Maladie dermatophytique de revelation tardive

Dermatophytic disease, described for the first time in 1959 by Hadida and Schousboe, is a chronic dermatophyte infection of the skin and viscera. It is a rare disease occurring mainly in Maghreb. Immunological studies have highlighted a deficit of cellular immunity with autosomal recessive transmission responsible for tolerance to dermatophyte. The first signs of this disease usually occur during childhood. Our patient suffered from pachyonychia affecting all his nails and erythematous, circinate, pruritic, scaly lesions occurring in all his seed coat from the age of 50 years. These disorders were gradually followed by alopecia and hair removal of all body hairy areas, palmoplantar keratoderma as well as bilateral axillary and inguinal adenopathies. Tricophyton violaceum was isolated from patient’s nails. No immune deficiency was found or visceral involvement within the limits of the assessments made. The evolution was marked by transient improvements, resistance of adenopathies and skin appendage involvement as well as by multiple relapses despite griseofulvin therapy. Dermatophytic disease is a serious life-threatening disease due to its inexorable evolution toward visceral involvement. The improvement of patient’s immune system associated with antifungal therapy may be the best treatment.