A two-week-old female infant presented with a rash first noted for two days (Fig. 1). The rash was on the face and scalp. There were multiple lesions with an annular, raised, scaly margin that was erythematous and pustular in part, central depigmentation was also noted. The mother had a similar rash two years earlier. In the subsequent two years several members of the extended family had developed a similar rash. The differential diagnosis considered were Neonatal Lupus or Tinea Faciei. Fungal scrapings taken from the baby were negative on direct examination with potassium hydroxide but was positive for Tricophytum tonsurans in culture. Treatment with oral Griseofulvin and topical Clotrimazole for two weeks resulted in clinical clearance of the rash.

Fig. 1. Tricophytum tonsurans lesions over the face.

Tricophytum tonsurans is an anthropo-philic endothrix dermatophyte infection. There is an equal sex incidence in children; in adults it is more common in women. Transmission is from person to person and there is no other known host. It may persist into adulthood. Clinically it may be difficult to diagnose from other erythematous skin lesions. Diagnosis is made by mycology; endothrix dermatophytes do not fluoresce under wood’s light. Potassium hydroxide examinations for hyphae may be negative. It is difficult to diagnose on clinical examination. Tropical antifungals are usually ineffective in treating Tinea capitis and Tinea facei. Systemic griseofulvin, for six weeks, is the treatment of choice in children. Erroneous treatment with steroid results in Tinea incognito, a less clearly defined pustular folliculitis.

Justine Daniels,
Amitava Pahari,
Department of Pediatrics,
North Middlesex University Hospital,
Sterling Way, Edmonton,
London N18 1QX,
United Kingdom.
E-mail: [email protected]