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April 2009

Agminated Papules and Pustules on the Flank—Diagnosis

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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Dermatol. 2009;145(4):479-484. doi:10.1001/archdermatol.2009.35-b

The appearance of the lesion and the patient's occupation raised suspicion for a dermatophyte infection. The presence of eosinophils on microscopic examination further heightened this concern. However, analysis using microscopic sections taken from deeper in the specimen and periodic acid–Schiff stain were unrevealing. Within just 2 weeks, the fungal culture demonstrated colony growth. The combined colony characteristics (velvety with a creamy white color) and abundant chlamydospores in chains on lactophenol cotton blue preparation were characteristic of T verrucosum. The patient was successfully treated with oral terbinafine (250 mg/d) for 2 weeks. Evaluation of his cattle by a veterinarian was recommended.