Major outbreak of dermatophyte infections leading into imitation of different skin diseases: Trichophyton mentagrophytes is the main criminal fungus

INTRODUCTION: It is well known that fungal skin infections lead into different clinical presentations but when some countries face epidemic or outbreak of infection, this will lead into more confusions in clinical presentation, so more new odd clinical faces of the disease.
METHODS: This is a case series study where 500 cases with misdiagnosis or suspicion of different skin diseases but with suspicion of fungal skin infections that presenting with unusual clinical pictures were collected during the period from 2016-2021 years. Skin samples from lesions of the cases including scales and hair were collected and examined by direct microscopic examination. In addition, skin scraping and hair were taken from 92 patients (as a sample for culture and/or polymerase chain reaction) with suspicion and misdiagnosis of dermatophyte infections during the period from April to December 2019, for mycological diagnostics and sequencing.
RESULTS: This study included 500 patients,298(59.6%) male and 202(40.4%) females with varying types of dermatophyte infections. All patients had atypical clinical presentations with prior misdiagnosis of different non-fungal skin diseases.Dermatophyte infections were mimicking the following diseases: Psoriasis-like lesion(50.2%) was the most common clinical presentation while dermatitis-like seen in 107(21.4%)patients,photosensitivity-like in 24(4.8%) cases,keratoderma in 17(3.4%),seborrheic dermatitis-like in 14(2.8%),napkin dermatitis-like in 12(2.4%),folliculitis-like in 12(2.4%),rosacea-like in 12(2.4%),moth eaten alopecia in 11(2.2%),lupus erythematosus-like in 10(2%),discoid lupus erythematosus-like in 8(1.6%),granuloma annularae-like in 4(0.8%), pityriasis alba-like in 3(0.6%) and others.
DISCUSSION AND CONCLUSION: Iraq is running major outbreak of dermatophyte infections that have bizzare clinical pictures and imitating many skin diseases commonly psoriasis, dermatitis, photosensivity and keratoderma. Trichophyton mentagrophytes represented the most frequent dermatophyte that has been isolated.