Boudghène-Stambouli O, Mérad-Boudia A
Service de Dermato-Vénérologie, Centre Hospitalo-Universitaire de Tlemcen, Algérie.
Ann Dermatol Venereol. 1998 Oct;125(10):705-7.
Dermatophytic disease is a chronic dermatophytosis involving the skin and viscera and caused by benign dermatophytes which cross the skin barrier. We present a case presenting previously unreported giant cutaneous horns.
A male Algerian patient aged 29 years consulted for chronic skin disease which had progressed for 2 years. Manifestations included warts, papulonodules, eczematiform lesions, lichenifications, alopecia, onyxis, multiple node enlargement and giant cutaneous horns on the plantar aspect of the feet making walking difficult. The patient's kinhood included 10 members and the patient's parents were first cousins; no other family member had a similar disease state. Laboratory findings included eosinophilia (11%, 550 cells/mm3), an inflammatory syndrome, and normal phosphorus and calcium levels despite demineralization of the hands and feet. The tuberculin interdermal reaction was positive but the trichophytine interdermal reaction was negative. Trichophyton violaceum was found in all mycological samples from skin and nails. The histology examination of skin biopsies revealed acanthosis, considerable hyperkeratosis, and myceleal filaments invading the horny layer, the sweat glands and hair follicles. Abscesses and granulomas were also seen in the superficial dermis. Oral griseofulvin 1 g per day and topical applications with ketoconazole gave clear improvement.
Dermatophytic disease is a chronic dermatophytosis observed mainly in North Africa. The locally high rate of consanguinous marriages would suggest autosomal recessive inheritance of a genetic anomaly possibly associated with deficient cellular immunity. The lesions are polymorphous and develop progressively, probably due to diminished cellular immunity. This case with giant cutaneous horns would be a new variant. Antifungals can provide definitive cure. The pathogenesis of this severe dermatophytosis remains to be established.
皮肤癣菌病是一种由良性皮肤癣菌穿过皮肤屏障引起的累及皮肤和内脏的慢性皮肤癣菌病。我们报告一例出现先前未报道的巨大皮角的病例。
一名29岁的阿尔及利亚男性患者因慢性皮肤病前来就诊，该病已进展2年。表现包括疣、丘疹结节、湿疹样病变、苔藓化、脱发、甲癣、多处淋巴结肿大以及足底巨大皮角，导致行走困难。患者家族中有10名成员，其父母为近亲结婚；没有其他家庭成员有类似疾病状态。实验室检查结果包括嗜酸性粒细胞增多（11%，550个细胞/mm³）、炎症综合征，尽管手足有脱矿，但磷和钙水平正常。结核菌素皮内反应呈阳性，但毛癣菌素皮内反应呈阴性。在所有皮肤和指甲的真菌学样本中均发现紫色毛癣菌。皮肤活检的组织学检查显示棘层肥厚、明显的角化过度以及菌丝侵入角质层、汗腺和毛囊。在浅表真皮中也可见脓肿和肉芽肿。每天口服1克灰黄霉素并外用酮康唑后病情明显改善。
皮肤癣菌病是一种主要在北非观察到的慢性皮肤癣菌病。当地较高的近亲结婚率提示可能与细胞免疫缺陷相关的遗传异常的常染色体隐性遗传。病变多形且逐渐发展，可能是由于细胞免疫减弱。这个伴有巨大皮角的病例将是一个新的变体。抗真菌药物可提供根治。这种严重皮肤癣菌病的发病机制仍有待确定。
