Journal of Pediatric Nursing (2014) 29, 195–196
Correspondence
Tinea faciei: An Old Friend Revisited
Despite cutaneous fungal infections due to dermato-
phytes have a well defined and characteristic clinical
semiology, sometimes the long shadow of atopic dermatitis
makes it easy to misdiagnose these entities, as in the
following case report.
A 2-year-old male patient presented to our clinic with a 6-
week-history of facial lesions. Lesions appeared several days
after contact with a domestic cat. A 2-week-history of similar
lesion on the beard was referred by the father of the patient.
With a primary diagnosis of atopic eczema, a treatment based
on topical steroids and emollient creams was initiated with
no response after 4 weeks.
On clinical examination, three erythematous plaques were
located on forehead, right preauricular and submandibular
areas. The 7-cm sized plaque on preauricular area had scaly,
erythematous active borders with a clear centre and isolated
pustules, showing the characteristic ring-shape (Figure 1).
Diagnosis
Trichophyton rubrum was isolated on the fungal culture.
The patient has an excellent therapeutic response to
Figure 1 Round erythematous skin lesion on the right preauricular area with raised and desquamative border, concentric halo of apparently
healthy skin and erythematous centre with follicular pustules. On the chin and forehead, satellite lesions of similar appearance.
0882-5963/$ – see front matter © 2014 Elsevier Inc. All rights reserved.
griseofulvin 20 mg/kg, resulting in the complete resolution
of the lesions 6 weeks later.
Discussion
Tinea faciei is a skin fungal infection due to dermato-
phytes. This condition is common on paediatric patients. Our
case shows the characteristic lesions, which may lead to a
certain diagnosis. Besides, the characteristic history of
animal contact and high contagiosity among relatives are
helpful to make the correct diagnosis (Kelly, 2012).
Application of topical steroids may modify the clinical
appearance of the lesion, which is known as T. incognito.
The diagnosis of this condition can be challenging. In
addition, the topical steroid may spread the infection to
the follicles, which is known as trichophytic Majocchi
granuloma (del Boz, Crespo, & de Troya, 2012). The
first-line therapy for T. faciei is griseofulvin 20 mg/kg
for 6–8 weeks (Gupta, Cooper, & Bowen, 2008). Fungal
cultures or direct examination should be performed before
steroid application in facial lesions in order to distinguish
eczema from dermatophytosis and avoid misdiagnosis.
In conclusion, we report a case of T. faciei in
transformation to T. incognito caused by T. rubrum. This
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case highlights the importance of clinical knowledge of
T. faciei and the value of performing complementary tests
prior to starting the treatment.
Molina-Leyva Alejandro MD
Ruiz-Carrascosa Jose Carlos MD
Department of Dermatology
San Cecilio University Hospital
University of Granada, Granada, Spain
E-mail address: alejandromolinaleyva@gmail.com
http://dx.doi.org/10.1016/j.pedn.2013.11.010
Correspondence
References
del Boz, J., Crespo, V., & de Troya, M. (2012). Pediatric tinea faciei in
southern Spain: A 30-year survey. Pediatric Dermatology, 29,
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Gupta, A. K., Cooper, E. A., & Bowen, J. E. (2008). Meta-analysis:
Griseofulvin efficacy in the treatment of tinea capitis. Journal of Drugs
in Dermatology, 7, 369–372.
Kelly, B. P. (2012). Superficial fungal infections. Pediatrics in Review, 33,
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