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Trichomycosis Pubis

  • Author: Vladimir O Osipov, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 18, 2014
 

Background

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.

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Pathophysiology

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.[8] A recent report also described these associations.[9]

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Epidemiology

Frequency

United States

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.

International

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.

Mortality/Morbidity

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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Contributor Information and Disclosures
Author

Vladimir O Osipov, MD Pathologist In Charge, QML Townsville

Vladimir O Osipov, MD is a member of the following medical societies: American Society for Clinical Pathology, United States and Canadian Academy of Pathology, Royal College of Pathologists of Australasia, College of American Pathologists

Disclosure: Nothing to disclose.

Coauthor(s)

Milton W Datta, MD Assistant Professor, Departments of Pathology, Urology, and Hematology-Oncology, Emory University School of Medicine

Milton W Datta, MD is a member of the following medical societies: College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Peter Langenstroer, MD Associate Professor, Department of Urology, Medical College of Wisconsin

Peter Langenstroer, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Scott M Acker, MD Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham

Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Clinical Pathology, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

References
  1. Crissey JT, Rebell GC, Laskas JJ. Studies on the causative organism of trichomycosis axillaris. J Invest Dermatol. 1952 May. 19(3):187-97. [Medline].

  2. Freeman RG, McBride ME, Knox JM. Pathogenesis of trichomycosis axillaris. Arch Dermatol. 1969 Jul. 100(1):90-5. [Medline].

  3. McBride ME, Freeman RG, Knox JM. The bacteriology of trichomycosis axillaris. Br J Dermatol. 1968 Aug. 80(8):509-13. [Medline].

  4. Paxton FV. On a disease condition of the hairs of the axilla, probably of parasitic origin. J Cutan Med. 1869. 3:133.

  5. Savin JA, Somerville A, Noble WC. The bacterial flora of trichomycosis axillaris. J Med Microbiol. 1970 May. 3(2):352-6. [Medline].

  6. Montes L, Vasquez C, Cataldi M. Electron microscopic study of infected hairs in trichomycosis axillaris. J Invest Dermatol. 1963. 40:273-8.

  7. White SW, Smith J. Trichomycosis pubis. Arch Dermatol. 1979 Apr. 115(4):444-5. [Medline].

  8. Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol. 2008 Feb. 58(2 Suppl):S57-8. [Medline].

  9. Bonifaz A, Váquez-González D, Fierro L, Araiza J, Ponce RM. Trichomycosis (trichobacteriosis): clinical and microbiological experience with 56 cases. Int J Trichology. 2013 Jan. 5(1):12-6. [Medline]. [Full Text].

  10. Lestringant GG, Qayed KI, Fletcher S. Is the incidence of trichomycosis of genital hair underestimated?. J Am Acad Dermatol. 1991 Feb. 24(2 Pt 1):297-8. [Medline].

  11. Zaias N, Taplin D, Rebell GS. Final Report, Republic of Panama Medical Research. Washington, DC: Walter Reed Army Institute of Research; 1964.

  12. Bargman H. Trichomycosis of the scrotal hair. Arch Dermatol. 1984 Mar. 120(3):299. [Medline].

  13. Noble WC, Savin JA. Trichomycosis of the scrotal hair. Arch Dermatol. 1985 Jan. 121(1):25. [Medline].

  14. Rosen T, Krawczynska AM, McBride ME, Ellner K. Naftifine treatment of trichomycosis pubis. Int J Dermatol. 1991 Sep. 30(9):667-9. [Medline].

 
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