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Tinea Nigra Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
 
Updated: Jun 22, 2016
 

History

Generally, patients with tinea nigra are asymptomatic. Rarely, pruritus may be reported. The absence of any discomfort often delays the patient's decision to seek medical advice.

Patients who live in the inland areas of the United States generally report a history of foreign travel, most often to the Caribbean islands. In addition, patients may have acquired this infection while visiting the tropical regions of Asia or Africa. Those who reside in the coastal regions do not necessarily report any travel outside of the United States.

Uezato et al[11] reported a case of tinea nigra palmaris from Okinawa, Japan on the left palm of a 13-year-old girl, who had noticed the pigmented, asymptomatic macule on her left palm approximately 4-5 years prior to presentation. She stated the lesion became lighter after a bath and darkened some time later. Physical examination revealed a 4 X 5-cm, dark brown, and irregularly shaped macule.

Histological findings were reported as follows: "Direct potassium hydroxide (KOH) microscopic examination from skin scrapings revealed branched brown hyphae with light brown septa. A fungal culture on Sabouraud's agar media produced wet, medium brown, yeast-like colonies, the surface of which later became black and shiny. A slide culture disclosed light brown, elliptic or peanut-shaped conidia comprised of one to two ampullaceous cells. Scanning electron microscopic examination of the conidia showed both annellation [sic] conidia with lunate bud scars and sympodial conidiogenesis."

DNA was extracted from separately cultured fungi, and polymerase chain reaction with primers specific to H werneckii was performed; results showed positive bands. Direct sequencing was performed with the DNA segments from the positive bands. Type C H werneckii was determined to be the causative fungus, based on the base sequences obtained, and tinea nigra due to H werneckii was diagnosed.

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Physical

Tinea nigra is characterized by the presence of a painless brown-to-black macule, as shown in the image below. The macule appears insidiously as a small dark spot.

Tinea nigra, evident as a painless cluster of brow Tinea nigra, evident as a painless cluster of brown-to-black macules. Courtesy of Dr. Peter Santalucia.

Hyperpigmentation of the macule ranges from light brown to black discoloration, resembling silver nitrate or India ink stains. The borders are typically discrete. The pigmentary change may appear mottled or velvety.

The lesions are typically solitary, although more than one lesion can be present. Solitary lesions are typically located on the palmar surfaces of the hands or plantar surfaces of the feet, and they may extend to the fingers or toes, respectively. Other areas of the body, such as the neck and chest wall, are more rarely affected.

The shape of the lesion varies, and they may appear ovoid, round, or irregular. The lesion slowly grows over weeks to months. The size may range from a few millimeters to several centimeters in diameter, depending on the duration of the infection.

Other physical findings, such as erythema or induration, are absent. Rarely, scaling is present. Dermoscopic examination may facilitate the in vivo diagnosis of tinea nigra.[12, 13] Manual and digital dermatoscopic images show irregularly distributed dark brown-pigmented dots with a filamentous aspect,[14] that is, brown strands or spicules.[15]  There may also be a parallel ridge pattern, one associated with melanomas.[16]

Although tinea nigra is often easily diagnosed on clinical grounds alone,[17] the use of dermoscopy for palmar or plantar pigmentation may enhance the recognition of tinea nigra.[18, 19] Characteristic features evident on dermoscopy are superficial fine, wispy, light-brown strands forming a reticularlike patch with a uniform brown color. These strands do not follow the furrows and ridges normally observed in this skin. There are no pigment network, globules, and stripes that would suggest a melanocytic neoplasm.[20]

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Causes

Tinea nigra is due to infection by the fungus, P werneckii, which is classified in the family Dematiaceae, class Hyphomycetes, phylum Deuteromycota. Infection occurs after inoculation subsequent to trauma. The dermatomycosis tends to occur in areas with an increased concentration of eccrine sweat glands. Hyperhidrosis appears to be a risk factor for this disease.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Vinay Arya, MD, to the development and writing of this article.

References
  1. Schwartz RA. Superficial fungal infections. Lancet. 2004 Sep 25-Oct 1. 364(9440):1173-82. [Medline].

  2. Perez C, Colella MT, Olaizola C, Hartung de Capriles C, Magaldi S, Mata-Essayag S. Tinea nigra: report of twelve cases in Venezuela. Mycopathologia. 2005 Oct. 160(3):235-8. [Medline].

  3. Badali H, Carvalho VO, Vicente V, et al. Cladophialophora saturnica sp. nov., a new opportunistic species of Chaetothyriales revealed using molecular data. Med Mycol. 2009 Feb. 47(1):51-62. [Medline].

  4. Blank H. Tinea nigra: a twenty-year incubation period?. J Am Acad Dermatol. 1979 Jul. 1(1):49-51. [Medline].

  5. Lenassi M, Vaupotic T, Gunde-Cimerman N, Plemenitas A. The MAP kinase HwHog1 from the halophilic black yeast Hortaea werneckii: coping with stresses in solar salterns. Saline Systems. 2007. 3:3. [Medline].

  6. Rezusta A, Gilaberte Y, Betran A, Gene J, Querol I, Arias M, et al. Tinea nigra: a rare imported infection. J Eur Acad Dermatol Venereol. 2010 Jan. 24(1):89-91. [Medline].

  7. Chen GY, Cheng YW, Wang CY, Hsu TJ, Hsu MM, Yang PT, et al. Prevalence of skin diseases among schoolchildren in Magong, Penghu, Taiwan: a community-based clinical survey. J Formos Med Assoc. 2008 Jan. 107(1):21-9. [Medline].

