Trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients

Trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chro nic cutaneous and nail infections. even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneo us eruptions that were treated with a potent topical corticosteroid. All th ree patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasi on of T. rubrum. invading directly from the epidermis with no evidence of s ystemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression. may increase the risk of direct dermal invasion of dermatophyte infections. However. even in these patients, the r isk of systemic spread still appears very low. Amphotericin B did not appea r effective in treating these dermatophyte infections.