# Epidermophyton floccosum, an etiological agent of tinea pedis and tinea unguium: about two cases

## TL;DR

This paper reports two cases of fungal infections caused by Epidermophyton floccosum and highlights the role of molecular techniques in accurate diagnosis.

## Contribution

The paper presents two clinical cases where molecular methods confirmed E. floccosum as the causative agent.

## Key findings

- E. floccosum was identified in a case of tinea pedis using real-time PCR.
- A case of tinea unguium was also confirmed as E. floccosum via molecular techniques.
- Molecular biology aids in accurate diagnosis when conventional methods are insufficient.

## Abstract

Dermatophytia is an infection caused by keratinophilic filamentous fungi. The distribution of dermatophytes varies by country and geographic area. Epidermophyton (E) floccosum has experienced a downward trend in recent years. It is an anthropophilic dermatophyte that causes mainly skin infections in humans. We report two observations of a tinea pedis and a tinea unguium due to E. floccosum. A 70-year-old diabetic patient was admitted to dermatology to manage leg erysipelas. The patient had scaly plantar keratoderma and intertrigo of the toe-web spaces. Mycological sampling showed at direct examination mycelial filaments. A real-time Polymerase Chain reaction (PCR) allowed the identification of E. floccosum. The patient was treated with terbinafine ointment and short-term antibiotic therapy with favorable clinical course. A 70-year-old patient presented with subungual hyperkeratosis of the two big toenails, longitudinal melanonychia on the right, xanthonychia and distal onycholysis on the left. Microscopic examination of fungal colonies allowed the identification of Epidermophyton floccosum. A confirmation of the species diagnosis was carried out by real-time PCR. The patient was treated with terbinafine 250 mg daily for 6 months. Conventional techniques are, in most cases, sufficient for diagnosing superficial mycosis. However, identification is sometimes difficult, hence the importance of the contribution of molecular biology in the diagnosis.