纹身部位的癣
Tinea on a Tattoo.
作者信息
Oanţă Alexandru, Irimie Marius
机构信息
Marius Irimie, MD, 40, Zizinului Street, Bl. 31, Sc. C, Ap. 2, 500414, Brasov, Romania;
出版信息
Acta Dermatovenerol Croat. 2016 Aug;24(3):223-4.
In the last twenty years, the prevalence of individuals with tattoos in the general population has increased in Europe (1) as well as in Australia (2) and the United States of America (3). A series of complications such as acute inflammatory reactions, allergic contact dermatitis (4,5), photoinduced, lichenoid, and granulomatous reactions (6, 7), pseudolymphoma (8), pseudoepitheliomatous hyperplasia (9), skin infections (6), and skin cancers (10) may occur on tattoos. Infectious complications on tattoos include bacterial infections (pyoderma, leprosy, syphilis, cutaneous tuberculosis, mycobacteriosis) (11-14), viral infections (molluscum contagiosum, warts, herpes simplex, hepatitis B and C) (15-17), and fungal infections (sporotrichosis, dermatophytosis) (18,19). We present the case of a 29-year-old immunocompetent female patient who was consulted for the development of an erythematous-squamous placard that appeared on a tattoo about 18 days after tattooing. Dermatological examination revealed a circular, erythematous, scaly plaque, with centrifugal growth and central resolution, presenting an active, raised, erythematous, vesiculopustular edge, giving the appearance of tinea corporis. The lesion's starting point was on the tattoo in two colors located on the middle third of the left calf and subsequently evolved to beyond the surface of tattoo (Figure 1). No other skin, scalp, or nail lesions were observed. Mycological examination of the material obtained by scraping of the scales and the vesicles from the edges and the surface of the plaque revealed numerous hyphae on direct microscopy examination, and white, flat colonies with a cottony surface and radial grooves developed in Sabouraud dextrose agar culture (Figure 2). Spindle-shaped, thick-walled macroconidia and a few pyriform microconidia were observed on microscopic examinations of the colonies. Based on macroscopic and microscopic characteristics, Microsporum canis was identified. Gram stain and bacterial culture results were negative. Patient history revealed the presence of a pet dog that was diagnosed with mycosis, the etiologic agent being M. canis. After 21 days of treatment with oral terbinafine (250 mg/day) and topical application of terbinafine 1% cream once a day, the lesion disappeared and mycological examination (direct microscopy and culture) was negative. In the case of tattoos, cutaneous inoculation of a dermatophyte may occur after 1-3 weeks of tattooing, corresponding to the healing phase of the tattoo application. Dermatophyte inoculation can be done by direct contact with an infected person or animal or, exceptionally, by telluric contamination. Despite the increasing number of tattooed people, there are only a few published cases of dermatophytosis arising on tattoos (19,20). Ammirati reported dermatophyte infection caused by Trichophyton tonsurans that occurred two weeks after tattooing, clinically presenting as concentric annular lesions with active vesiculopustular edges which progressively included the entire tattoo (19). Similarly, in our case the infection with M. canis occurred during the healing phase, the dermatophyte lesion occurring after 18 days from tattoo application by direct contact with the dog parasitized with M. canis. In conclusion, dermatophyte infection of tattoos remains possible, although rare.
在过去二十年中,欧洲(1)、澳大利亚(2)以及美利坚合众国(3)普通人群中纹身者的比例均有所上升。纹身可能会引发一系列并发症,如急性炎症反应、过敏性接触性皮炎(4,5)、光诱导反应、苔藓样反应和肉芽肿反应(6,7)、假性淋巴瘤(8)、假上皮瘤样增生(9)、皮肤感染(6)以及皮肤癌(10)。纹身的感染性并发症包括细菌感染(脓疱病、麻风、梅毒、皮肤结核、分枝杆菌病)(11 - 14)、病毒感染(传染性软疣、疣、单纯疱疹、乙型和丙型肝炎)(15 - 17)以及真菌感染(孢子丝菌病、皮肤癣菌病)(18,19)。我们报告一例29岁免疫功能正常的女性患者,她因纹身约18天后出现的红斑鳞屑性斑片前来就诊。皮肤科检查发现一个圆形、红斑、鳞屑性斑块,呈离心性生长且中央消退,边缘活跃、隆起、红斑、有脓疱水疱,外观类似体癣。病变起始于左小腿中1/3处的双色纹身处,随后发展至超出纹身表面(图1)。未观察到其他皮肤、头皮或指甲病变。对从斑块边缘和表面刮取的鳞屑及水疱材料进行真菌学检查,直接显微镜检查发现大量菌丝,在沙氏葡萄糖琼脂培养基培养中形成白色、扁平、表面有棉絮状且有放射状沟纹的菌落(图2)。在菌落显微镜检查中观察到纺锤形、厚壁的大分生孢子和一些梨形小分生孢子。根据宏观和微观特征,鉴定为犬小孢子菌。革兰氏染色和细菌培养结果均为阴性。患者病史显示其养有一只被诊断为真菌病的宠物狗,病原体为犬小孢子菌。口服特比萘芬(250毫克/天)并每天外用1%特比萘芬乳膏治疗21天后,病变消失,真菌学检查(直接显微镜检查和培养)结果为阴性。对于纹身而言,皮肤癣菌接种可能在纹身1 - 3周后发生,这与纹身操作的愈合阶段相对应。皮肤癣菌接种可通过直接接触感染者或感染动物发生,或极少见地通过土壤污染发生。尽管纹身人群数量不断增加,但仅有少数关于纹身上发生皮肤癣菌病的病例报道(19,20)。阿米拉蒂报告了由断发毛癣菌引起的皮肤癣菌感染,发生在纹身两周后,临床上表现为同心环状病变,边缘有活跃的脓疱水疱,逐渐累及整个纹身(19)。同样,在我们的病例中,犬小孢子菌感染发生在愈合阶段,皮肤癣菌病变在纹身应用18天后通过直接接触感染犬小孢子菌的狗而出现。总之,纹身的皮肤癣菌感染虽然罕见,但仍有可能发生。