這二年皮膚科年會都有提到的 人傳人的皮癬菌
NEJM 去年9月24日的照片挑戰。N Engl J Med 2024;391:1837。Trichophyton indotineae（印度毛癬菌）確實可以在人與人之間傳播。
NEJM 去年9月24日的照片挑戰
Trichophyton indotineae（印度毛癬菌）確實可以在人與人之間傳播。
傳染途徑說明
Trichophyton indotineae 屬於皮癬菌（dermatophytes）的一種，這類真菌主要以皮膚、毛髮、指甲等角質組織為營養來源，感染後會造成各種皮膚癬症。
皮癬菌的傳播方式包括直接的皮膚接觸（如與感染者接觸）以及間接接觸（如共用毛巾、床單、衣物等物品）。
近期國際間報告指出，Trichophyton indotineae 甚至可透過性接觸傳播，尤其在生殖器、臀部、臉部等部位出現皮疹時，需特別警惕。 [覺得同時出現要想〕😅
實際案例 〔今年AMWC也有看到臺灣case
美國、歐洲、日本等地已陸續出現 Trichophyton indotineae 造成的皮膚癬症，部分病例明確指出患者是在與感染者密切接觸（包括性行為）後發病。
有研究報告記載，一名美國女性疑似透過性接觸感染 Trichophyton indotineae，且該菌株對常用抗真菌藥物（如terbinafine）具抗藥性。
公共衛生意義
由於 Trichophyton indotineae 可人傳人，且部分菌株具抗藥性，對於皮膚癬症的防治帶來挑戰。
皮膚癬症患者應避免與他人共用個人用品，並及早接受正確的診斷與治療，以防止傳播。
Trichophyton indotineae 會透過人與人直接或間接接觸傳染，包含但不限於性接觸。若出現疑似皮癬症狀，尤其是生殖器、臀部、臉部等部位，建議及早就醫檢查與治療，以避免進一步傳播及抗藥性問題。
A previously healthy 30-year-old man presented to the dermatology clinic with a 6-month history of an extensive, itchy rash. He had migrated to the United States from Turkey by way of several countries. During his travels, the rash had worsened despite previous treatment with antifungal and glucocorticoid creams. No oral antifungal medications had been prescribed. The physical examination was notable for erythematous, annular, scaly plaques on the right shoulder and inner arm (Panel A), as well as the lower abdomen, groin, and thighs (Panel B). A potassium hydroxide preparation of a skin scraping showed fungal hyphae. Owing to the finding of extensive tinea in an immunocompetent patient who had recently traveled, genetic sequencing of fungal isolates was performed, and Trichophyton indotineae was identified. A final diagnosis of tinea corporis and tinea cruris caused by T. indotineae was made. T. indotineae is an emerging dermatophyte with resistance to topical antifungals and oral terbinafine and with decreased responsiveness to fluconazole and griseofulvin. Clinicians should consider testing for the presence of T. indotineae when managing treatment-refractory or extensive tinea corporis, tinea cruris, and tinea faciei, especially in patients who have traveled in South Asia (although the organism is now reported worldwide). Genetic sequencing is required for species confirmation. After a 6-week course of itraconazole, the rash resolved.
本文僅供衛生教育參考，不能取代專業醫師的診斷、治療或處方。實際用藥種類、強度與療程需由醫師依個別病況判斷。若症狀急速惡化、大面積起水泡、合併發燒或傷口化膿，請立即就醫。