Remember to consider dermatophyte infection when dealing with recalcitrant dermatoses.

Abstract

Superficial fungal infections of the skin are among the most common infections encountered in medicine. The diagnosis is easily confirmed with simple office-based procedures. In certain clinical situations, the diagnosis can be elusive. We analyzed clinical data on five patients who came in referral for treatment of a recalcitrant dermatosis. All patients had their diagnosis confirmed by a positive potassium hydroxide preparation from skin scrapings or by a skin biopsy positive for fungal elements. All showed clinical improvement and ultimate resolution of their skin lesions with topical and/or systemic antifungal therapy. Diagnosis can be complicated by previous use of corticosteroid-containing topical and/or systemic agents, a clinical history closely resembling that of a photosensitive disorder, and a lack of clinical-histopathologic correlation. Laboratory procedures and skin biopsy of an ambiguous appearing lesion can be diagnostic, but an accurate diagnosis is dependent on communication between the clinician and the pathologist. We recommend that office-based procedures be done early in treatment so that subsequent efforts can be directed toward providing appropriate therapies.