Indian Journal of Paediatric Dermatology

LETTERS TO EDITOR
Year
: 2016  |  Volume : 17  |  Issue : 2  |  Page : 153--154

Tinea corporis in an 8-day-old infant


Alia A Rizvi, Amrinder J Kanwar 
 Department of Dermatology, School of Medical Science and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India

Correspondence Address:
Alia A Rizvi
D-189, Sector-41, Noida - 201 301, Uttar Pradesh
India




How to cite this article:
Rizvi AA, Kanwar AJ. Tinea corporis in an 8-day-old infant.Indian J Paediatr Dermatol 2016;17:153-154


How to cite this URL:
Rizvi AA, Kanwar AJ. Tinea corporis in an 8-day-old infant. Indian J Paediatr Dermatol [serial online] 2016 [cited 2020 Jul 6 ];17:153-154
Available from: http://www.ijpd.in/text.asp?2016/17/2/153/175652


Full Text

Sir,

Fungal infections of skin in the full-term new born are uncommon except for candidal vesiculopustular diaper rash and thrush.[1]

We herein, report an 8 days old full-term neonate who presented with two well-defined, round 5 cm × 5 cm, asymptomatic depigmented annular plaques with a raised, erythematous scaly margin over the back, since 6 days [Figure 1]. According to the mother, a single lesion was noted on the 2nd day of birth. Within the next 2 days, another similar lesion appeared and both increased rapidly in size. The neonate was discharged from the hospital after 4 days as the mother was suffering from pyrexia. It was a full-term vaginal delivery. The neonate was prescribed some topical applications (nature unknown) with no relief. The parents were extremely concerned about the loss of pigment. The depigmentation was so striking that a diagnosis of vitiligo with an inflammatory border was considered. Other diagnoses which crossed the mind were tinea corporis, dermal dendritic hamartoma, and porokeratosis. A potassium hydroxide (KOH) skin scraping from the edge of the lesions did not reveal any fungal elements. The neonate was prescribed tacrolimus 0.03% ointment once a day. A follow-up visit at 2 weeks revealed remarkable repigmentation at the center of the lesions [Figure 2]. However, these had increased in size. The diagnosis of dermatophytic infection was reconsidered and confirmed on KOH microscopy of skin scrapings from the active edge of all lesions. It revealed the presence of numerous long, septate, branched hyphae typical of dermatophytes. Culture on Sabouraud dextrose agar media grew Trichophyton rubrum. The neonate was prescribed topical eberconazole with complete resolution of the lesions in 2 weeks. Examination of parents and close relatives of neonate did not reveal any dermatophytic infection.{Figure 1}{Figure 2}

Superficial dermatophytosis caused by Microsporum, Epidermophyton, and Trichophyton is extremely uncommon in neonates and is usually associated with an index case in family members or pet animals.[2]

This could possibly be due to high sebum secretion rates in neonates. Sebum has been shown to have antibacterial and antifungal properties.[3]

The present case is interesting in several aspects. The lesions appeared on the 2nd day of birth. This has been reported twice earlier.[4],[5] However, in the present case, overt dermatophytic infection was not present in parents and close relatives. It is possible that the neonate acquired the infection from the caretakers in the hospital. The inability to demonstrate fungal elements initially was possibly due to local applications of some medications which could have suppressed the clinical manifestations. Singh, who produced experimental T. rubrum infection of intact human skin by putting a suspension of T. rubrum culture under occlusion, observed that 5 days were enough to produce the lesion and under optimal conditions the incubation period may be less.[6] Sloper reported the incubation period to be 3 days for the organism.[7] In our patient, it was less as the lesions were noted on the 3nd day of birth. The other interesting feature in our case is the marked depigmentation. Dermatophytes including T. mentagrophytes, T. rubrum, Epidermophyton floccosum, and Microsporum gypseum can synthesize melanin or melanin-like pigments.[8] In our case, however, there was depigmentation. It is possible that topical tacrolimus resulted in the local extension of the dermatophytic infection as it has the potential to include worsening of dermatophytosis in a manner similar to a topical corticosteroid. Our case thus becomes the third to be reported in literature in which the dermatophytic infection occurred on the 2nd day of birth.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

References

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2Mittal RR, Shivali S. Tinea faciei and tinea capitis in a 15-day-old infant. Indian J Dermatol Venereol Leprol 1996;62:41-2.
3Atherton DJ. The neonate. In: Champion RH, Burton J, Ebling FJ, editors. Textbook of Dermatology. 5th ed. Oxford: Blackwell Scientific Publications; 1992. p. 383-4.
4Kanwar AJ, Sharma R, Das Mehta S, Kaur S. Tinea faciei in a 2-day-old infant. Pediatr Dermatol 1990;7:82.
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6Singh G. Experimental Trichophyton infection of intact human skin. Br J Dermatol 1973;89:595-9.
7Sloper JC. A study of experimental human infection due to Trichophyton rubrum,Trichophyton mentagrophytes and Epidermophyton floccosum with particular reference to the self limitation of the resultant lesions. J Invest Dermatol 1995;25:21-8.
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