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Both, psoriasis and atopic dermatitis are multifactorial diseases with an unknown pathogenesis. To elucidate the influence of fungal infections in the onset or recurrence of those inflammatory skin disease we determined the frequencies of Candida and dermatophyte infections of the skin and orointestinal tract concomitantly seen in patients with psoriasis or atopic dermatitis. We analyzed the files of more than 40,000 in-patients of the Department of Dermatology, Kiel. Sex- and age-adjusted relative risk were calculated. The results demonstrate that patients with psoriasis (N = 3006) presented with a decreased rate of tinea. This was significant for tinea corporis (RR = 0.13, p < 0.01). Candida infections of the skin were seen more often in psoriasis patients compared to controls. Differentiating between Type I (early onset) and Type II (late onset) psoriasis only Type I psoriasis patients presented with decreased dermatophyte infections and increased Candida colonization of the intestinum. However, patients with Type II psoriasis demonstrated an increased rate of candidosis cutis and candidosis oris as compared to controls. Patients with atopic dermatitis (N = 1808) displayed a decreased overall incidence of tinea and Candida infections. Furthermore, in patients with atopic dermatitis a Candida colonization of the orointestinal tract was found elevated (RR = 1.51, p < 0.01), whereas tinea corporis (RR = 0.24, p < 0.01) and candidosis cutis (RR = 0.30, p < 0.001) was found decreased compared to controls. Our results show that the influence of fungal infections on the two skin diseases investigated is not as strong as often considered. The increased relative risk in patients with atopic dermatitis to present with Candida colonization in the digestive tract or vice versa may contribute to the pathogenesis of atopic dermatitis.

The case report presented herein documents the unusual simulaneous occurrence of psoriasis and tinea corporis in a patient and reviews the diagnostic and therapeutic problems that arose during the treatment of these two morphologically similar papulosquamous diseases. The report emphasizes the need for careful re-evaluation of patients who have atypical response to therapy.

Thirty-four psoriatic patients (23 males, 11 females) were found to have skin manifestations of dermatophyte infection. Tinea pedis was observed in 20 cases, tinea cruris in 6 and tinea manuum in 2. T. rubrum was the causative agent in all of these with the exception of 2 cases caused by E. floccosum. Lesions of tinea corporis were found intermingled with psoriatic plaques in various areas of the body skin in 6 patients (4 males, 2 females); T. rubrum was isolated from 5 of these and M. canis from one. Twenty-one of these psoriatic patients also had lesions caused by C. albicans in the toe-webs and interdigital aspects of the fingers, the latter being associated with paronychia in 9 cases. These findings indicate that we should remain aware of the possibility of fungus manifestations in patients with psoriasis, which would not appear to be an exceptional occurrence.

One hundred and seven psoriatics with palmoplantar involvement were clinically examined. They were selected from 921 patients filed in 1976 with the diagnosis psoriasis. Fifty per cent of the patients with palmoplantar psoriasis had flexural changes. The frequency of palmar involvement in patients with inverse psoriasis compared to patients with psoriasis vulgaris was increased 5.3 times. Pustulosis palmoplantaris (PPP) in addition to psoriasis was diagnosed in 18 patients (17%). A dermatophyte infection was observed in 1 of 48 patients examined for tinea infection. Positive patch tests were obtained in 8 of 47 patients, 7 of whom had more than one test reaction. The result gives no evidence of tinea infection and contact allergy as important factors in maintaining palmoplantar psoriasis.

In a 29-year-old woman suffering from hereditary palmoplantar keratoderma of the Unna Thost variety, psoriasis appeared at an age of 28 years. The keratoderma on the soles was complicated with a dermatophyte infection, which made the differential diagnosis towards psoriasis difficult. Histopathologic examination of punch biopsy from the soles showed no conclusive signs of psoriasis. An increased thickness of the horny layer, which in PAS staining showed fungus hyphae, was found.

Two dermatophytic agents, Trichophyton rubrum and Trichophyton mentagrophytes were used in the experimental inoculation of psoriatic lesions in 27 volunteer patients (13 males and 14 females with an age range from 17 to 72 yr). T. rubrum was inoculated in 14 patients and T. mentagrophytes (varietas granulare) in 13. For purposes of control in each patient the same agent was also inoculated on healthy skin. Results were noted once a week for a period of 1 mo. A positive response was found in 12 of the 14 patients inoculated with T. rubrum but only in 4 of the 13 inoculated with T. mentagrophytes. Healthy skin was found to have a positive response in only 5 cases, in 4 with T. rubrum, and in 1 with T. mentagrophytes. These results confirm the possibility of invasion of psoriatic lesions by dermatophytes and suggest that the coexistance of psoriasis and dermatophytic infection may be not always purely coincidental. The importance of the awareness of the presence of mycotic lesions and their possible spread with the application of steroid ointments under occlusive dressings in a psoriatic patient is stressed.