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Trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients
K J Smith1, M Welsh, H Skelton
1Department of Dermatology and Pathology, University of Alabama, EFH Suite 414, 1720 University BLVD, Birmingham, AL 35294-0009, USA.
Abstract:
Trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. Amphotericin B did not appear effective in treating these dermatophyte infections.
Insights
Severe Trichophyton rubrum infections can invade deep skin layers in immunocompromised patients with acute leukemia. This risk increases with pancytopenia and topical corticosteroid use, though systemic spread remains rare.
Area of Science:
- Dermatology
- Mycology
- Hematology
Background:
- Trichophyton rubrum typically causes superficial, keratinophilic infections.
- Deep dermal invasion by T. rubrum is rare, especially in immunocompetent individuals.
Observation:
- Three patients with acute leukemia developed invasive T. rubrum cutaneous disease.
- These patients had pre-existing skin conditions treated with potent topical corticosteroids.
- Aggressive chemotherapy led to pancytopenia and immunosuppression.
Findings:
- Deep dermal invasion of T. rubrum occurred directly from the epidermis.
- No evidence of systemic spread was observed in these cases.
- Amphotericin B was ineffective in treating these invasive infections.
Implications:
- Systemic pancytopenia combined with local immunosuppression may predispose to deep dermal invasion by dermatophytes.
- The risk of systemic spread of T. rubrum remains low even in severely immunocompromised patients.
- Further research is needed to understand and manage invasive dermatophytosis in immunocompromised hosts.