- Author: Vladimir O Osipov, MD; Chief Editor: Dirk M Elston, MD more...
Trichomycosis is a bacterial infection of the hair shaft found in sweat gland–bearing areas; it has been described most commonly in the axillary region. While initially believed to be uncommon in the inguinal region, a series of papers have described trichomycosis particular to the inguinal area and have suggested that this disease is underestimated in the general population.
This discussion of trichomycosis, a disease specific to the hair and sweat gland–bearing regions of the body, concentrates on the involvement of the pubic region in men (trichomycosis pubis). First described in the axillary region by Paxton in 1869, the causative role of multiple bacterial Corynebacterium species was established by Freeman et al in 1969.[1, 2, 3, 4, 5] Use of the term trichomycosis, and the implied causative role of fungi, has been maintained. The color differences noted at presentation of the condition, their association with particular corynebacteria, or the possible role of associated cocci have not been clarified.
The causative organism associated with most cases is Corynebacterium tenuis, which prefers the moist microenvironment of the inguinal regions. While as many as 33% of adults have colonization by bacteria in the inguinal or axillary regions, factors such as hyperhidrosis initiate more extensive growth and clinical manifestation. The exact origin of the cement substance that creates the grossly visible nodules is debated. Electron microscopy studies favor origin from the causative agents, while others have favored elaboration from apocrine sweat.[6, 7] The actual nidus may be through the modification of apocrine sweat by elaborated cement substance to create the insoluble material that holds bacteria to the hair shaft.
Rho et al describe a so-called "corynebacterial triad" that includes erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. A recent report also described these associations.
Detailed examination of racial, age, or geographic incidence has not been performed, and examinations in the United States are limited to case reports. A more detailed examination (but still limited) has been performed outside the United States.
Studies in Panama and the United Arab Emirates revealed rates as high as 39% in patients attending a dermatology clinic.[10, 11] These results correlated with the notably higher incidence in areas of high humidity, warmth, and poor hygiene. The only other study to mention incidence noted the presence of trichomycosis pubis when examining institutionalized mentally retarded patients for trichomycosis axillaris in Edinburgh, Scotland, and noted that of 609 men examined, 16 (2.6%) had pubic disease, of which 3 of the cases (0.5%) were not associated with axillary involvement. Ages of the males affected were 18 and 21 (3 patients) and can be culled only from case reports.
Morbidity is low, with most patients unaware of the colonization. When presenting, the most common complaint is a foul odor, and this may continue to cause problems, since trichomycosis often recurs.
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