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LETTER TO EDITOR
Year : 2005  |  Volume : 71  |  Issue : 2  |  Page : 130-131

Trichophyton rubrum infection of the prepuce


Asansol, Kolkata, India

Correspondence Address:
Amiya Kumar Mukhopadhyay
'Pranab', Ismile (near Dharmaraj Mandir), Asansol - 713301, Dist. Burdwan, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.14004

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How to cite this article:
Mukhopadhyay AK. Trichophyton rubrum infection of the prepuce. Indian J Dermatol Venereol Leprol 2005;71:130-1

How to cite this URL:
Mukhopadhyay AK. Trichophyton rubrum infection of the prepuce. Indian J Dermatol Venereol Leprol [serial online] 2005 [cited 2019 Sep 17];71:130-1. Available from: http://www.ijdvl.com/text.asp?2005/71/2/130/14004


Sir,



Dermatophyte infection of the penis and scrotum is rare. It is difficult to explain why the penile shaft is generally not involved in patients affected by tinea cruris. Glans penis involvement is considered even rarer,[1] whereas dermatophytosis of the prepuce has not been reported in the literature. Here we report a patient who presented with scaly lesion on the prepuce, which on investigation was found to be due to Trichophyton rubrum.



A 29-year-old male presented with itching and burning sensation of the preputial sac since the last ten days. He was married and denied history of any extramarital sexual exposure in the recent or remote past. On further enquiry he gave the history that his wife had got ringworm infection of the groin and anterior abdomen but did not have any history of vaginal discharge. On examination, the uncircumcised prepuce showed an erythematous, moist lesion with raised margins [Figure - 1]. The border of the lesion revealed the presence of moist scales. There was no scaling or any other lesion on the glans, or on the shaft of the penis, scrotum, intertriginous area or elsewhere on the body. The patient was otherwise in normal health.



On investigation, routine examination of blood, serum glucose, VDRL and HIV status could reveal no abnormality. A 10% potassium hydroxide smear prepared from the scaly area of the lesion showed the presence of fungal hyphae. Culture on Sabouraud's dextrose agar media with gentamicin grew Trichophyton rubrum. He was treated with 1% clotrimazole gel and started improving in a few days; a repeat culture after two weeks failed to show growth of any fungus.



Dermatophyte infection from the inguinal area may extend to the scrotum and uncommonly to the penis, but rarely occurs on the glans or prepuce.[2],[3],[4] In the present case the provisional clinical diagnosis was Candida infection of the prepuce, however a ring-like configuration with central clearing and mild scaling at the border prompted the 10% KOH smear and subsequent culture, which proved the infection to be of T. rubrum.



It is widely accepted that dermatophytes are keratinophilic in nature and they invade their host by enzymatic digestion of the keratin. However, many workers have been unable to demonstrate enzymes produced by dermatophytes with keratin-specific proteinase activity. In vitro, non-keratin substances extracted from keratinized tissues will support the growth of dermatophytes much better than the keratin.[5] This may be true for the present case, since anatomically the glans penis and inner surface of the prepuce are covered with non-keratinized epithelium. Also the uncircumcised preputial surface is continually moist and may accumulate smegma, which is an excellent medium for the growth of pathogens. Tropical climate also plays an important role in the pathogenesis of dermatophytosis of the genitalia.[6] In the present patient, probably all these factors led to dermatophyte infection in a rare site, perhaps from contact with the spouse's ringworm infection during sexual activity.



There have been some reports of extensive and persistent cases of tinea corporis in which dermal and subcutaneous involvement has been a feature. A few cases of deep dermatophytoses affecting bone, the central nervous system and lymph nodes, have been reported, but no satisfactory explanation for this highly unusual behavior of the dermatophytes is yet available.[5]

 
  References Top

1.D'Antuono A, Bardazzi F, Andalou F. Unusual manifestation of dermatophytosis. Int J Dermatol 2001;40:164-6.  Back to cited text no. 1      
2.Dekio S, Jidoi J. Tinea of the glans penis. Dermatologica 1989;178:112-4.  Back to cited text no. 2  [PUBMED]    
3.Pillai KG, Singh G, Sharma BM. Trichophyton rubrum of the penis. Dermatologica 1975;100:252-4.  Back to cited text no. 3      
4.English JC, Laws RA, Keough JC, Wilde JL, Foley JP, Elston DM. Dermatosis of the glans penis and prepuce. J Am Acad Dermatol (on line) 1997; 37(1). Available from: URL:http://www.eblue.org/scripts/om. dll/serve. Accessed on 16.8.2004.  Back to cited text no. 4      
5.Hay RJ, Moore M. Mycology. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th Ed. Oxford: Blackwell Science; 1998. p. 1277-376.  Back to cited text no. 5      
6.Vora NS, Mukhopadhyay AK. Incidence of dermatophytosis of penis and scrotum. Indian J Dermatol Venerol Leprol 1994;60:89-91.  Back to cited text no. 6      


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