Asnani Divya, Singh Shrishti, Gupta Aayush
Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri-Pune, India.
Case Rep Dermatol. 2024 Nov 19;16(1):254-258. doi: 10.1159/000542483. eCollection 2024 Jan-Dec.
The annular lesions of dermatophytosis can closely resemble the plaques of psoriasis, posing significant diagnostic and treatment challenges. Methotrexate, a common treatment for psoriasis, can exacerbate the former due to its immunosuppressive effects.
A middle-aged man with chronic plaque psoriasis was on tablet methotrexate (7.5 mg once weekly) and topical steroids for 1 year. Despite some improvement, new annular lesions emerged whenever topical steroids were tapered. Frustrated with the lack of disease control, the patient finally visited a tertiary care center, where tinea corporis was diagnosed alongside psoriasis via dermoscopy, mycological tests, and histopathology. Methotrexate and steroids were discontinued, and the patient was started on antifungals. Once the dermatophytosis was brought under control, methotrexate was resumed alongside targeted application of steroid and antifungal creams.
The coexistence of tinea corporis and psoriasis can be challenging to diagnose and treat, necessitating thorough clinical evaluation and mycological testing. Proactive monitoring and timely intervention are crucial to prevent complications and ensure optimal management outcomes in immunosuppressed individuals with dermatophyte infections.
皮肤癣菌病的环状损害可能与银屑病斑块极为相似，给诊断和治疗带来重大挑战。甲氨蝶呤是银屑病的常用治疗药物，因其免疫抑制作用可使前者病情加重。
一名患有慢性斑块状银屑病的中年男性服用甲氨蝶呤片（每周一次，每次7.5毫克）并外用类固醇药物治疗1年。尽管病情有所改善，但每当外用类固醇药物减量时，就会出现新的环状损害。由于对疾病控制不佳感到沮丧，患者最终前往一家三级医疗中心就诊，通过皮肤镜检查、真菌学检测和组织病理学检查，诊断为体癣合并银屑病。停用甲氨蝶呤和类固醇药物，开始给予抗真菌药物治疗。一旦皮肤癣菌病得到控制，恢复使用甲氨蝶呤，并针对性地外用类固醇和抗真菌乳膏。
体癣和银屑病并存的情况诊断和治疗颇具挑战，需要进行全面的临床评估和真菌学检测。对于免疫抑制的皮肤癣菌感染患者，积极监测和及时干预对于预防并发症及确保最佳治疗效果至关重要。
