Pietro Nenoff

Zusammenfassung: Die unter Federführung der Deutschen Dermatologischen Gesellschaft e. V. (DDG) erstellte S1‐Leitlinie soll Ärzten eine strukturierte Entscheidungsgrundlage für die Versorgung von Patienten mit Tinea capitis bieten und zur Verbesserung der Diagnosesicherheit, Therapieadhärenz und Prävention beitragen. Die Tinea capitis ist eine durch Dermatophyten verursachte Infektion der behaarten Kopfhaut, die überwiegend im Kindesalter auftritt und weltweit eine häufige dermatologische Erkrankung darstellt. In den letzten Jahren ist in Europa, begünstigt durch Migration, Tourismus und sozioökonomische Faktoren, ein verändertes Spektrum der auslösenden Dermatophyten zu beobachten, insbesondere durch eine Zunahme anthropophiler Erreger wie Trichophyton tonsurans und Trichophyton violaceum . Therapeutisch ist eine Kombination aus systemischer und lokaler antimykotischer Behandlung angezeigt, eine alleinige topische Therapie ist in der Regel nicht ausreichend. Die Wahl des systemischen Antimykotikums richtet sich bei Kindern primär nach dem Erregerspektrum, wobei Trichophyton ‐Infektionen bevorzugt mit Terbinafin ( off‐label ) und Microsporum/Nannizzia ‐Infektionen mit Itraconazol ( off‐label ) oder Griseofulvin behandelt werden sollten. Bei erwachsenen Patienten ist das Mittel der ersten Wahl erregerunabhängig Terbinafin. Darüber hinaus adressiert die Leitlinie Maßnahmen zur Unterbrechung von Infektionsketten, einschließlich der Mitbehandlung asymptomatischer Kontaktpersonen, hygienischer Maßnahmen sowie des Managements bei Ausbruchsgeschehen in Gemeinschaftseinrichtungen.

Summary: The consensus‐based guideline developed under the auspices of the German Dermatological Society (DDG) is intended to provide physicians with a structured framework for clinical decision‐making in the management of patients with tinea capitis and to contribute to improved diagnostic accuracy, treatment adherence, and prevention. Tinea capitis is a dermatophyte‐induced infection of the scalp that predominantly affects children and represents a common dermatological condition worldwide. In recent years, a marked shift in the epidemiology of causative dermatophytes has been observed in Europe, driven by migration, tourism, and socioeconomic factors, with an increasing prevalence of anthropophilic species, particularly Trichophyton tonsurans and Trichophyton violaceum . From a therapeutic perspective, a combination of systemic and topical antifungal treatment is recommended, as topical monotherapy is generally insufficient. In pediatric patients, the choice of systemic antifungal therapy is primarily guided by the identified pathogen, with Trichophyton infections preferably treated with terbinafine ( off‐label ) and Microsporum/Nannizzia infections with itraconazole ( off‐label ) or griseofulvin. In adult patients, terbinafine is recommended as first‐line therapy irrespective of the causative species. In addition, the guideline addresses measures to interrupt chains of infection, including the treatment of asymptomatic carriers, implementation of hygiene measures, and management of outbreak situations in community settings.

Dermatophytoses (synonymous with tinea) are superficial fungal infections of the skin, hair, and nails, typically caused by dermatophytes in the genera of Trichophyton and Microsporum. Dermatophyte infections are common and are estimated to affect roughly 20–25% of the global population. Historically, tinea infections have been treated with short courses of topical and/or oral antifungal therapies, however, the last decade has seen increasing antifungal treatment failure. Trichophyton (T.) indotineae (previously termed Trichophyton mentagrophytes—genotype VIII) has emerged as the primary species driving antifungal treatment failure worldwide. Clinically, T. indotineae infection may present as a typical dermatophyte infection, or atypically may mimic eczema, psoriasis, or other inflammatory dermatoses. Patients are often strikingly itchy and may be using topical steroid creams inappropriately in combination with antifungal and antibiotic agents. Terbinafine, once considered a first-line oral agent for tinea infections, often fails against T. indotineae, for which prolonged courses of itraconazole (often at higher than typical dermatophyte dosing) are now regarded as the treatment of choice. Fluconazole and griseofulvin demonstrate limited efficacy. Antifungal susceptibility testing may guide treatment choices but is not well established for dermatophytoses. Dermatologists should be aware of an approach to evaluating and treating refractory dermatophyte infections. Increased awareness among clinicians, including in infectious diseases, primary care, and the emergency room, is also important to facilitate early recognition, appropriate management, and timely referral. Dermatologists may play a key role in promoting antifungal stewardship and educating other clinician groups about emerging dermatophyte infections. In this review, we detail T. indotineae with a focus on clinical presentation, diagnostic confirmation, and treatment.