  8. Cabrera R, Sabatin N, Urrutia M, Sepúlveda R. [Tinea nigra: a allochthonous case report in Chile]. Rev Chilena Infectol. 2013 Feb. 30(1):90-3. [Medline].

  9. Hall J, Perry VE. Tinea nigra palmaris: differentiation from malignant melanoma or junctional nevi. Cutis. 1998 Jul. 62(1):45-6. [Medline].

  10. Tseng SS, Whittier S, Miller SR, Zalar GL. Bilateral tinea nigra plantaris and tinea nigra plantaris mimicking melanoma. Cutis. 1999 Oct. 64(4):265-8. [Medline].

  11. Uezato H, Gushi M, Hagiwara K, Kayo S, Hosokawa A, Nonaka S. A case of tinea nigra palmaris in Okinawa, Japan. J Dermatol. 2006 Jan. 33(1):23-9. [Medline].

  12. Zalaudek I, Giacomel J, Cabo H, Di Stefani A, Ferrara G, Hofmann-Wellenhof R, et al. Entodermoscopy: a new tool for diagnosing skin infections and infestations. Dermatology. 2008. 216(1):14-23. [Medline].

  13. Maia Abinader MV, Carvalho Maron SM, Araújo LO, Silva Ado A. Tinea nigra dermoscopy: A useful assessment. J Am Acad Dermatol. 2016 Jun. 74 (6):e121-2. [Medline].

  14. Paschoal FM, de Barros JA, de Barros DP, de Barros JC, Filho CD. Study of the dermatoscopic pattern of tinea nigra: report of 6 cases. Skinmed. 2010 Nov-Dec. 8(6):319-21. [Medline].

  15. Haliasos EC, Kerner M, Jaimes-Lopez N, Rudnicka L, Zalaudek I, Malvehy J, et al. Dermoscopy for the pediatric dermatologist part I: dermoscopy of pediatric infectious and inflammatory skin lesions and hair disorders. Pediatr Dermatol. 2013 Mar. 30(2):163-71. [Medline].

  16. Noguchi H, Hiruma M, Inoue Y, Miyata K, Tanaka M, Ihn H. Tinea nigra showing a parallel ridge pattern on dermoscopy. J Dermatol. 2015 May. 42 (5):518-20. [Medline].

  17. Muir J. Tinea nigra and dermoscopy. Australas J Dermatol. 2012 Feb. 53(1):e14; author reply e15. [Medline].

  18. Piliouras P, Allison S, Rosendahl C, Buettner PG, Weedon D. Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases. Australas J Dermatol. 2011 Aug. 52(3):191-4. [Medline].

  19. Darrigade AS, Saint-Marie D, Dufour J, Edouard S, Graille J, Cheuret M, et al. [The value of dermoscopy in the diagnosis of tinea nigra]. Ann Dermatol Venereol. 2014 Feb. 141(2):167-9. [Medline].

  20. Rossetto AL, Corrêa PR, Cruz RC, Pereira EF, Haddad Junior V Filho. A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis. An Bras Dermatol. 2014 Jan-Feb. 89(1):165-166. [Medline]. [Full Text].

  21. Tilak R, Singh S, Prakash P, Singh DP, Gulati AK. A case report of tinea nigra from North India. Indian J Dermatol Venereol Leprol. 2009 Sep-Oct. 75(5):538-9. [Medline].

  22. Chen WT, Tu ME, Sun PL. Superficial Phaeohyphomycosis Caused by Aureobasidium melanogenum Mimicking Tinea Nigra in an Immunocompetent Patient and Review of Published Reports. Mycopathologia. 2016 Feb 16. [Medline].

  23. Madke B, Doshi B, Wankhede P, Nayak C. Palmar lichen planus mimicking tinea nigra. Indian J Dermatol. 2013 Sep. 58(5):407. [Medline]. [Full Text].

  24. Babel DE, Pelachyk JM, Hurley JP. Tinea nigra masquerading as acral lentiginous melanoma. J Dermatol Surg Oncol. 1986 May. 12(5):502-4. [Medline].

  25. Burke WA. Tinea nigra: treatment with topical ketoconazole. Cutis. 1993 Oct. 52(4):209-11. [Medline].

  26. Rossetto AL, Cruz RC. Tinea nigra: successful treatment with topical butenafine. An Bras Dermatol. 2012 Nov-Dec. 87(6):939-41. [Medline].

  27. Marks JG Jr, King RD, Davis BM. Treatment of tinea nigra palmaris with miconazole. Arch Dermatol. 1980 Mar. 116(3):321-2. [Medline].

  28. Shannon PL, Ramos-Caro FA, Cosgrove BF, Flowers FP. Treatment of tinea nigra with terbinafine. Cutis. 1999 Sep. 64(3):199-201. [Medline].

  29. Rossetto AL, Cruz RC. Spontaneous cure in a case of Tinea nigra. An Bras Dermatol. 2012 Feb. 87(1):160-2. [Medline].

 
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Tinea nigra, evident as a painless cluster of brown-to-black macules. Courtesy of Dr. Peter Santalucia.
Tinea nigra, showing hyperkeratosis and mild acanthosis. A scant amount of perivascular lymphocytic infiltrate may be found in the papillary and subpapillary layers of the dermis (hematoxylin and eosin stain). Courtesy of Thomas N. Helm, MD.
Tinea nigra, with histologic section demonstrating periodic acid-Schiff–positive septate hyphae within the stratum corneum. Courtesy of Thomas N. Helm, MD.
 
 
 
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