[Dermatophytic disease: exuberant hyperkeratosis with cutaneous horns]

Area of Science:

• Medical Mycology
• Dermatology
• Clinical Case Study

Background:

• Dermatophytic disease is a chronic fungal infection affecting skin and viscera, caused by dermatophytes breaching the skin barrier.
• This condition is notably prevalent in North Africa, with a potential link to autosomal recessive inheritance and compromised cellular immunity.

Observation:

• A 29-year-old Algerian male presented with a two-year history of chronic skin disease, including warts, alopecia, and significant giant cutaneous horns on his feet.
• Laboratory results revealed eosinophilia, inflammatory syndrome, and positive tuberculin reaction, with Trichophyton violaceum identified in all samples.
• Histopathology showed acanthosis, hyperkeratosis, and fungal elements within skin structures, alongside abscesses and granulomas.

Findings:

• The patient exhibited polymorphous lesions and giant cutaneous horns, a previously unreported presentation of dermatophytic disease.
• Diagnosis was confirmed by mycological and histological examinations, identifying Trichophyton violaceum as the causative agent.
• Treatment with oral griseofulvin and topical ketoconazole resulted in marked clinical improvement.

Implications:

• This case highlights a potential new variant of dermatophytic disease characterized by giant cutaneous horns.
• The findings suggest a possible genetic predisposition, possibly related to immune deficiency, contributing to the severity and presentation of the disease.
• Further research into the pathogenesis of severe dermatophytosis is warranted to establish definitive understanding and treatment strategies.