David Elpern M.D., Williamstown, MA, USA on
July 14, 2005
This is an important presentation since we see these patients
a few times a year. It underscores the importance of a KOH prep.
The advancing scaly border is a salient finding. Also, examining
the rest of the patient as was done here.
How was she treated? I find systemic therapy works best here
and still favor griseofulvin.
Julian Manzur M.D., Havana, Cuba on July 15,
2005
Infections by dermatophytes are very common in our country
and tinea faciale is not rare, sometimes misdiagnosed and treated
with topical steroids.
Lesions are generally annular (ring shaped) with an asymmetric
distribution. I think these are very helpful hints. As you say
is very important to practice KOH
Henry Foong FRCP, Ipoh, Malaysia on July 16,
2005
I agree that this is not an uncommon condition in our practice.
Just about a month ago, I saw 2 cases of tinea faciale and I
think a high index of suspicion is important not to miss this
condition. Other clues include unilateral involvement, distinct
border with an annular margin, sometimes with ear involvement,
and history of advancing scaly lesion. KOH examination would
be most helpful to confirm clinical suspicion. I almost invariably
put these patients on oral antifungals as these patients may
not tolerate the topicals well and may result in poor compliance
and lower cure rates. The following 2 patients below illustrate
the typical features. The 2nd patient was earlier seen by another
practitioner who used some topicals which had caused some undesirable
effects.
Khaled El-hoshy M.D., Troy, Michigan, USA on
July 18, 2005
Three weeks ago, I saw a 14 yr old boy with 6 months hx of
facial scaly erythematous rash; on topical steroids. Two weeks
of lamisil 250 mg qd did the miracle. Tinea Incognito is a well
earned name!
Ibrahim Misk M.D., Amman, Jordan, on July
18, 2005
A very nice case for discussion with colleagues with an open
mind.
Azad Kassim M.D., Hasa, Saudi Arabia on July
19, 2005
Actually, in countries where cutaneous fungal infection is
common, one can see such cases infrequently and might be confused
and misdiagnosed as cases of rosacea, seborrheic dermatitis
and lupus erythematosus. Our dear colleague, Professor Sharquie
wants to raise an issue that in any suspicious case with long
standing red scaly patches on face, tinea faciei should be put
in mind, and side lab. direct KOH smear is a must and solve
a lot of queries when it is timely performed.
Benjamin Barankin M.D., Department of Dermatology,
University of Alberta, Edmonton, Canada on July 20,
2005
Thank you for presenting this very interesting case. This case
is a great reminder of the power of the KOH, an open mind, and
the visual & deductive wisdom of dermatologists.
Sushil Ratti M.D., Ipoh, Malaysia on July
29, 2005
This condition requires high index of suspicion especially
when the clinical signs are totally masked by the misuse of
topical steroids. My maxin is any scaly lesion which does not
have a specific diagnosis is to be considered for skin scrapping
and quite often with appropriate treatment you will get a very
grateful patient.The microscope forms a very important tool
in our daily practice.
Janjua Shahbaz M.D., Lalamusa, Pakistan on
July 29, 2005
A wonderful case presentation indeed. All varieties of dermatophyte
infection are commonly seen in our practice in Pakistan. Most
of the time these present as tinea incognito due to liberal
and prolonged use of topical steroids either as self medication
or prescribed by the general practioners due to lack of awareness
and misdiagnosis. To address this problem, refresher courses
in basic dermatology should be planned for the general practitioners.
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