Zusammenfassung: Bei einem 5-jährigen Mädchen bestanden seit Monaten trockene erythematosquamöse Papeln und Plaques an Armen und Beinen. Seit mehreren Wochen entwickelte sich außerdem am linken Unterschenkel ein großflächiges erosives und nässendes sowie schmerzhaftes Areal. Aus einem Abstrich von der Wundfläche am Unterschenkel ließ sich ein Methicillin-resistenter Staphylococcus aureus (MRSA) anzüchten. Der MRSA-Stamm war gegen Cotrimoxazol, Clindamycin und Doxycyclin empfindlich. In der Pilzkultur ließ sich der zoophile Dermatophyt Trichophyton (T.) quinckeanum anzüchten. Die Identifizierung beruhte auf morphologischen Kriterien. Eine Bestätigung der Identifizierung erfolgte mittels Polymerase Chain Reaction (PCR) und Sequenzierung der ITS (Internal Transcribed Spacer)-Region-Pilz-DNA. Der Vater und die 15-jährige Schwester waren ebenfalls von der Dermatophytose betroffen. Die wahrscheinliche Infektionsquelle für alle drei von der Dermatomykose Betroffenen war eine Katze, ein Freigänger. Das 5-jährige Mädchen wurde topisch mit Octenidinhydrochlorid 0,1% in Basiscreme behandelt, außerdem antibiotisch mit Cotrimoxazol. Zusätzlich kamen eine Ciclopirox-haltige Creme und Itraconazol 100 mg Kapseln, 1-mal täglich über 4 Wochen, zur Anwendung. Die Schwester und der Vater erhielten Terbinafin zur oralen antimykotischen Therapie. Unter dieser Behandlung heilte die Dermatophytose bei allen drei Patienten folgenlos ab. T. quinckeanum ist ein Emerging Pathogen in Deutschland mit Schwerpunkt des Vorkommens in Mittel- und Ostdeutschland. Der zoophile Dermatophyt wird von Mäusen über Katzen auf den Menschen übertragen. Die oft entzündlichen Dermatomykosen betreffen Kinder und Erwachsene. Bei einer gleichzeitig auftretenden sekundären Infektion durch Bakterien, hier einem MRSA, muss zusätzlich antiseptisch und gegebenenfalls auch antibiotisch behandelt werden.

Background: Trichophyton quinckeanum is a zoophilic dermatophyte causing mouse favus, that was only sporadically detected in Germany for decades. Since 2014, an increasing number of isolates have been found in central Germany, giving rise to dermatophyte skin infections and skin appendix infections like tinea capitis or even kerion Celsi.Objectives: The goal of this study was to characterize the specific features of dermatophyte infections due to T. quinckeanum.Methods: We collected the data of 550 isolates of T. quinckeanum from Germany between March 2014 and December 2024 in the laboratory in Mölbis, Germany, in order to identify specific features of the zoophilic dermatophyte infection.Results: To our knowledge, we present the highest number of cases ever published. Infection rates show a yearly recurring increase in autumn and winter months, whereas infection rates in spring and summer months are typically low. The peak of infections in the current epidemic in central Germany was seen in 2021. Mainly children, teenagers and young adults are affected.Conclusions: T. quinckeanum has now become a relevant pathogen in Germany and surrounding countries. Even though the current epidemic is in decline, it is to be expected that in the future, infection rates will again correlate with the cyclic mouse population numbers, as they are the main source of infection. Climate change may also play an important role for mouse populations. Transmission to humans typically occurs via an intermediate host like cats (and less likely dogs), which is why pet owners are most at risk.

Summary Background Tinea pseudoimbricata is a variant of tinea incognito, with multiple erythematous concentric rings (ring in a ring) and pruritus. Misuse of topical corticosteroids is a major exogenous factor. Objective We provide an overview of published cases and report the first case series from Romania. Patients and methods A narrative review of the literature was conducted in PubMed and amended by ResearchGate. A series of pediatric cases from Romania with clinical suspicion of tinea pseudoimbricata was investigated by clinical examination, KOH preparations of skin scrapings, and mycological culture when possible. Results We collected 137 cases of tinea pseudoimbricata from the literature and added a series of 5 pediatric patients from Romania. Oral treatment with fluconazole was effective in all of them. Worldwide, most reports came from India (86%), 3.5% were from other Asian countries, 3.5% were from the Americas, and 7% were from Europe. M. canis and T. mentagrophytes were identified in 2 patients from Romania. T. mentagrophytes, T. rubrum, and T. tonsurans are the dominant species worldwide, but molecular diagnostics were available for only a minor part of cases. Conclusion Tinea pseudoimbricata is most common in India. This is the first case series on tinea pseudoimbricata from Romania. Tinea pseudoimbricata is an emerging disease in Europe. Identification of fungi has rarely been done by molecular mycology. This may have caused an overestimation of T. mentagrophytes and an underestimation of T. indotineae.

: Over the past few years, a recalcitrant dermatophytosis has been observed on the Indian subcontinent, including Sri Lanka, which has caused a major public health issue in the region. An emerging species, Trichophyton indotineae, first described as Trichophyton mentagrophytes ITS genotype VIII, is thought to be responsible for this fast-spreading, mostly terbinafine-resistant dermatophytosis. Recalcitrant dermatophytosis is a challenge to dermatologists, and knowing the causative species and antifungal sensitivity in the earlier stage of management would be invaluable. We report a case series of patients with dermatophytosis caused by T. indotineae in Sri Lanka. This is the first detection of this highly terbinafine-resistant strain in Sri Lanka, and existence of this species should be taken seriously by dermatologists and healthcare policymakers for better management of tinea infections and antifungal stewardship in the country.