What is your diagnosis?What is your diagnosis?

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha

M 75, left hand lesionM 75, left hand lesion

Acute folliculitis and perifollicular abscess

Yeast and hyphae in the hair follicle (PAS-fungus stain)

Yeast and hyphae in the abscess (PAS-fungus stain)

Diagnosis: Deep fungal folliculitis (Majocchi's Diagnosis: Deep fungal folliculitis (Majocchi's granuloma)granuloma)

Deep dermal folliculitis, perifollicular abscess and Deep dermal folliculitis, perifollicular abscess and granulomatous inflammation with PAS positive fungal granulomatous inflammation with PAS positive fungal hyphae and yeasts within the hair follicles and the hyphae and yeasts within the hair follicles and the perifollicular inflammatory exudate. perifollicular inflammatory exudate.

Fungal infection of the skinFungal infection of the skin– Incidence linked with contiguous dermatophytosis, Incidence linked with contiguous dermatophytosis,

immunosuppression, & use of topical steroidsimmunosuppression, & use of topical steroids Trichophyton rubrum Trichophyton rubrum

– Most commonly implicated dermatophyteMost commonly implicated dermatophyte Common on the legs of young women who frequently Common on the legs of young women who frequently

shave shave