Diffuse trichophytia of the glabrous skin with persistent scalp lesions in adults infected with Trichophyton violaceum

Abstract

The author describes with detail, the case of a woman 21 years old, presenting a diffuse erythemato-sguamous dermatose of the smooth skin, besides lesions on the scalp, alI the nails of the hands and almost all the nails of the feet. The first alterations of the scalp, smooth skin and phanera, are more than 17 years old. During all this time the disease spread itseIf slowIy but surely. The lesions of the smooth skin (figs. 3, 4, 5, 6) are spread almost over the whole body, with exception of a few zones as for instance, the anterior part of the trunk. In a general way, they are small irregular or rounded surfaces, some even figurate sections of circle intertwined among themselves. They are of a reddish hue; slightly elevated on account of being covered by white-yellowish, not very adhering scales. On the scalp (fig. 1), on its very top, there is a large area markedIy denuded. The few remaining hairs have a normal length and aspect and are chiefly united in small faggots irregularly distributed over the depilated surface. This, resulting from the confluence of inumerabIe small, depressed, rosy ar lustrous white scars, presents here and there, small black spots, which are nothing else than follicles with a fragment of hair wraped in its center like a riveted nail. The nails (fig. 2) are alterated on their distal 2/3; they are thickened, opaque, grayish white, slightly yellow. Their outer surface is irregular, rough, disfigured by many elevations and suIci, or else depressed in a rough bottomed concavity. The microscopic examination of the scales, smooth skin lesions and fragments of nail, evidences mycelium filaments of irregular thickness septated in small square or oval sections. The intrafollicular fragments of hair, riveted on the follicles like black dots, .are richly parasited. They are invaded from within, by many sporulated filaments, with rounded articles like a rosary. The entire thickness of the hair, inside the cuticle is filled with such filaments. The cultures in media containing maltose and glicose where partic1es of hair and scales were sowed, were all positive. A fungus was obtained and by its characteristic macroscopic aspect and mycological studies of slide culture, was classified as Trichophyton violaceum (fig. 7). Histological preparations from biopsies of scalp lesions evidenced the alterations of the cutaneous tissue near the parasited hairs and the particular disposition of those in the interior af the follicle which characterises the endothrix trichophyton. (fig. 8, 9, 10, 11, 12).

In extensive general considerations, the author refers with statistics from others and his own, to the importance of Tricophyton violaceum as parasite of scab, specially on account of its vast .geographic distribution and its frequency in our country; he describes its more frequent lesions, specially that which is one of  the most characteristic of  T. violaceum, i.e., the remarkable polymorphism of its clinical manifestations. For this reason, it occupies a very ímportant position among the scab producing fungi, chiefly in the genus Trichophyton. The author insits upon the details of the case now presented and which render it an excepcional observation, similar to the cases described by Mguebrow. Among these details he particularly refers to the patient's age, who though an adult, presents ring-Worm lesions on the scalp, which is not the rule; also he points out the existence, on the scalp, of numerous scars determined by lesions which are not of the kerion order, and wich are not as a rule, the reliquat of depilating diseases due to other mycologic species. Finally he notes the abnormal spreading of the smooth skin lesions, which in this case are distributed to almost the whole surface of the body.The author states that among us, such extensive invasions of smooth skin epidermomycosis is not rare, but as a rule are caused by an epidermic infestation through Epidermophyton rubrum. This is our first case in which T.