Expanding, Red Plaque

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Case in Point Expanding, Red Plaque Benjamin Barankin, MD, FRCPC 49-year-old male has a mildly pruritic, Aexpanding, red plaque on his right cheek and neck. He has no history of skin problems and an old prescription for a mid-potency steroid does not seem to help. 1.What is the most likely diagnosis? a. Perioral dermatitis b. Allergic contact dermatitis c. Tinea faciei d. Granuloma annulare Figure 1. A mildly pruritic, expanding, red plaque on the right cheek e. Discoid lupus erythematosus and neck. importantly, tinea faciei may signal dermato - 2. What is the most common cause for phyte infection elsewhere, such as tinea pedis, this lesion in North America? tinea cruris and/or onychomycosis, so other a. Trichophyton mentagrophytes areas must be checked. Typically, one observes b. Malassezia furfur erythematous annular plaques witht isloighnt sur - c. Pseudomonas aeruginosa face sca©le and some pruritusi. bu d. Trichophyton tonsurans Ditrect microscopy tusring a10d%, potassium h is nlo ig D dow e. Staphylococcus aureus r hydroxide andl cultaurne can be euseful in confirm - y ci s c l us p ing trhe diagsneorsis. Hisotonloagic examination may be o e d u ers 3. How could you managCe this lesion? mrequiisred in driffpicult cases. Topical antifungals, m hor y fo o Aut op a. Oral antifungal C d. eslpeecially ciclopirox olamine or terbinafine, are r ite ing b. Topical antifungal o hib a s the treatment of choice. In more chronic cases or le pro int a use pr c. Cryotherapy S ed and where a fungal folliculitis may be present ( e.g. , or oris iew d. Ultrapfotent utothpical stye,rovids topical steroids for some time), oral antifungals ot na pla N U dis D e. a and b may be required. x Tinea faciei is a superficial fungal infection of the face caused by dermatophytes which feed on the top layer of skin, keratin. It can affect any age and there is no gender difference in fre - e - 3 ; d - 2 ; c - 1 : s r e w s n quency. Trichophyton tonsurans is the most A common cause of tinea faciei. The infection can come from pets or from other humans. Most Dr. Barankin is a Dermatologist practicing in Toronto, Ontario. The Canadian Journal of Diagnosis / July 2009 11.

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