CANDIDA FOLLICULITIS MIMICKING TINEA BARBAE

A 55-year-old man, a farmer, was referred to our dermatology departmen t in June 1993 with inflammatory and infiltrated nodular lesions on hi s left cheek and neck. These nodular lesions had appeared about a mont h previously and had enlarged quickly. He was unaware of any anteceden t trauma. Physical examination revealed a painless, slightly erythemat ous, soft, fluctuant plaque which measured 8 cm in diameter. It consis ted of follicular papules and pustules and was partially covered with brown-black crusts (Fig. 1). Two similar plaques, 3 cm in diameter, we re also detected on the neck. The regional lymph nodes were not palpab le. The hair on the lesions was easily removed with a pair of forceps without causing pain. The patient had not previously had any skin dise ase. Laboratory investigations, including full blood count, erythrocyt e sedimentation rate, serum concentrations of sodium, potassium, chlor ide, transaminases, alkaline phosphatase, sugar, cortisol, and renal f unction tests, were all normal. No fluorescence was seen on Wood's lig ht examination. Direct microscopic examination with 15% potassium hydr oxide solution revealed yeast cells and hyphae in three consecutive sc rapings of the lesions. Candida albicans was isolated from the mycolog ic cultures; but no growth was observed in mycologic cultures of oral and anogenital mucosae swabs. Bacteriologic cultures of the lesions we re also negative. A skin biopsy was performed for histologic confirmat ion. Examination of the biopsy specimen revealed dermal oedema and PAS (+) yeast cells among the infiltration of lymphocytes and plasma cells (Fig. 2). The patient was started on a regimen with fluconazole 100 m g once a day orally for a week, after which the dosage was decreased t o 100 mg once every other day for a month. Also, the hair on the lesio ns was depilated. We noted a significant clinical improvement at the f ifth week of the therapy (Fig. 3). Repeated mycologic examinations of the lesions were all negative even 1 month after the end of the therap y.