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November 1991

Exacerbation of Tinea Corporis During Treatment With 1% Clotrimazole/0.05% Betamethasone Diproprionate (Lotrisone)

Am J Dis Child. 1991;145(11):1224-1225. doi:10.1001/archpedi.1991.02160110014007

Sir.—An 8-year-old girl with tinea corporis of the knee was treated with a combination product of 1% clotrimazole and 0.05% betamethasone diproprionate cream (Lotrisone). She had a prolonged course, with persistent pustules and inflammation that permanently scarred her knee. The histologic appearance was that of a Majocchi's granuloma, a fungal dermal abscess similar to a kerion. We postulate that the cause was local immunosuppression by the fluorinated steroid in this cream.

Patient Report.—Eleven weeks before presentation, an 8-year-old girl had played in a barn in which many cats made their home. Nine weeks before presentation, she developed an erythematous, ring-shaped, scaly lesion on her right knee, diagnosed by her family physician as "ringworm." A combination cream containing 1% clotrimazole and 0.05% betamethasone diproprionate was prescribed to be applied twice daily until the lesion resolved.

The cream was faithfully applied without occlusion for 9 weeks, but instead of