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Trichophyton Mentagrophytes Type Granular In: Tinea Corporis and Tinea Cruris Caused by Asthma Bronchiale Patient
Trichophyton Mentagrophytes Type Granular In: Tinea Corporis and Tinea Cruris Caused by Asthma Bronchiale Patient
ABSTRACT
Tinea corporis is a fungal infection of the skin dermatophytes
glabrosa except the hands, feet and groin, while tinea cruris is a
common infection in the groin area, genitals, pubic area, perineum and
perianal skin, which causes the fungus most often derived from the
genus Trichophyton, Microsporum and Epidermophyton.
It was reported one case of tinea corporis and tinea cruris caused by
Trichophyton mentagrophytes type granular on a man of 54 years old.
Diagnosis was established based on clinical features, direct microscopic
examination with kalium hidroxyde (KOH) 10% and culture in vitro.
Patients was treated with oral ketokonazole and myconazole2% cream
with clinical and mycologycal improvement.
Keywords: tinea corporis, tinea cruris, trichophyton mentagrophytes
type granular
Address for correspondence : Arif Risdianto, dr., Department of Dermatovenereology Medical Faculty of Hasanuddin University /
Wahidin Sudirohusodo Hospital Makassar , Blok Z /7 Perum Citra Sudiang Indah Jl. Sukhoi Makassar, South Sulawesi, Indonesia
90242, arif_risdianto@yahoo.com
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Arif Risdianto
tinea corporis and tinea cruris caused by trichophyton mentagrophytes type granular in asthma bronchiale
patient
INTRODUCTION
cultured in vitro.
Direct microscopic
examination showed long and branched
hyphae which is characteristic of the
dermatophyte infection but the level of
specificity and sensitivity is less. Cultured
in vitro by using Saboraud Dextrosa Agar
(SDA) can be used to determine the
characteristics of the macroscopic and
microscopic organisms is diagnostically
specific techniques but takes a long
(10, 11)
time.
(5)
(11, 12)
Treatment
of
dermatophyte
infections usually respond well to topical
antifungal within 2-4 weeks. If patients
have extensive lesions or fail with topical
treatments, anti-fungal preparations can
be administered orally, among others,
griseofulvin, ketoconazole, itraconazole
and terbinafin.(12, 13)
Reported one case of tinea corporis and
tinea cruris in a man aged 54 years old
caused by Trichophyton mentagrophytes
granular type that responds well to oral
ketoconazole and topical miconazole 2%
cream.
CASE REPORT
A man aged 54 years old ,
came to
dermatology clinic Salewangan hospital,
Maros with complaints itchy red patches
on the chest, back, buttocks since 1 year
ago. Originally appeared in the form of red
spots on the chest area, getting larger
became red patches and scales on top
then spread to the upper back and
buttocks . These complaints were often
perceived recurrent. Itching is felt
especially when sweating. A history of
drug treatment in the form of itching CTM
and betamethasone ointment purchased
at a pharmacy, but
no clinical
improvement. Patients admitted often
wear a jacket every day. History contact
with pets denied. History therapy for
asthma, patient took prednisone since 24
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2
IJDV
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Arif Risdianto
tinea corporis and tinea cruris caused by trichophyton mentagrophytes type granular in asthma bronchiale
patient
IJDV
demarcated,
erythematous papules on
the edge of lesions . At the center of the
lesion are experiencing the healing area
(central healing), and squama. (Figure 1)
Diagnosis was tinea corporis and tinea
cruris.
Direct microscopic examination of
skin scrapings by using 10% KOH solution
gives an overview long and branched
hyphae (Figure 2). Based on anamnesis,
physical examination, and examination of
skin scrapings with KOH 10%, patient
was diagnosed tinea corporis and tinea
cruris.
Culture examination conducted
with specimens of skin scrapings on media
Saboroud's Dextrose Agar (SDA). Macroscopically visible presence of white to
creamy-colored colonies with a pile of
cotton surfaces such as fine and coarse
granular. (Figure 3 a,b,c,d) On microscopic examination by using Lactophenol
Cotton Blue (LCB) of culture appears
microconidia are clustered, rarely macroconidia shaped like a cigar, sometimes
there is a spiral hyphae. (Figure 4 a,b)
Description of macroscopic and microscopic colonies according to the dermatophyte species Trichophyton mentagrophytes granular type. Final diagnosis was
tinea corporis and tinea capitis caused by
Trichophyton mentagro-phytes granular
type.
Management therapy oral ketoconazole 200 mg per day and topical
miconazole 2% cream applied twice a day.
On day 10 therapy ,
clinical pictures
showed hypopigmentation and hyperpigmentation macules and no scales.
Topical therapy with miconazole 2% be
continued. Re-examination of KOH 10%,
long and branched hyphae not found
.(Figure 5 a,b,c,d).
DISCUSSION
Diagnosis of tinea corporis and
corporis caused by Trichophyton mentagrophytes granular type was established
based on the patient history, physical
examination and
direct microscopic
examination with 10% KOH preparations
using skin scrapings followed specimens
culture examination to determine the
cause of dermatophytosis species.
In the history of a male patient 54
years with complaints of itching on the
chest, back, buttocks and above the pubic
experienced since 1 year ago, white
scales, often recurrent. Itching is felt
especially when sweating and patients
admitted often wore jacket. In accordance
with the literature that tinea corporis and
tinea cruris generally provide complaint
and intensified itching when sweating.
High humidity, excessive perspiration and
clothing that covered a predisposing factor
for the emergence of dermatophyte
infection.(5, 8, 14) Patients often have a
history of taking prednisone for asthma
hospital since the age of 20 years and
often recurred. Immunosuppression drugs
may increase the risk of dermatophyte
(15)
infection.
In one study by Woodfolk
indicates that there is a very strong
relationship
between
asthma
with
dermatophyte infections especially those
caused by the genus Trichophyton. This
study showed that Trichophyton infections
may trigger the development of asthma
and other allergic diseases or otherwise
through the mechanism of immediate
hypersensitivity and delayed hypersen-
Arif Risdianto
tinea corporis and tinea cruris caused by trichophyton mentagrophytes type granular in asthma bronchiale
patient
(24)
IJDV
2.
to
2005.
8.
9.
Adiguna
MS.
Epidemiologi
dermatomikosis
di
Indonesia.
In:
Budimulja U, Kuswadji, Bramono K,
Menaldi SL, editors. Dermatomikosis
superfisial. Jakarta: Balai Penerbit FKUI;
2004. p. 1-6.
3.
4.
5.
6.
7.
Arif Risdianto
tinea corporis and tinea cruris caused by trichophyton mentagrophytes type granular in asthma bronchiale
patient
29. Erbagci
Z.
Topical
Therapy
for
Dermatophytoses Should Corticosteroids
be
Included?
Am
J
Clin
Dermatol2004;5(6):375-84.