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LETTER TO EDITOR
Year : 2004  |  Volume : 70  |  Issue : 2  |  Page : 116-117

Ringworm of the scalp in a 5-day-old neonate


Department of Dermatology, Venereology & Leprology, Dr. S. N. Medical College, Jodhpur

Correspondence Address:
H. No. 3, MDM Hospital Road, Jodhpur
[email protected]



How to cite this article:
Singhi M K, Gupta LK, Ghiya B C, Dhabhai R. Ringworm of the scalp in a 5-day-old neonate. Indian J Dermatol Venereol Leprol 2004;70:116-7


How to cite this URL:
Singhi M K, Gupta LK, Ghiya B C, Dhabhai R. Ringworm of the scalp in a 5-day-old neonate. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2020 Nov 27];70:116-7. Available from: https://www.ijdvl.com/text.asp?2004/70/2/116/6909


Sir,
While moniliasis in newborns is not uncommon, superficial dermatophyte infection is quite rare. We report a neonate with ringworm of the scalp caused by Trichophyton rubrum, present since the fifth day of birth.

A 10-day-old baby girl was seen in the Skin Outpatient Department with multiple erythematous plaques on her scalp since 5 days. She was a full term Caesarian delivery with a birth weight of 3.1 kg. She had a normal cry at birth. Examination of the child revealed multiple erythematous annular plaques of varying sizes on the frontal and parietal regions of the scalp [Figure - 1]. The lesions had active scaly papular margins. The scalp hairs were normal and could not be plucked out easily.

KOH examination of skin scrapings from the active edge revealed the presence of numerous long, septate, branched hyphae. Culture on Sabouraud's dextrose agar grew Trichophyton rubrum. KOH microscopy from plucked scalp hair was performed on three occasions and was negative; culture for fungus also showed no growth after 4 weeks of incubation. Examination of mother and other family members did not show any evidence of dermatophytosis. There was no history of keeping pets in the family. The baby was treated with topical clotrimazole solution with complete resolution of lesions in 2 weeks.

Dermatophyte infection is rare in infancy; neonatal infection is still rarer. Infection is acquired by deposition of viable arthrospores or hyphae on the surface of susceptible persons. The source of infection is usually an active lesion on an animal or another human; fomites and soil may serve as other sources of infection. In young children infected with Trichophyton rubrum and Epidermophyton floccosum, the infection is usually acquired from their parents.[1] The incubation period of dermatophytosis is 1-3 weeks. There have been a few case reports of tinea occurring in 21-day, 8-day, 6-day and 2-day-old neonates.[2],[3],[4],[5] The earliest case was reported by Lynch in 1876 who noted tinea faciei in an infant only 6 hours old.[6] However, this was not documented with KOH microscopy or culture.

The development of scalp ringworm at day 5 of birth in this case is indeed interesting. The mother of the child and other family members did not have any evidence of active ringworm. However, the possibility of an asymptomatic family member carrier of Trichophyton rubrum serving as a source of infection can not be ruled out. Such a carrier state has been reported with Trichophyton tonsurans.[7] The infection may also have been acquired from infected hospital staff or clothing. Another interesting observation in our patient was the occurrence of tinea on glabrous skin of the scalp without involvement of the hair. The case has therefore been designated as “ringworm of scalp” and not as 'tinea capitis' where involvement of hair is a sine qua non. 

   References Top

1.Hay RJ, Moore M. Mycology. In: Champion RH, Burton JL, Burn DA, Breathnach SM, editors. Textbook of dermatology. 6th ed. Oxford: Blackwell Scientific; 1999. p.1294.  Back to cited text no. 1    
2.Bansal NK, Sharma M, Gupta LK, Mittal A. Tinea corporis in neonate due to Trichophyton violaceum. Indian J Dermatol Venereol Leprol 1995;61:247.  Back to cited text no. 2    
3.Jacob AH, Jacob PH, Moore N. Tinea faciei due to Microsporum canis in a 8-day-old infant. JAMA 1972;219:1476.  Back to cited text no. 3    
4.Ghorpade A, Ramanan C. Tinea capitis and corporis due to Trichophyton violaceum in a 6-day-old infant. Int J Dermatol 1994;33:219-20.  Back to cited text no. 4  [PUBMED]  
5.Ghorpade A, Ramanan C, Durairaj P. Trichophyton mentagrophytes infection in a 2-day-old infant. Int J Dermatol 1991;30:209-10.   Back to cited text no. 5  [PUBMED]  
6.Lynch J R. Case of ringworm occurring in an infant within 6 hours of birth. Med Press Circ 1876;21:235.  Back to cited text no. 6    
7.Sharma V, Hall JC, Knapp JF. Scalp colonization by Trichophyton tonsurans in an urban pediatric clinic? Asymptomatic carrier state. Arch Dermatol 1988;124:1511-3.  Back to cited text no. 7    

 

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