DERMATOPHYTIC DISEASE - GIANT CUTANEOUS HORN

Background. Dermatophytic disease is a chronic dermatophytosis involvi ng the skin and viscera and caused by benign dermatophytes which cross the skin barrier. We present a case presenting previously unreported giant cutaneous horns. Case report. A male Algerian patient aged 29 ye ars consulted for chronic skin disease which had progressed for 2 year s. Manifestations included warts, papulonodules, eczematiform lesions, lichenifications, alopecia, onyxis, multiple node enlargement and gia nt cutaneous horns on the plantar aspect of the feet making walking di fficult. The patient's kinhood included 10 members and the patient's p arents were first cousins; no other family member had a similar diseas e state. Laboratory findings included eosinophilia(11%, 550 cells/mm(3 )), an inflammatory syndrome, and normal phosphorus and calcium levels despite demineralization of the hands and feel. The tuberculin interd ermal reaction was positive but the trichophytine interdermal reaction was negative. Trichophyton violaceum was found in all mycological sam ples from skin and nails. The histology examination of skin biopsies r evealed acanthosis, considerable hyperkeratosis, and myceleal filament s invading the horny layer, the sweat glands and hair follicles. Absce sses and granulomas were also seen in the superficial dermis. Oral gri seofulvin Ig per day and topical applications with ketoconazole gave c lear improvement. Discussion. Dermatophytic disease is a chronic derma tophytosis observed mainly in North Africa. The locally high rate of c onsanguinous marriages would suggest autosomal recessive inheritance o f a generic anomaly possibly associated with deficient cellular immuni ty. The lesions are polymorphous and develop progressively, probably d ue to diminished cellular immunity. This case with giant cutaneous hor ns would be a new variant. Antifungals can provide definitive cure. Th e pathogenesis of this severe dermatophytosis remains to be establishe d.