Journal of Medical Microbiology (2007), 56, 1122–1123 DOI 10.1099/jmm.0.

47000-0

Case Report Tinea pedis and tinea unguium in a 7-year-old child

V. Tullio,1 G. Banche,1 M. Panzone,2 O. Cervetti,2 J. Roana,1 V. Allizond,1
N. Carlone1 and A. M. Cuffini1
Correspondence 1
Department of Public Health and Microbiology, University of Turin, Turin, Italy
A. M. Cuffini 2
Clinica Dermatologica II, Dipartimento di Discipline Medico-Chirurgiche, University of Turin, Turin,
[email protected]
Italy

This report documents tinea pedis and tinea unguium in a 7-year-old child. In all cultures
Received 12 October 2006 Trichophyton rubrum was present. As tinea pedis and tinea unguium affect adults more often
Accepted 26 March 2007 than children, they might be overlooked and misdiagnosed in the latter.

Case report San Lazzaro Dermatologic Hospital, University of Turin.

A 7-year-old white boy had a 6 year history of itching, Cutaneous samples were collected by gently scraping the
scaling and erythematous interdigital tinea pedis. His lesions, while ungual specimens were collected by scraping
lesions appeared pruritic and inflamed, especially those the distal portion of the affected nail, the nail plate, as well
located on his feet and between his toes; treatment with as the nail bed, using a sterile scalpel. Before taking any
unspecific topical agents was unsuccessful. He presented further samples, the area was swabbed with distilled water
longitudinal white striae with ungual fragility on the third and soap so as to remove any medication that might have
right toenail. Family history did not reveal remarkable been applied and could still have been present.
findings, except for a long lasting plantar hyperhidrosis. All the specimens were placed in a drop of potassium
The child’s father also had pruritic bullae on his right hydroxide solution (10 %) on a glass slide, and examined
plantar surface; direct microscopic examination and under a microscope to detect any fungal hyphae. Cultures
culture confirmed tinea pedis. were performed with the remaining samples using Myco-
biotic agar medium (Biolife) and Sabouraud dextrose agar
Medical examination of the child’s right foot revealed a
(Biolife), and kept at 25 uC for 15 days. Potassium
scaling lesion, slightly erythematous in the third and fourth
hydroxide examination of the nail and skin scrapings was
interdigital spaces, while the third right toenail showed
positive for branching septate hyphae, and fungal culture
longitudinal white striae with initial onycholysis (Fig. 1).
was predictive of dermatophyte growth. After a preliminary
During scraping of the area, an increase of ungual fragility was
diagnosis, fungal cultures were sent for final identification
detected. The clinical picture suggested a fungal infection.
to the Mycology Laboratory, Department of Public Health
Different samples surrounding the active border of the and Microbiology, University of Turin.
lesions were obtained from the child at the Medico-
The macroscopic aspect of the colony found on the Myco-
Surgical Discipline Department, Dermatological Clinic II,
biotic agar medium appeared typically white and cottony,
with a red-wine colour on the reverse of the colony.
Furthermore, branched, hyaline, septate, racket-like and
chandelier-like hyphae were observed during microscopic
examination; several droplet-like microconidia formed
along the length of the hyphae and no macroconidia were
observed. Both direct microscopic and macroscopic exami-
nation allowed the identification of Trichophyton rubrum.
Tinea pedis and tinea unguium are two highly prevalent
cutaneous fungal infections in the adult population; they
are relatively rare in young children (under 10 years)
(Fernandes et al., 2001; Lange et al., 2004; Neri et al., 2004).
It has to be underlined that when these infections do occur
in children they are often misdiagnosed (Geary & Lucky,
1999). In fact, in the juvenile age group many dermatoses
observed in the feet and toenails are associated with
Fig. 1. Tinea unguium. Longitudinal white striae with a beginning dyshidrosis, eczematoid dermatitis, psoriasis, hyperhidro-
of onycholysis. sis, lichen planus and traumatic diseases (Guenst, 1999).
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 Tinea pedis and tinea unguium in a 7-year-old child

Initially, in children, tinea pedis could be mistaken for one order to provide the most appropriate treatment. Hence,
of the dermatoses described above and hence wrongly making the right diagnosis is the key to obtaining
treated. Consequently it could develop into a chronic lesion epidemiological data as regards the exact prevalence of
favouring ungual infection (Geary & Lucky, 1999). Tinea tinea pedis and tinea unguium in children, and evaluating
pedis may present with various clinical patterns. The major if they are underestimated, rare or increasing.
clinical forms are: interdigital dyshidrosis (‘athlete’s foot’)
and the moccasin-type. Moccasin-type tinea pedis infections
are erythematous and squamous lesions extending to the Acknowledgements
entire plantar surface of the foot, which is extensively The authors thank Professor M. G. Teriaca (Rosmini Institute,
involved. Itching may be also present and intense. University of Turin) for a helpful English review of this manuscript.

Tinea unguium, sometimes consequential to tinea pedis, is

characterized by onycholysis and thickened, discoloured References
(white, yellow, brown, black), brittle and dystrophic nails.
Although inflammation is uncommon, some patients may, Chang, P. & Logemann, H. (1994). Onychomycosis in children. Int J
however, experience pain. The most common aetiological Dermatol 33, 550–551.
agents of tinea pedis, isolated in adults, are T. rubrum and Fernandes, N. C., Akiti, T. & Barreiros, M. G. (2001). Dermatophytoses
Trichophyton mentagrophytes var. interdigitale. In our case in children: study of 137 cases. Rev Inst Med Trop Sao Paulo 43, 83–85.
report, T. rubrum was isolated in a child affected by both Geary, R. J. & Lucky, A. W. (1999). Tinea pedis in children presenting
tinea pedis and tinea unguium, thus demonstrating that as unilateral inflammatory lesions of the sole. Pediatr Dermatol 16,
ungual infection could be a consequence of tinea pedis, and 255–258.
confirming the data in the literature (Ploysangam & Lucky, Guenst, B. J. (1999). Common pediatrics foot dermatoses. J Pediatr
1997). No external contagious source was found; therefore, Health Care 13, 68–71.
tinea pedis infection in the child could be associated with Jang, K. A., Chi, D. H., Choi, J. H., Sung, J. K., Moon, K. C. & Koh, J. K.
the father’s fungal infection, suggesting a family back- (2000). Tinea pedis in Korean children. Int J Dermatol 39, 25–27.
ground and confirming what has been observed by other Lange, M., Nowichki, R., Baranska-Rybak, W. & Bykowska, B.
authors (Chang & Logemann, 1994; Jang et al., 2000). (2004). Dermatophytosis in children and adolescents in Gdansk,
Poland. Mycoses 47, 326–329.
In conclusion, we reported this case for its peculiar and Neri, I., Piraccini, M. B., Guareschi, E. & Patrizi, A. (2004). Bullous
exceptional findings, and its association with tinea pedis tinea pedis in two children. Mycoses 47, 475–478.
and tinea unguium in a 7-year-old boy. Therefore, we sug- Ploysangam, T. & Lucky, A. W. (1997). Childhood white superficial
gest that mycological detection is mandatory to distinguish onychomycosis caused by Trichophyton rubrum: report of seven cases
between a foot dermatosis and tinea pedis in children, in and review of the literature. J Am Acad Dermatol 36, 29–32.

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