Tinea capitis caused by Trichophyton violaceum successfully treated with fosravuconazole
Abstract
Dear Editor, Trichophyton violaceum, one of the anthropophilic dermatophytes, is associated with high rates of asymptomatic carriage. The presence of dermatophytes on the scalp hairs of elderly individuals can be a source of infection.1 Tinea capitis is often a recalcitrant infection indicating a long course of oral antifungal medication. We successfully treated a patient with a black dot ringworm caused by T. violaceum using oral fosravuconazole. An apparently healthy 82yearold woman presented to our hospital with annular erythemas on the right side of her neck in August 2020. She lived by herself. Topical steroids had been administrated intermittently for 4 months to no avail. She reported that discoloration and thickening of her big toenails had been treated with topical efinaconazole for 20 months (Figure 1a). A direct microscopic examination of skin and nail samples revealed fungal elements, supporting a diagnosis of tinea corporis et unguium. Moreover, a dermoscopic examination to investigate the cause of mild hair loss revealed numerous black dots on her right temporal region (Figure 1b). Direct microscopy of her hair disclosed endothrix infection with numerous large conidia (Figure 1c). A plate culture of skin and hair on Sabouraud’s dextrose agar at 25°C yielded a deepviolet colony with a yellowbrown reverse after 2 months (Figure 1d). A toenail specimen culture was negative. Although both macroconidia and microconidia were few or absent in T. violaceum,2 we…
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