Description, Causes and Risk Factors:
Alternative Name: Majocchi granulomas.
Tinea profunda is also known as nodular granulomatous perifolliculitis, is an uncommon fungal folliculitis. It has been described as, “certain superficial fungus diseases which sometimes exhibit fungal elements invading the epidermis, pilosebaceous follicles and dermis to mimic deep cutaneous mycotic disorders.”
Tinea profunda is observed among immunocompetent and immunocompromised patients and is caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. Other causes may include T. mentagrophytes and Epidermophyton floccosum. Experts do not know whether these granulomas appear in response to the organism itself, or after the release of follicular contents. It commonly occurs in young women that shave their legs frequently.
The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism.
Tinea profunda has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocompromised patients a subcutaneous nodular type is observed.
Symptoms include patches on any hairy area, such as the scalp, face, forearms, hands, and legs. Tinea profunda may be worsened by shaving legs in an upward direction, which causes the hair follicles to be inoculated with athlete's foot fungus. The lesions may first appear as single or multiple oval patches that evolve into pustules and nodules with or without background redness and scaling.
If the condition is associated with the use of topical steroids, they may be affected by the complications of topical steroid therapy, including atrophied skin and spidery veins, rosacea, or patches of loss of color on the skin that looks like leprosy.
Based on the clinical morphology, the differential diagnosis largely includes other conditions that follow a follicular pattern, such as variations of folliculitis, acne, pseudofolliculitis barbae, eosinophilic pustular folliculitis and acne keloidalis.
Fungal elements can be viewed on H&E (hematoxylin and eosin stain), but PAS (periodic acid-Schiff stain) and GMS (Gomori methenamine silver stain can also be used.Histology alone cannot identify the causative organism, but fungal culture can confirm the suspected fungus.
Tinea profunda usually responds to topical antifungal or drying powders, such as those that contain miconazole, clotrimazole, or similar ingredients. Severe or chronic infection may require further treatment by a doctor. Stronger, prescription topical antifungal medications, such as ketoconazole or sulconazole, may be needed. In some cases, topical corticosteroids may be added to the topical antifungals. Antibiotics may be needed to treat secondary bacterial infections.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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