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Cervical intertrigo: Think beyond fungi
Intertrigo cervical: más allá de los hongos
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En los casos en que solo se requiera determinar una sola, si es baja, se debe realizar la medida de otra enzima, ya que se debe tener presente la posibilidad de deficiencia de múltiple sulfatasa. Esto es importante principalmente para aquellas que tienen terapia de reemplazo enzimático, ya que la terapia solo debe ser administrada para una deficiencia, y se puede cometer el error de tratar una deficiencia de múltiples sulfatasas con una sola terapia si no se verifica. Una vez se tenga el valor se debe confirmar con determinación en leucocitos o fibroblasto, lo que establece el diagnóstico definitivo. En la línea azul se señala el último paso, que sería la prueba molecular, y si está disponible se debe realizar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Luis Suarez-Guerrero, Pedro José Iván Gómez Higuera, Juan Sebastian Arias Flórez, Gustavo Adolfo Contreras-García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jorge Luis" "apellidos" => "Suarez-Guerrero" ] 1 => array:2 [ "nombre" => "Pedro José Iván" "apellidos" => "Gómez Higuera" ] 2 => array:2 [ "nombre" => "Juan Sebastian" "apellidos" => "Arias Flórez" ] 3 => array:2 [ "nombre" => "Gustavo Adolfo" "apellidos" => "Contreras-García" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0370410615002582?idApp=UINPBA00004N" "url" => "/03704106/0000008700000004/v1_201608250156/S0370410615002582/v1_201608250156/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S037041061500265X" "issn" => "03704106" "doi" => "10.1016/j.rchipe.2015.10.010" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "116" "copyright" => "Sociedad Chilena de Pediatría" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Chil Ped. 2016;87:288-92" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4649 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 4134 "PDF" => 475 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Síndrome de Sotos diagnosticado por hibridación genómica comparativa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "288" "paginaFinal" => "292" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sotos syndrome diagnosed by comparative genomic hybridisation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 962 "Ancho" => 2551 "Tamanyo" => 160291 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Análisis cromosómico por microarreglos de alta resolución de todo el material genético. Los puntos negros indican material genético en parámetros normales, sin exceso o déficit. En rojo se muestra pérdida de material genético del brazo largo del cromosoma 5, de 2.082 MB correspondiente a la región 5q35.2 q35.3 que incluye el gen NSD1.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Wilmar Saldarriaga, Laura Camila Molina-Barrera, Julián Ramírez-Cheyne" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Wilmar" "apellidos" => "Saldarriaga" ] 1 => array:2 [ "nombre" => "Laura Camila" "apellidos" => "Molina-Barrera" ] 2 => array:2 [ "nombre" => "Julián" "apellidos" => "Ramírez-Cheyne" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S037041061500265X?idApp=UINPBA00004N" "url" => "/03704106/0000008700000004/v1_201608250156/S037041061500265X/v1_201608250156/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief communication</span>" "titulo" => "Cervical intertrigo: Think beyond fungi" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "293" "paginaFinal" => "294" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Butragueño Laiseca, Blanca Toledo del Castillo, Rafael Marañón Pardillo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Butragueño Laiseca" "email" => array:1 [ 0 => "laura_bl@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Blanca" "apellidos" => "Toledo del Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rafael" "apellidos" => "Marañón Pardillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intertrigo cervical: más allá de los hongos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2000 "Ancho" => 1500 "Tamanyo" => 383889 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well demarcated, fiery-red neck crease patch typical of <span class="elsevierStyleItalic">Streptococcus pyogenes</span> intertrigo.