Apetato, M.

Baptista, J.

Borges, Ana Sofia

Brasileiro, A.

Galhardas, C.

Matos Pires, E.

English

Journal of the Portuguese Society of Dermatology and Venereology

345Qual o Seu Diagnóstico?Correspondência: Ana Sofia Ribeiro Borges Serviço de Dermatologia - Hospital de Sto António dos Capuchos - CHLCAlameda Santo António dos Capuchos1169-050 Lisboa, PortugalE-mail: a.sofia.r.borges@gmail.comDOI: https://dx.doi.org/10.29021/spdv.76.3.888 Recebido/Received19 Janeiro/January 2018 Aceite/Accepted22 Fevereiro/February 2018Lesões Faciais em Criança: Um Diagnóstico Desafiante          Borges A.S.1, Brasileiro A.1, Matos Pires E.1, Baptista J.1, Galhardas C.1, Apetato M.11Department of Dermatology and Venereology, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, PortugalPALAVRAS-CHAVE – Criança; Face; Pele; Tinha; Trichophyton.Facial Lesions in Children: Often a Challenging Diagnosis   KEYWORDS – Child; Face; Skin; Tinea; Trichophyto. dermatology quizQUAL O SEU DIAGNÓSTICO? CASE REPORT An 11-year-old girl was observed with mildly pruritic facial lesions consisting of well-demarcated symmetric erythematous scaly plaques involving both eyelids, isolated erythematous and scaly papules on the forehead, base of the nose and malar regions and a crusted-yellowish plaque with less well--defined borders on the tip of the nose (Fig.1). Lesions began 3 weeks before as mildly pruritic papules around the eyes that progressively increased. No other skin lesions were observed and systemic symptoms were absent. The child was otherwise healthy and parents denied personal or family history of atopy. No other dermatoses were known in the family. The dermatitis was initially diagnosed as eczema and a mid-potency topical corticosteroid cream was prescribed. Due to lesional extension with the occurrence of papules and pus-tules within the next week, an oral beta-lactam antibiotic was prescribed without improvement. On reviewing the history, the child reported she used to play with a pet rabbit. Revista SPDV 76(3) 2018; Lesões faciais em criança; Borges AS, Brasileiro A, Matos Pires E, Baptista J, Galhardas C, Apetato M.Figure 1   346Qual o Seu Diagnóstico?Revista SPDV 76(3) 2018; Lesões faciais em criança; Borges AS, Brasileiro A, Matos Pires E, Baptista J, Galhardas C, Apetato M.DIAGNOSIS TINEA FACIEI Direct microscopy examination of a KOH 40% prepara-tion of lesional skin scrapings revealed septate hyphae and culture on Sabouraud’s dextrose agar with cycloheximide isolated, on the third week, Trichophyton mentagrophytes var. granulare. The patient was treated with a 4-week course of oral terbinafine (125 mg/day, 4 g/kg) with complete resolution of skin lesions in 3 weeks, without relapse or side effects (Fig. 2).Tinea faciei is a dermatophyte infection of facial gla-brous skin. It often occurs in children, mainly associated with close contact with pets.1 In contrast to anthropophilic agents, the clinical presentation of zoophilic dermatophyte infec-tions, namely Trichophyton mentagrophytes var. granulare, is associated with more severe inflammation sometimes with pustules and the annular erythematous scaly plaque typical of dermatophyte infections is often absent.2 As a result of misdiagnosis, lesions are often treated with corticosteroids, which can result in progression or change in clinical appear-ance3,4, known as tinea incognito. Additionally, the facial anatomy, exposure to sunlight and frequent use of cosmet-ics often determine an atypical clinical presentation,1 which highlights the importance of tinea faciei in the differential diagnosis of facial dermatoses. In this case, the authors highlight the importance of con-sidering the diagnosis of tinea faciei in children presenting with a facial dermatosis, especially in those with a relevant epidemiologic context, in order to avoid misdiagnosis and consequently erroneous treatment with corticosteroids.Conflitos de interesse: Os autores declaram não possuir con-flitos de interesse. Suporte financeiro: O presente trabalho não foi suportado por nenhum subsídio ou bolsa. Confidencialidade dos dados: Os autores declaram ter segui-do os protocolos do seu centro de trabalho acerca da publica-ção dos dados de doentes. Protecção de pessoas e animais: Os autores declaram que os procedimentos seguidos estavam de acordo com os regula-mentos estabelecidos pelos responsáveis da Comissão de In-vestigação Clínica e Ética e de acordo com a Declaração de Helsínquia da Associação Médica Mundial. Consentimento do Tutor Legal: Obtido.Conflicts of interest: The authors have no conflicts of interest to declare. Financing Support: This work has not received any contribution, grant or scholarship. Confidentiality of data: The authors declare that they have followed the protocols of their work center on the publication of data from patients. Protection of human and animal subjects: The authors declare that the procedures followed were in accordance with the re-gulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Associa-tion (Declaration of Helsinki). Patient Consent Guardian: Consent obtained.REFERENCES 1. Nicola A, Laura A, Natalia A. A 20-year survey of tinea faciei. Mycoses. 2010; 53:504-8.2. Chen KL, Chien MM, Lu CY, Chiu HC. Zoophilic Tinea Faciei. J Pediatr. 2017; 182:395-395.e1.3. Lin RL, Szepietowski JC, Schwartz RA. Tinea faciei, an often deceptive facial eruption. Int J Dermatol. 2004; 43:437-40.4. Romano C, Ghilardi A. Eighty-four consecutive cases of tinea faciei in Siena, a retrospective study (1989-2003). Mycoses. 2005; 48:343-6.Figure 2   

Lesões Faciais em Criança: Um Diagnóstico Desafiante

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Lesões Faciais em Criança: Um Diagnóstico Desafiante

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Journal of the Portuguese Society of Dermatology and Venereology