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Indian Journal of Dermatology, Venereology, Leprology, Vol. 70, No. 2, March-April, 2004, pp. 116-117 Letter To Editor Ringworm of the scalp in a 5-day-old neonate Singhi MK, Gupta Lalit K, Ghiya BC, Dhabhai Ravindra Department of Dermatology, Venereology & Leprology, Dr. S. N. Medical College, Jodhpur Code Number: dv04037 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
Copyright 2004 - Indian Journal of Dermatology, Venereology, Leprology The following images related to this document are available:Photo images[dv04037f1.jpg] |
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