Abstract

Superficial fungal infections are among the most common skin diseases. This case study relates a 50-year-old female with atopy, who developed erythrosquamous tinea manus on the thumb and the thenar eminence of her right hand.

The lady reported a history of contact with a hedgehog – Erinaceus europaeus.

The zoophilic dermatophyte Trichophyton erinacei could be isolated from scrapings of the womans skin. A ciclopirox olamine cream was prescribed, which showed efficacy in attenuating symptoms. Additionally, an oral antifungal drug was prescribed for two weeks. These therapies aided in healing of the skin lesions.

Introduction

Superficial fungal infections are among the most common skin diseases, which occur in both healthy and immunocompromised individuals. These may be caused by dermatophytes – specifically Trichophyton, Epidermophyton and Microsporum species, yeasts and nondermatophytic molds. Timely and effective management with topical and systemic antifungals can ameliorate symptoms and reduce the duration of symptoms in patients with superficial fungal infections.

The term “tinea” exclusively denotes dermatophyte infections. Tinea infections are classified according to their anatomic location. Tinea manuum – dermatophyte infection of the hands, presents with the characteristic pattern—erythema and mild scaling on the dorsal aspect of the hands or as a chronic, dry, scaly hyperkeratosis of the palms. Most patients with tinea manuum of the palms also have tinea pedis – dermatophyte infection of the feet. Both these types of fungal infections should be treated with topical and oral antifungal medications.¹

Case Report

A 50-year-old female with atopy, presented with dry and scaly erythematous plaques on the palm of her right hand.

She reported a history of contact with a hedgehog – Erinaceus europaeus.

The woman was diagnosed with erythrosquamous tinea manuum on her thumb and the thenar eminence.

The zoophilic dermatophyte Trichophyton erinacei could be isolated from scrapings of the womans skin.

The patient was prescribed ciclopirox olamine cream, which which effectively attenuated the symptoms. Additionally, an oral terbinafine 250 mg daily was given for two weeks. These therapies helped in healing of the skin lesions.

Discussion

Ciclopirox olamine – a hydroxypyridone derivative, differs in structure and mechanism of action from the other known antifungal agents. This topical antifungal agent was approved by the US-FDA in the year 2004. The drug is available as a topical cream topical; its nail lacquer formulation is also used in for treating onychomycosis, tinea pedis, tinea corporis/cruris, pityriasis versicolor, seborrheic dermatitis, as well as vuvovaginal candidiasis.^1,2 Hydroxypyridones are the class of topical antifungal agents that have a completely different mechanism of action than other topical antifungals – azoles and allylamines.

Ciclopirox – the active compound, acts as a broad-spectrum antifungal, with additional antibacterial and anti-inflammatory properties. It acts through the chelation of polyvalent metal cations, such as ferric (Fe3+) and aluminum (Al3+). This leads to the inhibition of metal-dependent enzymes – cytochromes, catalase and peroxidase, leading to the disruption of cellular activities like mitochondrial electron transport processes, energy production and nutrient intake across cell membrane. This class of drugs can also alter membrane permeability resulting in the blockage of intracellular transport of precursors.²

Furthermore, ciclopirox has less serious side effects and is efficacious against various strains of fungi causing dermatophytic infections.³

Conclusion

Ciclopirox olamine is a potent topical agent for the management of tinea manuum, onchomychosis, tinea pedis, tinea corporis/cruris, pityriasis versicolor, seborrheic dermatitis and vuvovaginal candidiasis. The drug is effective against various fungal strains that cause dermatophyte infections. It can be used in concurrence with other systemic antifungal drugs and in cases with recurrent infection, it can be applied for prophylactic purposes. This agent expresses less serious side effects and has a good safety profile.

References

1. Noble SL, Forbes RC, Stamm PL. Diagnosis and management of common tinea infections. American Family Physician. 1998;58(1):163.
2. Sonthalia S, Agrawal M, Sehgal V. Topical ciclopirox olamine 1%: Revisiting a unique antifungal. Indian Dermatol Online J. 2019;10(4):481. doi:10.4103/idoj.idoj_29_19
3. Gupta A, Stec N, Summerbell R et al. Onychomycosis: a review. Journal of the European Academy of Dermatology and Venereology. 2020. doi:10.1111/jdv.16394