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August 18, 2008

Nodule on the Toe After Traveling to Africa—Diagnosis

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Arch Dermatol. 2008;144(8):1051-1056. doi:10.1001/archderm.144.8.1051-g

Histopathologic examination of the debrided material revealed annular structures consistent with an insect's respiratory and digestive tracts, as well as numerous round to oval structures consistent with eggs (Figure 2). Based on the patient's history of travel to Uganda, periungual lesion location, and the characteristic findings of white specks on the skin, a diagnosis of tungiasis was made. Treatment options were discussed with the patient, including curettage and electrodessication, surgical excision, ivermectin, and petrolatum. The patient elected curettage and electrodessication. The lesion was incised, and numerous tiny white eggs and brownish viscous material were extruded and removed. The remaining cavity extended approximately 7 mm in depth, just beneath the nail bed. The base was curetted and broadly electrodesiccated to ensure that no remaining viable organisms were left. The area was irrigated and packed with gauze. The patient was prescribed cephalexin hydrochloride, 500 mg, 3 times daily for 1 week. The lesion granulated over several weeks and healed well.

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