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purple black ringworm caused by trichophyton rubrum associated with generalized tinea one case
journal of dermatology 1998, volume 31, no. 5 case reports
author: chen lingdi zhu han jing liu youjun fighting
units: 200080 shanghai first people's hospital dermatology
female patient, 23-year-old nun. due to the head and face, neck, shoulders, back, chest, skin itching nearly 2 years. during the topical antifungal therapy, change clothes after ketoconazole tablets 0.2g, day 1, once more than 10 days, skin lesions have not improved from our department treatment. denied systemic disease, no tinea, onychomycosis history.
dermatology: the entire scalp to distribute large soy bean large circular patches of bright red infiltration (figure 1), rash, scaly gray surface adhesion, slightly sunken lesions center, part of the center of depigmentation around saw a black dot disease, hair loose and easy to pull out. double-cheek, ears, ears, neck, shoulder and back, upper chest to diffuse scattered soy bean ring large bright red edematous plaques, central depression, hypopigmentation, partly atrophic scar, marginal uplift, and see the needle size of the mound herpes, thin crusted and scaly gray and white, pinhead-sized pustules occasionally. oral mucosa, eyes, nasal mucosa, refers to the nails were normal.
figure 1 patients with head lesions
fungi examination: take scaly scalp, their hair a lot of direct examination see mycelium, made of clusters of spores, chamfer, scaly skin lesions microscopy see a lot of trunk branches, separated hyphae. take the disease, small scales and biopsy were inoculated on the sand castle glucose agar slant and flat. 3 weeks, see a white round colonies, with shiny, gradually expanded, the center was dark purple, light red edge of the external circle colorless ring, sink not statistically significant. microscopy: a short thick hyphae, and have more irregular protrusions, no antler-like hyphae, chlamydospores more, mostly among students. identification: purple trichophyton.
histopathology: take the lower right ear lesions, biopsy done pas staining within the stratum corneum are arranged in loose see short and thick piles of thick hyphae and spores, a large number of dermal inflammatory cell infiltration. clinical diagnosis: black ringworm associated with tinea.
treatment and outcome: oral itraconazole 200mg / d, for 2 weeks, 2 weeks after the lesions are degenerating, edematous plaques pale, flattened, itching reduced, leaving some skin lesions pigmentation spots, small scales, mycology tests were negative. 1 month follow-up, scalp hair regeneration, neck, shoulders, chest and back left hypopigmentation spots and scars. 6-month follow-up, no recurrence, the prognosis is still left some skin lesions hypopigmentation spots and atrophic scars.
(received :1997 -09-15 revised :1997-12-10)