Unusual Inflammatory Tinea Infections: Majocchi's Granuloma and Deep/Systemic Dermatophytosis

Abstract

Purpose of review: Inflammatory tinea is an uncommon group of dermatophyte entities that predominantly cause fungal infection of the skin and hair. This review intends to present all of the available evidence regarding its epidemiology, etiopathogenesis, clinical features, and diagnostic methods as well as treatments recommended for various inflammatory tinea infections. This article provides a review of Majocchi's granuloma and dermatophytic or Hadida's disease.

Recent findings: The new phylogenetic classification of dermatophytes includes nine genera, and those that affect humans are Trichophyton, Microsporum, Epidermophyton, and Nannizzia. Furthermore, molecular advancements have revealed impaired antifungal immune responses caused by inflammatory tinea, which are detailed in this article.

Summary: The common denominator in these pathologies is the presence of impaired immune responses and, consequently, an impaired inflammatory response by the host. It is necessary to be familiar with these immunological characteristics in order to use the appropriate diagnostic methods and to provide adequate treatment.

Keywords: Hadida; Majocchi’s granuloma; dermatophytic; inflammatory tinea.

Figure 1

Inflammatory tinea: Majocchi’s granuloma. (A) Majocchi granuloma characterized by erythematous nodules on the forearm. (B) Microphotography of a PAS-stained slide shows a vellus hair with adjacent mixed inflammatory infiltrate, epithelium spongiosis, exocytosis of neutrophils, and hyphae surrounding the hair shaft. (C) Closer view of the vellus hair showing septate hyphae within the follicular canal.