Refractory Trichophyton rubrum infection in lamellar ichthyosis.

[lamellar ichthyosis]

A 10 -month -old boy with congenital lamellar ichthyosis presented with a chronic Trichophyton rubrum infection . There was no history of atopy or immunosuppression , and examination revealed high total immunoglobulin E (IgE ) with a positive specific IgE for T .Â rubrum . Multiple treatments with fluconazole were necessary to control the infection . T .Â rubrum is present worldwide and is responsible for the vast majority of chronic dermatophytosis . Lamellar ichthyosis is a risk factor for chronic dermatophytosis because of excessive keratin and the barrier defect . A delayed -type hypersensitivity reaction to T .Â rubrum is associated with cure , whereas immediate hypersensitivity and IgE are not protective and may lead to chronic infection . Atopy and the Th 2 profile therefore seem to be associated with chronic dermatophytosis . The association between ichthyosis and atopy is well documented . T . rubrum also has an interesting ability to evade immunity , which helps explain the chronic infection . Finally , in ichthyosis , it is likely that fluconazole has difficulty penetrating the acanthotic stratum corneum , which explains treatment failure . We report this case to alert clinicians to the possible association between lamellar ichthyosis and chronic dermatophytosis and to report the difficulties of management .