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Group A <span class="elsevierStyleItalic">Streptococcus</span> (GAS) has a widely known role in several skin infections such as cellulitis, impetigo or erysipelas, but its involvement in intertrigo is clearly underrecognized and scarcely reported.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Intertriginous cervical dermatitis, caused by the friction of two appositional skin surfaces is a common entity in newborns and infants due to the predisposition of particular anatomic features, e.g. deep skin folds, drooling, limited neck space, chubbiness. Other typical sites of intertrigo in children are the inguinal, axillary and thigh areas.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondary infection frequently occurs, especially caused by common skin commensals (<span class="elsevierStyleItalic">Candida albicans</span> and other fungi) but other more worrisome pathogens such as <span class="elsevierStyleItalic">Staphylococcus aureus or</span> GAS must also be taken into consideration.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The differential diagnosis includes seborrheic and atopic dermatitis. These disorders are also triggers for intertrigo superinfections, which in turn can vastly exacerbate the previous skin condition.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Less frequent causes of intertrigo are erythrasma, inverse psoriasis, scabies and histiocytosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We describe a case of cervical streptococcal intertrigo to remind of this entity and with the aim of avoiding delays in diagnosis that can lead to worsening of symptoms and even systemic complications such as secondary bacteremia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 2-month-old male presented to the emergency department with a 4-day history of progressive intertriginous erythema. The child was otherwise healthy and afebrile, and his personal history was unremarkable, except for right plagiocephaly.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Physical examination revealed a fairy-red, well-demarcated, mild foul smelling weeping patch in the neck fold, more evident on the right side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no satellite lesions clearly visible and no other lesions were found in any other location. A bacterial superinfection was suspected and a swab sample was obtained to perform a rapid antigen detection test for GAS, with a positive result. Skin swab microbiological cultures later yielded an intense growth of GAS, and <span class="elsevierStyleItalic">S. aureus</span> was also detected, but no fungi were isolated. The patient was diagnosed with streptococcal intertrigo and a 10-day antibiotic course with amoxicillin plus clavulanic acid was prescribed. Topical treatment with mupirocin and zinc sulphate solution was also indicated. The patient was evaluated 24<span class="elsevierStyleHsp" style=""></span>h later with improvement of the lesions, with complete resolution of the condition within a week.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Even though streptococcal intertrigo has distinctive clinical features, this entity is often misdiagnosed and still underreported. In our review of the literature, we found 7 cases of this particular condition. Six of them were in infants under 6 months of age (3–5 months), whilst the remaining corresponded to a 2-year-old female,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> constituting our patient the youngest of the series. All but one of the cases involved the neck crease<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4–7</span></a> and one patient developed secondary bacteremia requiring hospitalization and intravenous antibiotic treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">GAS etiology may be suspected when a beefy-red, sharply-demarcated, smooth, satellite-free, typically unilateral lesion is found, with foul smell associated. A poor clinical response to topical antifungal and steroid treatment should also indicate toward the presence of this pathogen.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnostic suspicion is corroborated by a positive rapid streptococcal antigen test, and final diagnosis is given by skin swab culture.