Superficial dermatophytosis in early neonatal period: Two uncommon cases
Year: 2023
Type: article
Abstract: Dear Editor, Fungal infections other than those caused by Candida species, like superficial dermatophytosis, are rarely acquired during the early neonatal period (first week of life).[1,2] Infection is acquired by deposition of viable arthrospores or hyphae on the surface of susceptible persons. In neonates and young children, infection is usually acquired from their parents.[3] It is speculated that impaired or immature barrier function of skin of neonates, especially in preterm infants, plays an important role in acquiring dermatophyte infections during initial maternal-infant skin-to-skin contact. Furthermore, spread of dermatophytes during this very early period of life can also be assisted by immature microbiome and suboptimal immune responses.[1,4] Here, we are discussing two cases of superficial dermatophytosis in early neonatal period. Case 1: A 15-day-old full-term neonate, delivered vaginally at a tertiary healthcare centre, presented with two discrete annular lesions with fine scaling over its elevated borders over trunk since 10 days [Figure 1a and 1b]. In addition to the trunk lesions, there were multiple arciform to annular lesions with peripheral vesico-pustules and central clearing over fronto-temporo-parietal regions of the scalp for 5–6 days [Figure 1c].Figure 1: (a) Solitary, annular lesion with elevated borders and fine scaling over chest. (b) Solitary, annular lesion with elevated borders and fine scaling over back. (c) Multiple arciform to annular lesions with peripheral vesico-pustules and central clearing over fronto-temporo-parietal regions of the scalp for 5–6 daysCase 2: A 19-day-old full-term neonate, delivered at a peripheral health center, presented with a solitary, annular patch with an elevated border over back since 14 days [Figure 2]. The lesion also had peripheral scaling and a few grouped, erythematous papules in the center.Figure 2: Solitary, annular patch with fine scaling and elevated border over backIn both the cases, there was no hair loss or scarring associated with the lesions. The source of infection could not be traced, as none of the parents showed any evidence of dermatophytic infections. Spread of infection from other family members and hospital staff could not be ruled out as they couldn’t be examined for active or carrier status of dermatophytosis. There was no history of pets in both the families. Our differential diagnosis included superficial dermatophytoses, annular erythema of infancy, neonatal lupus, secondary syphilis, and atopic dermatitis. Given the strong suspicion for dermatophytosis, owing to clinico-morphological characteristics of the lesions, skin scrapings for KOH examination and fungal culture were taken from each presenting lesion in the both patients. KOH mount revealed the presence of numerous hyaline, long, septate, branched, hyphae, and culture on Sabouraud’s dextrose agar grew Trichophyton rubrum in both the cases. Gram’s stain from the vesico-pustules was negative. KOH examination of the hair root was not done. However, it can be helpful in such cases to differentiate between tinea glabrata and tinea capitis. The babies were treated with 1% clotrimazole cream with complete resolution of the lesions in 8 days and 10 days, respectively. Post-treatment KOH was negative for fungal hyphae in the both cases. Superficial dermatophytosis is very common among adults. However, it is infrequently seen in the pediatric population, especially in neonatal period. It is caused by Microsporum, Epidermophyton, and Trichophyton genera of dermatophytes. Rarity among neonates could possibly be due to high sebum secretion rates. Sebum has been shown to have antibacterial and antifungal properties.[2] Among the few cases reported among neonates in the past and in a recent review of the literature of neonatal and early infantile dermatophytoses [Table 1],[5] the most common organism cultured was Trichophyton rubrum.[2,3,5,6–8] Some risk factors that contribute to acquiring dermatophytosis in neonates include an active dermatophytic infection in close contacts, humid environment, epidermal immaturity, and immunosuppression. The immune system of neonates is relatively suppressed compared to that of adults. A genetic immunodeficiency can also be considered in such cases. Immunodeficiencies that predispose infants to fungal infections may include DiGeorge’s syndrome and severe combined immunodeficiency (SCID).[5] However, in our case, birth weight and weight changes during subsequent days were normal. Also, there was no history of extended hospitalization or evidence of any other cutaneous or systemic manifestations, and routine blood investigations were normal, strongly indicating absence of any concealed systemic disease.Table 1: Summary of some cases of neonatal and early infantile dermatophytoses in literature[ 5 ]Appearance of dermatophytic lesions at the early age of fifth day of life is interesting as the incubation period of dermatophytosis is reported to be 1–3 weeks[2] which makes its development in early neonatal period highly unlikely. However, much lesser incubation period have also been noted in couple of experimental studies.[9,10] Topical anti-fungals are commonly used due to a better safety profile in neonates. Topical anti-fungal agents are proposed to work more effectively in infants due to the same risk factor that predisposes them to acquiring the infection i.e; immature barrier function of the skin, leading to a shorter duration of treatment.[2,5] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Institution: Rabindranath Tagore Medical College
Language: English
Topic: Nail Diseases and Treatments
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4367337614