatic improvement
of the lesions. (Figure 1B)

A 73-year-old male
Disseminated arciform and
patient was diagnosed
round patches had been
with ichthyosis linearis
seen since his first
circumflexa in 1999
dermatology visit.
Previous empiric treatment to rule

out coincident fungal infection
included ketoconazole, topical
terbinafine, ketoconazole or
ciclopirox olamine.
This therapy had no impact.

Onycholysis, distal
During one of his regular
leukonychia, subungual
visits in July 2011, he
hyperkeratosis and
presented ill-defined
onychorrexis on the toenails
erythematous scaly papules
were also evident
and plaques on the trunk

and upper limbs (Figure 2A).
A mycological examination
demonstrated septate hyaline
hyphae, and a positive culture
for T. rubrum.
Skin biopsy presented

several hyphae within the
stratum corneum,
suggesting the diagnosis
of dermatophytosis
(Figure 2B)
Patient was treated with

terbinafine 250 mg qd for
120 days, with significant
improvement of skin
scaling and nail
dystrophy
(Figures 2C and 2D).

A 27-year-old female patient,
Tahun 2008
with Sjogren Larsson Syndrome

(congenital ichthyosis
she had onycholysis
associated to spasticity), had
and subungual
been followed since 2003.
hyperkeratosis on
toenails.
She was on Acitretin since

2004 and presented with
sudden worsening.
She was on ciclopirox

olamine nail lacquer and
ketoconazole cream for
more than 2 years with mild
improvement.

her mother reported severe worsening
of ichthyosis, despite regular use of
Acitretin.
Clinical examination demonstrated
Tahun
2011
lamellar desquamation of the lower

limbs, ill-defined erythematous
patches, and round scaly lesions on
trunk and left leg. (Figure 3A).
Direct mycological examination showed
hyaline septate hyphae and the culture
was positive for T. rubrum (Figure 3B).
Skin biopsy demonstrated several

hyphae within the stratum corneum.
Tahun
2011
Terbinafine 250 mg qd for 30 days led

to clearance of the erythematous
lesions, slight scaling persisted due to
baseline ichthyosis (Figure 3C).
Discussion
Several factors may lead to chronic

dermatophytosis in patients with ichthyosis:
defects of the skin barrier; defective cellmediated immunity, primarily responsible for
immunity against T. rubrum, in some cases with
atopic background; and finally, delayed keratin
scaling, facilitating persistence of fungal infection.
Lanjutan
The three cases investigated had positive
cultures for T. rubrum, which is the
mostprevalent pathogen in fungal cultures
in Brazil, accounting for 37.4% to 58.3% of
superficial fungal infections in several
studies in the Brazilian population.
Lanjutan
Typically, the clinical appearance of
dermatophyte infections is
characterized by round patches with
erythematous scaling circinate edges,
due to the combination of keratin
destruction and host inflammatory
response.
Lanjutan
Fungicidal activity of terbinafine is

higher and initiates faster than that of
azoles.
Lanjutan
Dermatologists should be aware that
associated dermatophytosis in patients
with ichthyosis may present as clinical
worsening of baseline scaling,
sometimes resistant to usual therapies,
such as acitretin.
Lanjutan
Allylamines seem to elicit a better

clinical response from these patients

Journal Reading 1

Uploaded by

Copyright:

Available Formats

Journal Reading 1

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Journal Reading 1

Uploaded by

Copyright:

Available Formats

JOURNAL READING

ICHTYOSIS ASSOCIATED WITH

Ichthyoses are a common group of

Several forms of ichthyosis are

One of the most prevalent

Case Report Patient 1

An 87-year-old female patient

dermatophytosis had been

accepted treatment with

The patient underwent several

were occasionally seen

Case Report Patient 1

Direct examination demonstrated hyaline septate

Thirty days after prescription of terbinafine 250

Case Report Patient 2

Disseminated arciform and

patient was diagnosed

round patches had been

with ichthyosis linearis

seen since his first

Previous empiric treatment to rule

Case Report Patient 2

visits in July 2011, he

onychorrexis on the toenails

erythematous scaly papules

were also evident

and plaques on the trunk

Case Report Patient 2

Skin biopsy presented

Patient was treated with

Case Report Patient 3

with Sjogren Larsson Syndrome

she had onycholysis

associated to spasticity), had

been followed since 2003.

She was on Acitretin since

She was on ciclopirox

Case Report Patient 3

lamellar desquamation of the lower

Case Report Patient 3

Skin biopsy demonstrated several

Terbinafine 250 mg qd for 30 days led

Several factors may lead to chronic

Fungicidal activity of terbinafine is

Allylamines seem to elicit a better

You might also like