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Treatment is based on a 7–10-day antibiotic course with oral amoxicillin<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>clavulanic acid (<span class="elsevierStyleItalic">penicillin and first-generation cephalosporins are other options</span>) and topical antibiotics. Antifungal or low potency steroid creams could be added, especially in patients with a personal history of atopic dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4–7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Intertriginous cervical dermatitis is a common disorder in newborns and infants. Secondary infection is frequent, typically caused by common skin commensals (<span class="elsevierStyleItalic">C. albicans</span>). GAS must be considered as one of the causative agents of intertrigo, distinctive clinical features characterize this condition. Clinical recognition of this entity is crucial for an early diagnosis, avoiding worsening of the lesions and systemic complications resulting from inappropriate treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2000 "Ancho" => 1500 "Tamanyo" => 383889 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well demarcated, fiery-red neck crease patch typical of <span class="elsevierStyleItalic">Streptococcus pyogenes</span> intertrigo.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Streptococcal intertrigo: an underrecognized condition in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. 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| 2024 February | 57 | 5 | 62 |
| 2024 January | 73 | 7 | 80 |
| 2023 December | 65 | 14 | 79 |
| 2023 November | 51 | 9 | 60 |
| 2023 October | 99 | 19 | 118 |
| 2023 September | 89 | 3 | 92 |
| 2023 August | 65 | 9 | 74 |
| 2023 July | 66 | 9 | 75 |
| 2023 June | 53 | 3 | 56 |
| 2023 May | 70 | 6 | 76 |
| 2023 April | 50 | 3 | 53 |
| 2023 March | 64 | 4 | 68 |
| 2023 February | 50 | 7 | 57 |
| 2023 January | 32 | 8 | 40 |
| 2022 December | 37 | 4 | 41 |
| 2022 November | 38 | 8 | 46 |
| 2022 October | 48 | 9 | 57 |
| 2022 September | 54 | 12 | 66 |
| 2022 August | 34 | 9 | 43 |
| 2022 July | 24 | 16 | 40 |
| 2022 June | 32 | 11 | 43 |
| 2022 May | 32 | 10 | 42 |
| 2022 April | 56 | 13 | 69 |
| 2022 March | 57 | 11 | 68 |
| 2022 February | 67 | 8 | 75 |
| 2022 January | 57 | 17 | 74 |
| 2021 December | 30 | 16 | 46 |
| 2021 November | 45 | 8 | 53 |
| 2021 October | 64 | 10 | 74 |
| 2021 September | 58 | 12 | 70 |
| 2021 August | 81 | 9 | 90 |
| 2021 July | 40 | 14 | 54 |
| 2021 June | 28 | 5 | 33 |
| 2021 May | 31 | 8 | 39 |
| 2021 April | 116 | 16 | 132 |
| 2021 March | 71 | 12 | 83 |
| 2021 February | 44 | 7 | 51 |
| 2021 January | 77 | 10 | 87 |
| 2020 December | 49 | 13 | 62 |
| 2020 November | 55 | 13 | 68 |
| 2020 October | 47 | 2 | 49 |
| 2020 September | 75 | 13 | 88 |
| 2020 August | 57 | 9 | 66 |
| 2020 July | 52 | 1 | 53 |
| 2020 June | 58 | 10 | 68 |
| 2020 May | 40 | 9 | 49 |
| 2020 April | 36 | 5 | 41 |
| 2020 March | 38 | 7 | 45 |
| 2020 February | 36 | 7 | 43 |
| 2020 January | 28 | 5 | 33 |
| 2019 December | 20 | 7 | 27 |
| 2019 November | 20 | 10 | 30 |
| 2019 October | 23 | 7 | 30 |
| 2019 September | 13 | 5 | 18 |
| 2019 August | 8 | 4 | 12 |
| 2019 July | 17 | 10 | 27 |
| 2019 June | 35 | 23 | 58 |
| 2019 May | 70 | 14 | 84 |
| 2019 April | 27 | 7 | 34 |
| 2019 March | 12 | 7 | 19 |
| 2019 February | 3 | 9 | 12 |
| 2019 January | 2 | 5 | 7 |
| 2018 December | 8 | 6 | 14 |
| 2018 November | 13 | 3 | 16 |
| 2018 October | 11 | 8 | 19 |
| 2018 September | 19 | 3 | 22 |
| 2018 August | 4 | 1 | 5 |
| 2018 July | 5 | 1 | 6 |
| 2018 June | 5 | 1 | 6 |
| 2018 May | 8 | 1 | 9 |
| 2018 April | 5 | 1 | 6 |
| 2018 March | 7 | 1 | 8 |
| 2018 February | 11 | 1 | 12 |
| 2018 January | 4 | 2 | 6 |
| 2017 December | 4 | 0 | 4 |
| 2017 November | 4 | 1 | 5 |
| 2017 October | 4 | 2 | 6 |
| 2017 September | 4 | 3 | 7 |
| 2017 August | 6 | 1 | 7 |
| 2017 July | 4 | 1 | 5 |
| 2017 June | 12 | 2 | 14 |
| 2017 May | 11 | 0 | 11 |
| 2017 April | 5 | 0 | 5 |
| 2017 March | 4 | 42 | 46 |
| 2017 February | 10 | 4 | 14 |
| 2017 January | 10 | 1 | 11 |
| 2016 December | 17 | 2 | 19 |
| 2016 November | 31 | 8 | 39 |
| 2016 October | 30 | 6 | 36 |
| 2016 September | 35 | 5 | 40 |
| 2016 August | 16 | 5 | 21 |
| 2016 July | 0 | 1 | 1 |
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