Atypical presentation of dermatophytosis: a presenting feature in three HIV patients

Dermatophytosis is a superficial fungal infection of keratinized tissues like skin, hair, and nails 1. Dermatophytosis manifests as an opportunistic infection being four times more prevalent in Acquired Immunodeficiency Syndrome (AIDS) patients 2,3. In India, the incidence of superficial fungal infections in Human Immunodeficiency Virus (HIV)-positive individuals is variable, ranging from 8% to 22% 2,4. Dermatological manifestations in HIV patients are atypical, more severe, and resistant to treatment compared to HIV-negative individuals 5. The frequently isolated species causing dermatophytosis are Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. Atypical, extensive, and anergic forms of dermatophytosis may at times constitute the presenting features of HIV-positive patients. Tinea imbricata or Tokelau is a fungal infection of the skin, manifesting as multiple concentric rings of erythematous papules, pustules, scaling, and crusting, caused by Trichophyton concentricum. Tinea pseudoimbricata or tinea indecisiva are the terms given for similar clinical presentations caused by fungal agents other than T. concentricum (e.g., T. tonsurans) 6. Here, we report two male patients and one female patient who presented with tinea pseudoimbricata, subsequently detected to be HIV-positive.