Abstract

Dermatophytosis is an infection of the hair, skin, or nails caused by a dermatophyte, which is most commonly of the Trichophyton genus and less commonly of the Microsporum or Epidermophyton genera. Tinea capitis, tinea pedis, and onychomycosis are common dermatologic diseases that may result from such an infection. The treatment of fungal infections caused by a dermatophyte has been successful when treated with antifungal agents. Dermatophytosis of scalp, face and the rest of the body surface are common, amounting to about 14% of dermatoses in skin clinic.

The threat for widespread dermatophytosis include genetic defects, chronic diseases, immunosuppressive therapy and misdiagnosis or delayed diagnosis. Trichophyton interdigitale is a strictly anthropophilic species that belongs to the Trichophyton mentagrophytes complex, which is the common pathogen causing Dermatophytosis.

Fungal keratitis, also termed keratomycosis, is an infectious disease of the cornea. Little awareness and deferred diagnosis of this condition lead to difficulties that can result in permanent loss of vision, and even require enucleation.

Case

A 70-years-old woman came to the dermatology department with multiple ringworm lesions on her face and limbs. The lesions initially appeared within inches of her left eyebrow 4 years ago, and then progressively extended across face, trunk and limbs. One year ago, she was diagnosed with fungal keratitis at a local hospital. She lost he left eye vision. Cutaneous symptoms had become worse in the last month. Dermatological investigations showed wide erythematous plaques with clear borders and scales, scattered red papules with ulceration, and scabs throughout her body. Onychomycosis was detected on her left hand nail. An ophthalmological examination showed conjunctival infection with secretion, corneal ulcer, and loss of vision in the left eye.

She complained of slight itchiness over the lesions and pain in left eye. Slide culture revealed branched septate hyphae and masses of spherical-to-pyriform microconidia. Histopathological examination of biopsy specimen revealed parakeratosis, mild acanthosis, dense dermal blood vessels, and lymphocyte and plasma cell infiltration. Laboratory tests revealed decreased levels of IgG. The other test results were all within normal ranges or negative. Severe clinical manifestations, the abnormal T-cell subsets and immunoglobulin levels, a genetic defect in the immune response to fungal infections was suspected.

Diagnosis and treatment

The clinical manifestations and examinations reveals dermatophytosis and keratomycosis caused by T. interdigitale with loss of vision in the left eye were made. She was treated with luliconazole cream (two applications per day) and itraconazole for 1 month. A significant improvementwas observed after 14 days. Successively, the patient presented to the ophthalmology department for left eye enucleation. There has been no recurrence during 3 months of follow-up.

Conclusion

Luliconazole is an imidazole antifungal agent that has been shown to have potent activity against a variety of fungi, especially dermatophytes. The effectiveness of luliconazole in the treatment of dermatophyte infections appears to be favorable. The strong clinical antifungal activity of luliconazole is possibly attributable to a combination of strong in vitro antifungal activity and favorable pharmacokinetic properties. Early diagnosis and aggressive medical treatment are of the utmost importance to improve therapeutic outcomes.

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