trichomycosis is a rare condition and few cases are reported in the literature , its name is wrong because it is not a fungal infection but is a superficial bacterial infection , so it should be called trichobacteriosis . due to the fact that the condition is asymptomatic and causes practically no discomfort , patients generally do not seek medical attention .
however , when a careful , deliberate search is performed in the clinical setting , it tends to appear more frequently . our principal objective is to present a series of cases , their clinical and microbiological aspects and emphasize that this clinical entity in axillar and genital hairs maybe is underestimated .
all patients included had diagnosis of clinical trichomycosis and were confirmed microbiologically . a clinical history , an examination under wood 's light and microbiological tests was performed on each patient . in all cases
, there took hair of the affected region , by means of court with scissors and the sample was divided in two parts for its study , for examination and culture .
the samples were examined microscopically with koh 20% and cotton blue preparations , and cultured in brain - heart infusion agar , and chocolate - blood agar .
positive cultures were gram - stained to identify coryneform - bacteria forms , and isolated cultures were subsequently identified by biochemical testing using the microscan - system .
the main demographic characteristics and microbiological findings of the study are shown in table 1 .
it is important to point out that 32 out of the 56 patients ( 57.1% ) sought medical attention because they felt a change in the texture of the affected hair , and the rest of the patients were diagnosed during careful , deliberate search by visual inspection and examination under wood 's light [ figures 13 ] .
eighteen of the fifty - six patients ( 32.2% ) related their condition to athletic activities and to the use of clothing made of lycra . of the 56 cultures that were obtained ,
only 18 were identified by the microscan walkaway 9651 system , which identified corynebacterium centers for disease control ( cdc ) group g / ld ; according to bergey 's manual , this is indicative of corynebacterium flavescens [ figures 4a & b and 5 ] .
flava ) yellow - fluorescence of trichomycosis pubic hairs ( wood light ) direct examination of trichomycosis hair ( a ) koh 10% , 10 ; ( b ) koh 10% , 40 culture of corynebacterium sp . , in chocolate - blood agar plate there were two patients who , in addition to axillary trichomycosis , also presented with two related conditions affecting the inguinal zone ( erythrasma ) and the soles of the feet ( pitted keratolysis ) table 2 .
trichomycosis , a more correct term would be trichobacteriosis or bacterial trichonodosis is a superficial infection , primarily of the axillary hair , which can exhibit three different clinical presentations : the most common clinical variant is trichomycosis flava ( yellow ) , while rubra ( red ) and nigra ( black ) variants occur much less frequently . from the earliest reported cases of trichomycosis , the causative agent was classified as c. tenuis . in light of the new taxonomic position of the genus corynebacterium , however , that particular species is no longer considered , and thus , the majority of the reports are left as corynebacterium sp .
however , some studies have shown that the causative agent belongs to the so - called group 2 ( ld2 ) ( also referred to as the cdc - g / ld group ) , that it corresponds to the c. flavescens species , and that it is related to the flava variant . in the present study ,
no specific causative agent could be identified in the remaining 38 cases , which were simply classified as corynebacterium sp . , according to their microscopic characteristics because presented gram - positive rod - shaped forms .
there are indications that the rubra and nigra variants of trichomycosis are actually caused by other microorganisms , specifically micrococcus castelani and micrococus nigricans , although this has yet to be proven definitively .
the causative agent of trichomycosis has not yet been isolated in nature , only from infected human hairs .
the disease is quite cosmopolitan , however , it is reported more frequently in humid and tropical climates ; it is an affliction of adolescents and young adults .
there are no differences in the rates of infection with respect to race or gender , although , in our culture it is seen with greater frequency in male patients since it is customary for women to shave their axillary hair .
there have been reports of man - to - man transmission of trichomycosis , particularly in groups that live in very close quarters , such as soldiers and athletes .
trichomycosis infection begins when the causative agent comes in contact with the hair shaft , and the bacteria adhere to the surface , or the cuticle , of the hair , using a cement - like substance , the chemical composition of which is not yet known , that is insoluble in water as well as in the other principal solvents ( i.e. , acetone , ethanol ) .
electron microscopy studies have clearly shown that the microorganism does not penetrate to the medulla 's cortex of the hair ; instead , it only adheres strongly to the surface of the hair and develops slowly until it forms concretions around the hair shaft .
levit has suggested that the adhesive substance is synthesized by both the apocrine glands of the human host and by the microorganism , which would explain why the disease develops in the areas of the body where it does ( i.e. , axillary , pubic and inter - gluteal hairs ) . as it pertains to our study , it is noteworthy that the majority of cases involve adult males , due to the fact that , in our culture , women generally tend to shave their axillary hair .
there were cases involving both extremes of age , but by the mean age of all the patients , it can be deduced that trichomycosis appears more often in young adults .
the specific results concerning the clinical location of the lesions are shown in table 1 . out of all the cases
studied , 97.4% presented with an infection of the axillary hairs , a figure , which is consistent with the majority of reports found in the literature .
