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Dermatophytes are fungi capable of invading keratinized tissues. Isolation of the fungus with the culture is essential to guide the treatment, because there are more resistant species like Microsporum canis. The chronic use of corticosteroids leads to the deregulation of immunity, promoting atypical manifestations of infections. Topical antifungal therapy is often insufficient, requiring systemic medications. We describe the case of a patient undergoing systemic corticosteroid therapy with a large figurate lesion who presented complete response to exclusively topical treatment.

Red face syndrome is characterized by an erythematous dermatitis that is produced by different entities. These include rosacea, seborrheic dermatitis, contact dermatitis, atopic dermatitis, psoriasis, cutaneous lupus, photodermatosis, post-topical steroid dermatosis, demodicosis, borderline borderline (BB) leprosy, mastocytosis, carcinoid, postneoplasia flushing, cutaneous lymphoma, tineas, ulerythema ophryogenes, and psychosomatic flushing. Red face is a relatively common dermatologic manifestation. Our goal is to review tinea corporis and other fungi that affect this region causing facial erythema and its therapeutic management., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Dermatophytes cause the majority of superficial mycoses in humans and animals. However, little is known about the pathogenicity of this specialized group of filamentous fungi, for which molecular research has been limited thus far. During experimental infection of guinea pigs by the human pathogenic dermatophyte Arthroderma benhamiae, we recently detected the activation of the fungal gene encoding malate synthase AcuE, a key enzyme of the glyoxylate cycle. By the establishment of the first genetic system for A. benhamiae, specific ΔacuE mutants were constructed in a wild-type strain and, in addition, in a derivative in which we inactivated the nonhomologous end-joining pathway by deletion of the A. benhamiae KU70 gene. The absence of AbenKU70 resulted in an increased frequency of the targeted insertion of linear DNA by homologous recombination, without notably altering the monitored in vitro growth abilities of the fungus or its virulence in a guinea pig infection model. Phenotypic analyses of ΔacuE mutants and complemented strains depicted that malate synthase is required for the growth of A. benhamiae on lipids, major constituents of the skin. However, mutant analysis did not reveal a pathogenic role of the A. benhamiae enzyme in guinea pig dermatophytosis or during epidermal invasion of the fungus in an in vitro model of reconstituted human epidermis. The presented efficient system for targeted genetic manipulation in A. benhamiae, paired with the analyzed infection models, will advance the functional characterization of putative virulence determinants in medically important dermatophytes.

A 12-year-old girl had been presenting a woody infiltration and erythema in the frontal region and on the entire left half of the face, leading to deformity of the nose and buccal fissure, and adenomegaly in a posterior cervical chain, for the last 18 months. Sinusitis was diagnosed and treated with antibiotics, and submitted to ethmoid sinusotomy, with no improvement. Several laboratory tests were made to find the correct diagnosis. An intradermal test for delayed hypersensitivity showed a positive reaction (5 mm) with necrosis for metabolic antigens for Conidiobolus. An oral mucosa biopsy showed a dense lymphohistiocytic infiltrate and focal points of necrosis. Gomori staining for fungi revealed countless wide, nonseptate hyphae. Amphotericin B was prescribed during 35 days, with no improvement. Terbinafine given orally was started in association with amphotericin B. Reduction of the lesions was observed 2 months later. No side effects were seen during 4 months of treatment.

A 42-year-old woman presented with a well-defined pruritic erythematous scaly plaque on the sole of each foot. The lesions, first noted about 15 years previously, were located in the medial plantar region and extended laterally. Mycological study revealed infection by Scopulariopsis brevicaulis. Treatment with oral itraconazole led to temporary improvement, but the symptoms returned after treatment had been stopped (presumably due to re-infection from ungual foci). Similar results were subsequently obtained with oral terbinafine. S. brevicaulis is an aetiologic agent of onychomycosis, panophthalmia following a penetrating eye injury and generalized infections in immunocompromised patients, but it is not considered as habitual fungal pathogen of the skin. Cutaneous lesions caused by S. brevicaulis are very rare. Our case was resistant to terbinafine and itracomazole.

A 27-year-old woman with acute lymphocytic leukemia developed red painful skin lesions, asymmetrically distributed over the face and extremities. They gradually increased in size and number, and in the center of each lesion blisters appeared followed by central necrosis with surrounding erythema. In several lesions the central necrosis was covered with a white powder shown to be fungal mycelium. Cultures from skin lesions and blood showed a Fusarium species. The skin lesions are helpful in recognizing this deep fungal infection in an immunocompromised host.