Profuse Atypic Dermatophytosis in a Person Infected By HIV

Case Report

Austin J Dermatolog. 2017; 4(1): 1070.

Profuse Atypic Dermatophytosis in a Person Infected By HIV

Ouédraogo MS1,2*, Ouédraogo NA2,3, Andonaba JB4, Tapsoba GP1,2, Korsaga/Somé N1,2, Sakandé J2,5, Barro/Traoré F2, Niamba P1,2 and Traoré A1,2

1Department of Dermatology, Yalgado Ouédraogo University Hospital, Burkina Faso

2University of Ouagadougou I Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso

3Unit of Dermatology, Raoul Follereau Center, Burkina Faso

4Department of Dermatology, Souro Sanon University Hospital, Burkina Faso

5Department of Laboratory, Yalgado Ouédraogo University Hospital, Burkina Faso

*Corresponding author: Ouédraogo MS, Department of Dermatology, Yalgado Ouédraogo University Hospital, University of Ouagadougou I Pr Joseph Ki Zerbo, 04 BP 8201 Ouagadougou 04, Burkina Faso

Received: April 03, 2017; Accepted: May 12, 2017; Published: May 23, 2017


Profuse dermathophytosis can be observed on people infected by HIV. The socio-economic context of Burkina Faso pushes the patients to primarily adopt traditional treatments that modify the clinical aspect of the lesions.

It was about a patient of 47 years old, a farmer, admitted at hospital for squamous pruritic skin lesions of the face and the chest, in a context of general alteration. The lesions were evolving since three years in a chronic and slowly extensive mode. A traditional treatment (black powder of Khaya senegalensis with shea butter) was done without any improvement of the lesions. The patient was seropositive to the HIV type 1, known since two years, and irregularly treated by TDF/ FTC/ EFV since six months with a voluntarily interruption one month ago. The examination showed large closets of various size skin flakes highly pigmented with clear limits, with circinate skin flakes borders on the face and the chest. The mycological examination of the skin flakes isolated a Trichophyton rubrum. The diagnosis of a circinate dermatophytosis profuse chronic modified by the traditional treatments to a person infected with HIV was established. The recovery was obtained after 3 months of antifungal local and general treatment.

The clinical atypia of this dermatophytosis was induced by the traditional treatments. The therapeutic vagrancy was responsible of the chronicity of this table. It is recommended to the people infected by HIV extended antifungal treatment in order to obtain an optimal efficiency. These patients are indeed a slow response to the treatments and a frequent recurrence.

Keywords: Circinate dermatophytosis; HIV; Traditional treatment


HIV: Human Immunodeficiency Virus; ARV: Antiretroviral; TDF: Tenofovir; FTC: Emticitrabine; EFV: Efavirens; Mg: Milligram; °C: Celsius Degree; Kg/m²: Kilogram/Square Meter; Mm³: Cubic Millimeter; g/dl: Gram/Deciliter


The dermatophytosis are mycosis cutaneous infections classified between the five cutaneous affections most frequently observed during the HIV infection [1-4]. Sixteen to 50% of these patients are concerned [2,5]. In Burkina Faso, a sahelian country situated in West Africa, Traoré and al in a hospital survey found that dermatophytosis were occupying the 2nd place of cutaneous infections on patients infected by HIV [4]. Their clinical aspect is variable. The profusion of the lesions is described on patients having less than 200 lymphocytes CD4/mm3 [1,2]. The resistance to the local and general antifungal and/or the relapses after the stopping of the treatment are frequent [1,5]. The traditional phytotherapyis the first solution for the Burkinabe people because it is lower cost than the modern treatments. However it can clinically modify the lesions and even be a source of some complications like eczema, irritation or over infection [6,7]. Khaya senegalensis and Butyrospermum parkii are plants with several properties. They are commonly used for traditional treatment of cutaneous diseases including dermatophytosis. We present a case of an atypical profuse dermatophytosis modified by a traditional treatment on a patient infected by HIV.

Case Presentation

A man of 47 years old was admitted on the 18th August 2014 for skin flakes on the face and the chest with general state altered. The starting was of 3 years by some skin flakes pruritic lesions of centrifugal extension on the chest, and later on the face, the inguinal fold and intergluteal fold. A traditional treatment was prescribed with Khaya senegalensis beverage to be drank, used in bath and in cataplasm (a black powder of barks mixed with shea butter Butyrospermum parkii) to be used on the lesions during one month. The disappearance of the lesions was not effective. An increase of the pruritus was observed. The patient was infected by HIV of type I, diagnosed since two years. He was irregularly treated in the health facility of the area where he was living. His Anti-Retroviral treatment (ARV) started 6 months ago was made of Tenofovir (TDF), Emticitrabine (FTC), Efavirens (EFV). He interrupted the treatment by his own will since a month. The examination showed large placards of variable size skin flakes on their surface with a high pigmentation very clear on the limits whose borders were skin flakes, circinated for most of them, except on the face and the front temporal area of the hair (Figure 1). The lesions were also visible on the neck, the posterior neckline (Figure 2), the antero lateral faces of the chest (Figure 3), the inguinal folds and the pubis (Figure 4), the intergluteal fold, the inferior cadrans of the right buttock, the left trochanterien area and the right knee. We didn’t notice any injury on the nails or palmoplantar zone. The patient was presenting a bad general aspect constituted by an infectious syndrome with a temperature at 38,5°C, a slimming with a body mass index at 14,34 kg/m² (18,5-25kg/m²), by pale conjunctiva and a deep asthenia. The tongue was clean without any injury. There was no edema of the lower limbs or notion of neither dysphagia nor chronic diarrhea. The neuropsychiatric exam was normal. We talked of a circinate profuse and chronic dermatophytosis modified by the traditional treatments on a person infected with HIV, a profuse seborrhea dermatitis and an erythema pellagroide. The blood count showed a normocytic normochromic anemia with an hemoglobin rate at 6,8g/dl (12-17g/dl), a leukopenia at 2300/mm³ (4000-10000/ mm3) with a lymphopenia at 575/mm³ (1500-4000/mm3). The number of lymphocytes CD4+ Tcell was of 22 cells/mm³ and the viral load of 390000 copies/ml. The mycological test of the skin flakes on two different areas (anterior face of the chest, face) showed the presence of mycelium filaments at the direct examination. The exam identified Trichophyton rubrum. The prescribed treatment was made of chlorexidine in foam solution flowing for the toilet, of ketoconazole cream to be applied once a day, an emollient cream made of glycerol, vaseline and paraffin liquid once a day, of ketoconazole tablets 200mg per day, of poly vitamins tablets (Alvityl® 1 tablet a day) and an hyper protidic regime. The evolution after three weeks was marked by a complete disappearance of the skin flakes. However, it was noted the presence of a vesicular erythematosus edge on the lesions of the chest (Figure 5), not elsewhere (Figure 6). After two months treatment, this active edge was persisting. Then, we prescribed sertaconazole cream in two applications per day and terbinafine tablet 250mg per day with a recovery of the lesions one month later.