there were two particularly noteworthy cases in which trichomycosis affected three different areas of the body at the same time ( axillary , pubic and inter - gluteal regions ) . according to some authors ,
a more thorough examination of trichomycosis patients is particularly important , since they feel that the figures reported of the frequency of genital involvement underestimate the actual number of cases .
another remarkable case in this study was the one in which the eyebrows were also affected .
this is truly an exceptional finding and we were not able to find a similar case reported in the literature , most likely resulted dissemination from the axillary region by means of auto - inoculation .
de - almeida et al . have recently reported a case of trichomycosis capitis , in an 8-year - old boy , this report also indicates that there may be cases distant areas and apocrine glands that can be clinically similar to cases of white piedra . in general ,
trichomycosis is characterized by the formation of concretions around the hair shaft ; these are invisible at first and there is only a slight thickening , which can be  felt  on palpation .
initially , the bacterial masses remain isolated or independent , and it is at this stage when it could be mistaken for pediculosis ( nit - lice ) . as the infection becomes chronic ,
the concretions extend along the entire length of the hair until they form a sheath , causing the hair to thicken , turn a yellowish , red or black color , and become creamy , opaque and soft .
it should also be mentioned that only 32/56 of patients ( 57.1% ) sought medical attention as a result of having felt a change in the texture of the hair , odor and in most cases accompanied by increased sweating ( hyperhidrosis ) , while the rest of the patients were diagnosed during a careful , deliberate search . practically , all of the patients ( 98% ) presented with the flava variant , and only one patient , who sought medical attention after developing  reddish sweat ,  presented with the rubra variant , and was and was proven by the isolation of cultures , which was due to a mixture of microorganisms : corynebacterium sp .
( white - yellow growth ) and serratia mascescens ( red growth ) , and probably the red form due to the latter bacteria produce carotenoid pigments .
there is a series of case reports in the literature involving patients with mixed infections caused by different corynebacteria , the so - called corynebacterial triad consisting of trichomycosis , erythrasma and pitted keratolysis ; in our study , there were two patients who also presented with erythrasma and pitted keratolysis , another example is the report of rho and kim , whom found a high incidence of trichomycosis in korean soldiers , co - existing with erythrasma ( 20.4% of cases ) and with pitted keratolysis ( 13% of cases ) .
as far as the microbiology is concerned , it is important to note that all of the cases in this study were confirmed by means of direct examination , in which the infection of the hair , in the form of concretions or bacterial masses consisting of coccoid and diphtheroid shapes measuring between 0.5 and 1 m , could be seen adhered to the hair , which rules out the majority of mycoses that affect the hair ( tinea and piedra ) .
wood 's light is extremely useful for diagnostic purposes , and above all , for delineating the extent of the infection , since the bacterial concretions emit fluorescence under low - intensity ultraviolet ( uv ) light , making it much easier to find the affected hairs . in terms of causative agents ,
was identified and isolated in all cases ( single agent in 98.2% and mixture in 1.8% ) .
microscopic examination revealed the presence of various gram - positive , coccoid and diphtheroid shapes or rod - shapes , measuring , on average , from 1.2 m to 1.8 m in length , and 0.4 - 0.6 m in width , and resembling  little drum sticks . 
it is important to note that 18 strains were identified as c. flavescens , which is consistent with the results obtained by garca - martos et al .
this organism is not generally considered virulent , although , it has been reported to cause endocarditis in some intravenous drug users .
an interesting finding in our study involved the case of the rubra variant , where two different pathogens were isolated , corynebacterium sp . and
serratia marcescens , the latter being an extremely opportunistic type of bacteria , with low virulence , and which produces a carotenoid pigment . in general therapy of trichomycosis
, many authors consider that the most effective treatment consist in shaving of the affected area for a period of 2 - 3 weeks , but the use of a concomitant treatment , such as sulfur soaps , is also recommended .
those patients who shave the affected area only once will generally experience a recurrence of the infection , since , the bacteria begin to develop the concretions once again as the hair grows back .
topical treatments containing any of the following : 3% sulfur , 2% formalin , 1% mercury ( ii ) chloride ( or mercuric chloride ) or 2% sodium hypochlorite , as well as topical antibiotics with fusidic acid , erythromycin and clindamycin , may also be used .
 background : trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by corynebacterium sp.objective:to bring a series of cases of trichomycosis , its clinical and microbiological experience.materials and methods : this report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically.results:fifty six confirmed cases of trichomycosis were included in this report . 
 the majority were men 53/56 ( 94.6% ) , mean age was 32.5 years . 
 the most commonly affected area was the axilla ( 92% ) , trichomycosis flava was the principal variant 55/56 ( 98.2% ) and signs and symptoms associated were hyperhidrosis ( 87.5% ) , hairs texture change ( 57.1% ) and odor ( 35.7% ) . 
 bacterial concretions were observed in all cases , and the predominant causative agent in 89.3% of all cases was corynebacterium sp . 
 thirty patients were included in therapeutic portion of the study , and 28 ( 93.3% ) of them experienced a clinical and microbiological cure.conclusion:trichomycosis is asymptomatic , superficial infection , which primarily affects axillary hairs . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION