David John Chandler

Trichophyton indotineae, an emerging cause of treatment-resistant dermatophytosis in Europe, is frequently resistant to terbinafine. We describe a case of T. indotineae infection in a 3-year-old boy that unusually demonstrated an excellent response to combined oral and topical terbinafine.

Background: Dermatophyte infections, which are among the most prevalent fungal infections globally, affect skin, hair and nails, accounting for significant morbidity. Epidemiological data on dermatophytosis in the UK are limited. One notable study in 2007 provided insights into the causative agents of dermatophyte infections in the UK; however, no extensive regional analysis has been published since. Objectives: The aim of this study was to provide a contemporary understanding of the epidemiology and causative agents of dermatophytosis in South‐East England. Method: This retrospective laboratory database review analysed all samples of skin, hair and nail that underwent mycological examination (microscopy and culture) in a single diagnostic microbiology laboratory in South‐East England over a period of 17 years (2006–2023). Results: Between 2006 and 2023, a total of 34,624 samples were collected, with the majority being nail ( n = 26,362), followed by skin ( n = 8015), hair ( n = 246) and one unknown sample type. Fungal culture yielded positive results in 22.0% ( n = 7601) of samples, with dermatophytes comprising 89.4% ( n = 6794) and non‐dermatophyte moulds 4.8% ( n = 366). Trichophyton species dominated dermatophyte isolates at 99.3% ( n = 6745), followed by Microsporum (0.5%, n = 37) and Epidermophyton (0.2%, n = 12). Onychomycosis of toenails was the most common infection ( n = 2774), predominantly affecting males (median age: 48 years); the cause was Trichophyton rubrum in 80.5% of cases, and infection was confirmed by positive direct microscopy in 80.3%. Tinea pedis ( n = 416), conversely, was more common in females (median age: 50 years). Other dermatophyte infections included tinea corporis ( n = 179), onychomycosis of the fingernails ( n = 99), tinea cruris ( n = 91), tinea capitis ( n = 82), tinea manuum ( n = 56) and tinea faciei ( n = 14). Trichophyton rubrum was the primary causative agent across all body sites except for tinea capitis, where Trichophyton mentagrophytes (30.5%), Trichophyton violaceum (19.5%) and Trichophyton tonsurans (15.9%) prevailed. Non‐anthropophilic species ( n = 165) caused infection across all body sites, but most caused tinea capitis (25.5%) and tinea corporis (20.0%) and affected younger individuals (median age: 29 years). Trichophyton mentagrophytes was the most common non‐anthropophilic dermatophyte. Over the 17 years, the prevalence of Trichophyton interdigitale declined by 20%, while Trichophyton rubrum increased from 78.4% in 2006 to 82.0% in 2023. No cases of Trichophyton indotineae were identified. Conclusion: This study highlights the high prevalence of Trichophyton rubrum as a cause of dermatophyte infections in South‐East England. Non‐anthropophilic infections are rare and demographically distinct, guiding case management and public health strategies.

Background: The range of skin disease associated with advanced HIV infection is well described. Effective antiretroviral therapy has modified the spectrum of skin disease associated with HIV infection. Objectives: To characterize the profile of skin conditions occurring in a UK population of people living with HIV (PLHIV) during admission to a tertiary hospital. Methods: A retrospective review of inpatient admission records was conducted for all patients admitted to a tertiary hospital between January 2018 and December 2022. Data were collected using a standardized data extraction form and analysed with Microsoft Excel using descriptive statistics. Results: We identified 199 patients [median age 53 years; interquartile range (IQR) 41.5–63.0]. The median duration of HIV infection was 12.75 years (IQR 6.10–19.58), with a median duration on antiretroviral therapy of 8 years (IQR 0–14) and a median CD4 count of 368 (IQR 90–656) on admission. In total, 303 cases of skin disease were identified; the majority were skin infections (n = 164; 54.1%), followed by inflammatory dermatoses (n = 53; 17.5%), skin tumours (n = 39; 12.9%) and drug reactions (n = 13; 4.3%). In 11.2% of cases (n = 34), the diagnosis was unknown. Of the primary skin infections seen, 45.7% (n = 75/164) were bacterial, 26.8% (n = 44/164) were viral, 22.0% (n = 36/164) were fungal and 2.4% (n = 4/164) were parasitic. The most common condition was cellulitis, which occurred in 45 patients (22.6%). Sixty patients (30.2%) presented with advanced HIV infection (CD4 <200 cells mm–3). The most common conditions in this group were oral candidiasis (n = 21; 35%), herpes simplex virus infection (n = 12; 20%), seborrhoeic dermatitis (n = 9; 15%) and Kaposi sarcoma (n = 9; 15%). Conclusions: Cutaneous infection was the most common category of skin problem in this population of PLHIV during hospital admission. Bacterial cellulitis was the most common dermatological condition overall, while oral candidiasis was the most common condition in those with advanced HIV infection. Further work is needed to better characterize the profile of skin disease in PLHIV, including in larger prospective cohorts and outpatient settings.

This article provides an overview of the neglected tropical diseases caused by fungi, which include mycetoma, chromoblastomycosis and sporotrichosis. These are chronic infections of the skin and subcutaneous tissue that can be locally destructive, leading to disfigurement and disability. Management of these conditions is challenging, often requiring prolonged antimicrobial therapy in combination with surgical treatment.

Porokeratosis ptychotropica (PPt) is a rare and therapeutically challenging variant of porokeratosis. Recent insights into dysregulated isoprenoid biosynthesis have suggested new therapeutic targets, although clinical success remains variable. We present the cases of two patients with PPt, one from London and one from Brighton, and their treatment outcomes, evaluating topical imiquimod and cholesterol/statin combination therapy. While imiquimod was poorly tolerated and ineffective, cholesterol/statin therapy provided symptomatic relief. These cases add to the limited literature on PPt and highlight the continuing challenges in its management.

Scabies is a common and disabling ectoparasitic infestation of the skin that can clinically present in ‘classical’ or ‘crusted’ forms. Diagnosis can often be made on the basis of clinical history and careful dermoscopic examination of the skin. The International Alliance for the Control of Scabies (IACS) diagnostic criteria can support the diagnosis and management of patients with suspected scabies. Older adults are a vulnerable population; the clinical presentation of scabies can be atypical in this group and treatment can be challenging. Institutional scabies outbreaks, such as in care homes, are typically challenging to identify and, therefore, subject to diagnostic delay. These outbreaks are hard to control and an important source of morbidity, requiring simultaneous treatment of those affected, which can be complicated and time consuming. The management of scabies outbreaks involves repeated, contemporaneous (if multiple individuals) treatments with topical scabicide applications to the whole body, with decontamination of the environment(s). In some situations, topical treatment may be inappropriate and delay effective treatment.

This article discussed basal cell carcinoma of the neophallus (neopenis) as an emerging complication of gender-affirming surgery.