Deep and disseminated dermatophytosis in immunocompromised populations-A systematic review.

In 30 seconds

This systematic review assessed patient characteristics, risk factors, diagnostic evidence and treatments for deep dermatophytosis in immunocompromised populations. It included 96 studies published from 1954 to 2025, documenting 134 patients with histopathology- and culture-confirmed disease; Majocchi’s granuloma was excluded. Trichophyton rubrum was the most frequently isolated pathogen, and both acquired and primary immunodeficiencies were associated with risk. Systemic dissemination was reported in 24 patients, including lymph-node and, less commonly, bone, lung and brain involvement. The authors emphasize diagnostic difficulty and the potential need for prolonged treatment.

Key findings

• The review identified 134 patients across 96 studies; Trichophyton rubrum was the most frequently isolated pathogen.
• Systemic dissemination was reported in 24 patients, commonly involving axillary or inguinal lymph nodes; bone, lung and brain infections were also described.
• Acquired immunodeficiencies, including renal transplantation, and primary immunodeficiencies, including CARD9 and STAT3 mutations, were reported as risk factors.
• Terbinafine and itraconazole were among treatments used; multidrug resistance and extended or lifelong treatment were noted as concerns.

Why it matters

Deep dermatophytosis can extend beyond keratinized tissues in immunocompromised patients, with reported involvement of internal organs as well as lymph nodes. Because diagnosis may be challenging and treatment can be prolonged, awareness of invasive disease and appropriate confirmatory testing are important when evaluating suspected dermatophytosis in this population.

What to keep in mind

The evidence is drawn from published case reports and studies rather than comparative trials, so it cannot establish treatment effectiveness or quantify risk across immunocompromised populations.