DERMATOFITIDES COMO UN RETO DIAGNÓSTICO: REPORTE DE CASO
Authors/Creators
- 1. Universidad Libre Seccional Cali. Valle del Cauca, Colombia.
- 2. Fundación Universitaria San Martín, Sede Sabaneta. Antioquia, Colombia. Grupo de Investigación en Dermatología (GRINDERMA).
- 3. Universidad de Boyacá. Tunja, Colombia.
- 4. Universidad Libre Seccional Cali. Valle del Cauca, Colombia
Description
Tipo de artículo: Caso clínico
Antecedentes: La reacción dermatofitide (o reacción id) es una dermatosis inflamatoria a distancia por hipersensibilidad a un foco dermatofítico primario, sin invasión fúngica directa del sitio afectado; es una entidad poco reconocida cuyo diagnóstico exige demostrar la infección primaria, la negatividad micológica local y la resolución tras el tratamiento antifúngico dirigido.
Presentación del caso: Hombre de 69 años, trabajador agrícola, con dermatosis interglútea de seis años de evolución (vesículas ulceradas y placas eritemato-descamativas pruriginosas) con mejoría parcial por tratamiento previo con terbinafina oral y tópica. Se documentó cromoniquia y onicólisis en múltiples uñas de ambos pies; el KOH y cultivo interglúteos fueron negativos, y el KOH y Gram ungueal, positivos para estructuras micóticas. La biopsia glútea mostró hiperqueratosis ortoqueratósica, granulosis y acantosis irregular sin alteraciones dérmicas, compatible con reacción dermatofitide superpuesta a liquen simple crónico. Se inició itraconazol oral en pulsos (200 mg/12 h, tres ciclos), amorolfina tópica ungueal e hidrocortisona tópica glútea, con mejoría marcada y sin efectos adversos a los seis de doce meses de seguimiento.
Conclusión: La reacción dermatofitide debe sospecharse ante dermatosis inflamatorias crónicas a distancia de un foco fúngico documentado, sobre todo con examen micológico local persistentemente negativo, ya que su reconocimiento permite reorientar el tratamiento hacia la infección primaria en vez de perpetuar terapias sintomáticas locales.
Abstract (English)
Article type: Clinical case
Background: Dermatophytid reaction (or id reaction) is a distant inflammatory dermatosis triggered by hypersensitivity to a primary dermatophyte focus, without direct fungal invasion of the affected site; it is an underrecognized entity whose diagnosis requires demonstrating the primary infection, negative local mycology, and resolution after targeted antifungal treatment.
Case presentation: A 69-year-old male farm worker presented with a six-year intergluteal dermatosis (ulcerated vesicles and pruritic erythematous-scaly plaques) with partial prior improvement under oral and topical terbinafine. Chromonychia and onycholysis were noted in multiple toenails bilaterally; intergluteal KOH and culture were negative, and nail KOH and Gram staining were positive for fungal structures. Gluteal biopsy showed orthokeratotic hyperkeratosis, granulosis, and irregular acanthosis without dermal abnormalities, compatible with a dermatophytid reaction superimposed on lichen simplex chronicus. Oral pulse itraconazole (200 mg twice daily, three cycles), topical nail amorolfine, and topical gluteal hydrocortisone were started, with marked improvement and no adverse effects at six of twelve planned follow-up months.
Conclusion: Dermatophytid reaction should be suspected in chronic inflammatory dermatoses distant from a documented fungal focus, particularly with persistently negative local direct mycology, since its recognition allows treatment to be redirected toward the primary infection rather than perpetuating local symptomatic therapies.
Files
sanum_v10_n4_a20.pdf
Additional details
Additional titles
- Translated title (English)
- DERMATOPHYTID REACTION AS A DIAGNOSTIC CHALLENGE: A CASE REPORT
Dates
- Collected
-
2026-07-26manuscrito recibido
- Accepted
-
2026-09-10evaluación doble ciego
- Available
-
2026-10-30publicación en numero de la revista
Software
- Repository URL
- https://revistacientificasanum.com/
- Development Status
- Active
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