Photo Rounds Friday Archive

Red pruritic area on forehead

Post Date: 07/03/2009

FIGURE 1	FIGURE 2
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A 55-year-old woman sought treatment for a red pruritic area on her forehead. She reported that that the redness and itching had developed 3 months earlier. The patient had hypertension, which was well controlled. She had no other health problems.

What's your diagnosis?

We diagnosed a fungal infection. The annular pattern on the face (FIGURE 1) was suggestive of a dermatophyte infection. The differential diagnosis included granuloma annulare and psoriasis.

We looked at the patient’s feet, groin, and under the breasts for additional clues. This patient had what appeared to be fungal infections in all of these areas. The patient had severe tinea pedis in a moccasin distribution and tinea cruris (FIGURE 2). We performed a scraping for fungus from the groin infection and added a fungal stain with potassium hydroxide to the slide. Branching hyphae were seen under the microscope. The patient was treated with an oral antifungal agent (terbinafine, 250 mg daily) for 1 month. Her fungal infection cleared from all sites.

This case was adapted from: Usatine R. Cutaneous fungal infections: overview. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:539-544.

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