Grzybica skóry gładkiej leczona jako alergia kontaktowa

Publication date: Available online 8 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Monika Sikorska, Roman Nowicki
Fungal skin infections are caused mainly by dermatophytes of the genus Trichophyton, Microsporum and Epidermophyton. Proper diagnosis based on clinical picture and mycological examination makes it possible to implement effective treatment – local, general or combination.Mycobacterial mycosis mostly develops on the skin of the scalp in the form of single or multiple lesions without inflammation. Zoophilic dermatophyte Microsporum canis is the most common causative pathogen, anthropophilic species such as Microsporum audouinii and Microsporum ferrugineum are observed occasionally. In case of zoonitic mycosis, a characteristic inflammation is formed on the periphery. Outside the scalp, skin of the face, neck, shoulders and the trunk can also be affected.Mycosis of smooth skin manifests in the form of oval or round erythematous patches or plaques with sharply defined borders, which spread circumferentially. The periphery of the lesion is inflamed with scaling and pustules, and centrally located resolution is observed. Pruritus in majority of the cases is a chief complaint. In most of the cases, a single lesion is observed, but over time, lesions tend to multiply and fuse together. Differential diagnosis of mycosis of the smooth skin includes seborrheic dermatitis, Gilbert's pink dandruff, mycosis fungoides, psoriasis and nummular dermatitis.The basis of treatment for microsporiasis is the use of topical preparations with antifungal agents. Local treatment is sufficient in most of the cases. General treatment (terbinafine, itraconazole, fluconazole or chleeprazole) is recommended if there is no improvement after topical treatment or in advanced disease stages.This article presents the case of a woman whose single facial fungal skin lesion was misdiagnosed as allergic contact dermatitis. Topical treatment with moderate-potent corticosteroids was used to achieve initial clinical improvement but discontinuation of therapy led to evolution of the lesion, which partially lost its original ring-shaped nature. The final diagnosis was based on mycological examination, and local and general antifungal treatment led to permanent cure.Not typical mycotic skin disease altered by immunosuppressive treatment is termed tinea incognito. Carelessly prescribing and using corticosteroids for infectious skin lesions results in complications as well as postponement of proper diagnosis and initiation of the treatment.



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