10.5826/dpc.1301a37
text/xml
2160-9381
2530
en
Cristina Martínez-Morán
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
terbinafine
An Unexpected Dermatophyte? Two Remarkable Cases of Tinea Barbae by Trichophyton benhamiae
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-04-10
2023-01-31
2023-03-01
e2023037
Dermatol Pract Concept
Cristina Martínez-Morán
2023/01/31
10.5826/dpc.1301a37
e2023037
Dermatology Department, Hospital de Fuenlabrada. Fuenlabrada, Madrid, Spain
2160-9381
terbinafine
en
e2023037
Sabou M, Denis J, Boulanger N, et al. Molecular identification of Trichophyton benhamiae in Strasbourg, France: A 9-year retrospective study. Med Mycol. 2018;56(6):723-734. DOI:10.1093/mmy/myx100. PMID: 29165673.
An Unexpected Dermatophyte? Two Remarkable Cases of Tinea Barbae by Trichophyton benhamiae
https://dpcj.org/index.php/dpc/article/download/2530/1916
   An Unexpected Dermatophyte? Two Remarkable
  Cases of Tinea Barbae by Trichophyton benhamiae
                Gloria Baeza-Hernández1, María de la Soledad Vallejo-Ruiz1,
    Ricardo Francisco Rubio-Aguilera1, Alberto Romero-Maté1, Cristina Martínez-Morán1


1 Dermatology Department, Hospital de Fuenlabrada. Fuenlabrada, Madrid, Spain



Key words: Trichophyton benhamiae, Arthroderma benhamiae, tinea barbae, dermatophytosis, terbinafine
Citation: Baeza-Hernández G, de la Soledad Vallejo-Ruiz M, Rubio-Aguilera RF, Romero-Maté A, Martínez-Morán C. An Unexpected
Dermatophyte? Two Remarkable Cases of Tinea Barbae by Trichophyton benhamiae. Dermatol Pract Concept. 2023;13(1):e2023037.
DOI: https://doi.org/10.5826/dpc.1301a37
Accepted: June 13, 2022; Published: January 2023
Copyright: ©2023 Baeza-Hernández et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Gloria Baeza-Hernández, Servicio de Dermatología, Hospital de Fuenlabrada, Camino del Molino 2, 28942
Fuenlabrada, Madrid, Spain. E-mail: gloria.baeza@salud.madrid.org




Introduction                                                             an erythematous plaque on his chin, with some pustules and
                                                                         erosions covered by serous-hematic crust, and a 2-3 cm nod-
Trichophyton (T.) benhamiae is considered an emergent zoo-               ule in the plaque’s border (Figure 2). Some of his closest fam-
philic dermatophyte, with more cases being reported from                 ily members were being treated for tinea corporis.
various countries around the world. We hereby present two                     Scales were gathered for fungal culture. In both cases,
cases of tinea barbae by T. benhamiae.                                   T. benhamiae was identified by MALDI-TOF (matrix-assisted
                                                                         laser desorption/ionization time-of-flight) mass spectrometry
                                                                         analysis. Terbinafine 250 mg daily for three months com-
Case Presentation
                                                                         pletely cleared the lesions in both patients.
Case 1. A 48-year-old man attended the emergency depart-
ment with a 1-month history of facial lesions treated with ci-
                                                                         Conclusions
clopirox and mupirocin ointment. He had a healthy pet dog.
On examination, he had extensive impetiginized crusts all                T. benhamiae, previously known as Arthroderma (A.) ben-
over the nasolabial triangle. Removal of the crusts r­ evealed           hamiae, is nowadays a species on its own according to the
erythematous, vegetating plaques on the nasolabial folds                 latest dermatophyte taxonomy, based on the analysis of
(Figure 1).                                                              the internal transcribed spacer (ITS) ribosomal DNA re-
    Case 2. Another 50-year-old man, owner of a healthy                  gion [1,2].
dog, came to the outpatient clinic complaining of a two-week                  Every year, more cases of T. benhamiae are being re-
facial rash previously treated with topical clobetasol and               ported worldwide particularly among children. This zoo-
gentamicin without improvement. On examination he had                    philic dermatophyte is mainly transmitted by guinea pigs,


Research Letter | Dermatol Pract Concept. 2023;13(1):e2023037                                                                         1
                                                                     Figure 2. Case 2: clinical picture of tinea barbae caused by Tricho-
Figure 1. Case 1: clinical image of tinea barbae caused by Tricho-
                                                                     phyton benhamiae. Erythematous plaques in the chin and right cheek,
phyton benhamiae. Erythematous vegetating plaques on the nasola-
                                                                     with erosions and pustules, with a 2-3 cm nodule in the chin plaque
bial folds, devoid of hair in some areas.
                                                                     border.



