Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Department of Dermatology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Cutis. 2020 Jun;105(6):314-316.
An unusual case of a 37-year-old woman with bullous tinea manuum caused by an infection with Trichophyton mentagrophytes is described. The patient presented with a pruritic erythematous vesicular rash on the right palm and interdigital web spaces between the first and second digits. The preliminary diagnosis was acute contact dermatitis, which was treated with oral and topical corticosteroids. The rash failed to respond to treatment, resulting in tinea incognito. At 2-week follow-up, a potassium hydroxide (KOH) preparation performed in clinic was positive for T mentagrophytes. The suspected source of infection was a domestic 4-toed, white-bellied African pygmy hedgehog (Atelerix albiventris). There was remarkable improvement of the lesion after 2 weeks with appropriate topical and systemic antifungal agents. This case illustrates that popular exotic pets such as the hedgehog can increase the risk for zoophilic dermatophytic infection, which can present as bullous lesions with little or no scale and can be confused with acute contact dermatitis. It is important for the clinician to recognize this presentation and provide close follow-up for lesions not responding to treatment.
本文描述了一例罕见的 37 岁女性手部水疱性癣菌病，由须癣毛癣菌感染引起。患者右手掌和第一、二指指间出现瘙痒性红斑水疱性皮疹。初步诊断为急性接触性皮炎，给予口服和外用皮质类固醇治疗。皮疹治疗无效，导致癣菌病不典型。2 周后复诊时，临床进行的氢氧化钾（KOH）制剂检查显示须癣毛癣菌阳性。感染的可疑来源是一只家养的四趾、白肚皮非洲小刺猬（Atelerix albiventris）。适当的局部和系统抗真菌药物治疗 2 周后，皮损明显改善。本例说明，像刺猬这样受欢迎的异宠可能会增加亲动物性皮肤癣菌感染的风险，这种感染可能表现为水疱性病变，几乎没有鳞屑，容易与急性接触性皮炎混淆。临床医生识别这种表现并对治疗无效的皮损进行密切随访非常重要。
