From the dermatological point of view, multifocal or multicentric
tineas are widespread dermatophytic
infections affecting two or more anatomical areas. In the immunosuppressed patient, these lesions are frequently atypical and the risk factors are not well established. The aims of this study were: to determine the risk factors associated to multicentric
tinea in immunocompromised patients; to evaluate the immune response by
trichophytin and
candidin skin test, to determine the etiological agent and to quantify some serum interleukines. Thirty-six multicentric
tinea and 37 localized
tinea patients, both with immunocompromised factors, were included. By means of a questionnaire several risk factors were identified; the
trichophytin and
candidin skin test was evaluated after 48 hours. Mycological direct examination and culture were performed. The
interleukins IL-2,
IL-4,
IL-10 and
interferon gamma were quantified by ELISA. Statistical analysis was made by Chi-square, U Mann Whitney and logistic regression. In disseminated
tinea patients a predominance of females (69%) versus localized
tinea patients (30%) was observed.
Prednisone,
azathioprine and
cyclophosphamide treatment was associated to multicentric
tinea.
Trichophytin was negative in all disseminated
tinea patients and positive in only three localized
tinea cases,
candidin was positive in six and eight cases of multicentric and localized
tinea respectively. Trichophyton rubrum was the most frequent etiological agent. No differences in
interleukin concentrations were found. Female gender and some immunosuppressor treatments were associated with a high probability to develop multicentric
tinea. In this study a defect in the cellular immune response was the possible explanation for the extensive reactions.