and seldom by other infected animals like rabbits, cats, dogs        methods like PCR and MALDI-TOF are necessary to ensure
and even a fox [3]. Our patients were both adults and only           correct identification of this emergent dermatophyte.
had contact with their pet dogs, which were apparently
­unaffected; however, we have no information about their
                                                                     References
veterinary evaluation. Retrospectively our patients couldn’t
remember being near a guinea pig, which can be silent car-            1. Shiraki Y, Hiruma M, Matsuba Y, et al. A case of tinea cor-
riers of T. ­benhamiae [4]. We haven’t found studies about               poris caused by Arthroderma benhamiae (teleomorph of Tinea
                                                                         mentagrophytes) in a pet shop employee. J Am Acad Dermatol.
T. benhamiae colonization in dogs.
                                                                         2006;55(1):153-154. DOI:10.1016/j.jaad.2005.05.048. PMID:
    Clinically, it usually causes highly inflammatory tinea
                                                                         16781312.
corporis and faciei which can be confused with impetigo,              2. de Hoog GS, Dukik K, Monod M, et al. Toward a Novel
delaying a correct diagnosis [5]. There are scattered reports            ­Multilocus Phylogenetic Taxonomy for the Dermatophytes.
of kerion celsi and onychomycosis [3,5]. To the best of our               ­Mycopathologia. 2017;182(1-2):5-31. DOI:10.1007/s11046-
knowledge, only one case of tinea barbae by T. benham-                     016-0073-9. PMID: 27783317. PMCID: PMC5283515.
                                                                      3. Tan J, Liu X, Gao Z, Yang H, Yang L, Wen H. A case of Tinea
iae has been previously reported by Braun et al in 2013, a
                                                                           Faciei caused by Trichophyton benhamiae: First report in China.
24-year-old male in which the authors identified A. benham-
                                                                           BMC Infect Dis. 2020;20(1):1-5. DOI:10.1186/s12879-020-
iae by PCR in the patient and in his guinea pig [6].                       4897-z. PMID: 32087692. PMCID: PMC7036192.
    Identification of T. benhamiae requires molecular meth-           4. Berlin M, Kupsch C, Ritter L, Stoelcker B, Heusinger A, Gräser
ods due to its similarity to other fungal species in standard              Y. German-wide analysis of the prevalence and the propagation
cultures. Yellow subtype of this fungus grows in colonies                  factors of the zoonotic dermatophyte trichophyton benham-
                                                                           iae. J Fungi. 2020;6(3):1-11. DOI:10.3390/jof6030161. PMID:
that may be diagnosed as Microsporum canis, and the un-
                                                                           32899171. PMCID: PMC7558194.
usual white subtype is usually identified as T. mentagro-
                                                                      5. Nenoff P, Uhrlaß S, Krüger C, et al. T Trichophyton species of
phytes. Polymerase chain reaction (PCR) of the ITS region                  Arthroderma benhamiae - a new infectious agent in dermatol-
and MALDI-TOF both allow for a correct diagnosis [7].                      ogy. J Dtsch Dermatol Ges. 2014;12(7):571-581. DOI:10.1111
    Treatment is akin to that of other dermatophyte infec-                 /ddg.12390. PMID: 24981469.
tions. If the infection covers an extensive area or hair follicles    6. Braun SA, Jahn K, Westermann A, Bruch-Gerharz D, Reifen-
                                                                           berger J. Tinea barbae profunda durch Arthroderma benhamiae.
are affected, oral treatment is preferred, terbinafine being the
                                                                           Der Hautarzt. 2013;64(10):720-722. DOI:10.1007/s00105-013-
first choice [3,5].
                                                                           2646-6. PMID: 24150818.
    Tinea barbae by T. benhamiae seems to be rare. Previ-             7. Sabou M, Denis J, Boulanger N, et al. Molecular identification of
ous contact with animals, especially guinea pigs, and inflam-              Trichophyton benhamiae in Strasbourg, France: A 9-year retro-
matory lesions on physical examination should prompt the                   spective study. Med Mycol. 2018;56(6):723-734. DOI:10.1093
diagnosis of T. benhamiae infection. Molecular diagnostic                  /mmy/myx100. PMID: 29165673.




2                                                                        Research Letter | Dermatol Pract Concept. 2023;13(1):e2023037
