Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review

Abstract

While typically exhibiting characteristic features, fungal infections can sometimes present in an unusual context, having improbable localization (eyelid, face, or joint); mimicking other skin diseases such as eczema, psoriasis, or mycosis fungoides; and appearing with unexpected color, shape, or distribution. The emergence of such a challenging clinical picture is attributed to the complex interplay of host characteristics (hygiene and aging population), environment (climate change), advances in medical procedures, and agent factors (fungal resistance and species emergence). We aim to provide a better understanding of unusual epidemiological contexts and atypical manifestations of fungal superficial diseases, knowing that there is no pre-established clinical guide for these conditions. Thus, a literature examination was performed to provide a comprehensive analysis on rare and atypical superficial mycosis as well as an update on certain fungal clinical manifestations and their significance. The research and standard data extraction were performed using PubMed, Medline, Scopus, and EMBASE databases, and a total of 222 articles were identified. This review covers published research findings for the past six months.

Keywords: Majocchi; dermatophytes; extensive dermatitis; hypopigmented skin; mycosis fungoides; onychomycosis; tinea corporis; tinea incognito.

Figure 1

(A) Unexpected otomycosis after self-induced trauma in schizophrenic patient. (B) Aspergillus flavus macroscopy after ear swab culture.

Figure 2

(A) Onycholyse associated with exudate and oedema in a patient under Docetaxel chemotherapy. (B) Budding yeast and creamy white colonies of Candida guillermondii on SDA.

Figure 3

(A) Microsporum canis tinea corporis in female with HIV at day 7 after hospitalization for cryptococcus neuromeningitis. (B) macroscopic aspect of skin scraping culture.

Figure 4

Tinea capitis due to Microsorum canis in a patient with underlying psoriasis vulgaris.

Figure 5

(A) Acne-like lesions on the back of a patient with Behcet’s disease. (B) Trichophyton rubrum culture after skin scraping.

Figure 6

(A) Onychogryphosis in a 75-year-old patient. (B) Aspergillus niger microscopy after culture.

Figure 7

(A) Unexpected tinea faciei in acromegaly patient under corticosteroids. (B) Trichophyton mentagrophytes culture after skin scraping.

Figure 8

(A) Candida albicans breast hyperkeratosis and discharge. (B) Creamy white colonies of Candida albicans.

Figure 9

(A) black ungual discoloration in vegetable vendor, (B) Aspergillus niger culture after ungual debris culture.

Figure 10

(A) Microsporum canis tina incognito mimicking tinea imbricata. (B) Microsporum canis culture result.

Figure 11

(A) Tinea versicolor misdiagnosed as Pityriasis alba. (B) microscopic aspect of Malassezia sp.

Figure 12

(A) Granular atypical dermatophytosis lesion before treatment, (B) the healing lesion after Terbinafine treatment.