Case Report and Literature Review of Impetigo-Like Tinea Faciei

Abstract

Impetigo, commonly caused by bacteria, is characterized by lesions of pustules, bullae or golden yellow crusts; it is seldom caused by fungi. Here, we report one case of a 17-year-old female patient with a 1-month history of erythematous pustules on her left cheek. She was clinically diagnosed with “impetigo”, but did not respond to 1 week of treatment with topical mupirocin cream (antibacterial agent). We then saw that a fungal colony grew on the culture, which was identified as T. mentagrophytes based on the morphological and molecular characteristics. The patient was then diagnosed with tinea faciei and was topically treated with 0.2% ketoconazole cream twice per day for 7 days. Through a literature review, we found another 18 cases of impetigo-like tinea faciei with similar clinical manifestations and pathogenic characteristics. Among these, the most common causative agent was T. mentagrophytes complex, which frequently occurs in children and adolescents and exhibits no gender preferences. Systemic and topical antifungals such as terbinafine or itraconazole are effective for impetigo-like tinea faciei caused by T. mentagrophytes complex. However, prolonged course of impetigo in more than 50% cases highlights the importance of mycological examination when dealing with apparent antibiotic-resistant impetigo cases in clinical settings.

Keywords:

• tinea faciei
• impetigo
• Trichophyton mentagrophytes

Abbreviations

A, anthropophilic; AFST, antifungal susceptibility tests; CBA, Columbia blood agar; CMZ, Clotrimazole; D, day; F, female; GRF, griseofulvin; ITC, itraconazole; ITS, internal transcribed spacer; KCZ, Ketoconazole; MALDI-TOF MS, matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry; M, male (in sex); M, month (in age); NTF, Naftifine; O, oral; Refs, references; SDA, Sabouraud-glucose Agar with Chloramphenicol; T, Topical; TRB, Terbinafine; Y, year; Z, zoophilic.

Data Sharing Statement

All the data are fully available without restriction. All data generated or analyzed during this study are included in this published article. The sequence data have been deposited in the GenBank database (http://www.ncbi.nlm.nih.gov/Genbank/index.html) with the accession number MZ712214.1.

Ethics Approval and Informed Consent

This study was approved by the Institutional Research and Ethics Committee of Jining No. 1 People’s Hospital to publish the case details (Ethical approval no. 2021-057). The patient provided written informed consent for publication of this case report and any accompanying images. The study was carried out in accordance with the principles of the Declaration of Helsinki. The first author vouches for the completeness and accuracy of the data and for the adherence of the study to the protocol.

Consent for Publication

Written informed consent was obtained from the patient’s parents described in this report. A copy of the written consent is available by request.

Acknowledgments

We thank the patient for granting permission to publish this information.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This work was supported in part by grants from the National Natural Science Foundation of China (NM 81773337), the Key Research and Development Plan of Shandong Province (NM 2019GSF108191), and the Key Research and Development Plan of Jining (NM 2021YXNS121), Shandong, China.