Letters to the Editor transepidermal elimination. Topical (retinoic acid, 12% lactic acid, 10% urea), mechanical (cauterization, curettage, dermabrasion, CO2 laser) and systemic (oral isotretinoin) treatment modalities are available.[1,5] AAyseyse SSeraperap KKaradag,aradag, EbruEbru CakCakõr1, AAylinylin PPelitlielitli Department of Dermatology, Ankara Kecioren Research and Training Hospital, 1Department of Pathology, Atatürk Chest Diseases and Thoracic Surgery Centre, Ankara, Turkey AAddressddress fforor correspondence:correspondence: Dr. Ayse Serap Karadag, Department of Dermatology, Ankara Kecioren Research and Training Hospital, Ankara, Turkey. E-mail: [email protected] DDOI:OI: 10.4103/0378-6323.55421 - PPMID:MID: ** Figure 1: Multiple, blue coloured, 1−3 mm sized vellus hair cysts localized on the anterolateral chest wall RREFERENCESEFERENCES 1. Reep MD, Robson KJ. Eruptive vellus hair cysts presenting as multiple periorbital papules in a 13-year-old boy. Pediatr Dermatol 2002;19:26-7. 2. Hong SD, Frieden IJ. Diagnosing eruptive vellus hair cysts. Pediatr Dermatol 2001;18:258-9. 3. Sárdy M, Kárpáti S. Needle evacuation of eruptive vellus hair cysts. Br J Dermatol 1999;141:594-5. 4. Strobos MA, Jonkman MF. Trichostasis spinulosa: itchy follicular papules in young adults. Int J Dermatol 2002;41: 643-6. 5. Kaya TI, Tataroglu C, Tursen U, Ikizoglu G. Eruptive vellus hair cysts: An effective extraction technique for treatment and diagnosis. J Eur Acad Dermatol Venereol 2006;20:264-8. Figure 2: Potassium hydroxide preparation showing numerous A ccasease rreporteport ooff ttineainea nnigraigra ffromrom vellus hairs in a serpentine array (magniÞ cation, X100) NNorthorth IIndiandia Sir, Tinea nigra is a rare superficial fungal infection of the skin. It is caused by Hortaea werneckii (formerly known as Phaeoannellomyces werneckii, Exophiala werneckii, and Cladosporium werneckii).[1] It occurs most frequently in tropical climates and presents as asymptomatic brown to black nonscaly macules with well-defined borders resembling silver nitrate stains. Macules may be single or multiple, rounded or may have irregular shapes. Palms are most often affected, but lesions may occur on soles or other parts of the body. A 32-year-old male resident of Pratapgarh (Uttar Figure 3: A dermal cyst which contains laminated keratin and multiple transversely and obliquely cut vellus hairs (H and E, Pradesh, India) presented in first week of March X200) 2008, with a nine-year history of slowly enlarging asymptomatic hyperpigmented macules on both EVHC are usually asymptomatic lesions but treatment is palms [Figure 1] and soles. Patient gave history of necessary for cosmetic reasons. Spontaneous resolution excessive sweating. There was no family history of can be seen in one-fourth of the patients because of similar condition. 538 Indian J Dermatol Venereol Leprol | September-October 2009 | Vol 75 | Issue 5 Letters to the Editor Table 1: Reported cases of tinea nigra from India Center No. of Site of Basis of Reference cases infection diagnosis Chennai 1 N A NA 2 Chennai 1 Palm KOH, Culture, 3 Histopathology Pondicherry 1 Palm KOH, Culture 4 Belgaum 2 Axilla KOH, Culture 5 NA = Information not available araguata. Tinea nigra has been reported rarely from India. So far, only five cases have been reported [Table 1] and all from South India.[2–5] Its only reporting from South India may be explained on the basis of the Figure 1: Hyperpigmented macules on palms presence of hot and humid conditions there. To the best of our knowledge, the present case is the first case Examination revealed multiple, small, oval macules of tinea nigra from North India. This may be due to its on palms and soles located almost symmetrically. actual rarity or due to underreporting. Examination of scrapings by 10% potassium hydroxide (KOH) mount showed dematicious, short, septate, and Topical application of effective antifungal agents branched hyphae with scattered budding cells. The usually clears the lesions within two to four weeks. scales were inoculated on Sabouraud’s dextrose agar Prolonged therapy may be necessary to prevent relapse. medium in duplicate. On 20th day of culture, moist, Repeated vigorous scrubbing or topical application yeast-like colonies were seen which were initially of keratolytic agents can reduce pigmentation. brown and later changed to shiny black. With age, the Topical terbinafine applied once daily for four weeks colonies produced abundant aerial hyphae and turned successfully cleared the lesions in the present case as olive to greenish black in color. Microscopically, there has been observed earlier.[6] were brown septate mycelia with annelloconidia. These conidia were seen singly or with septation. RRaginiagini TTilak,ilak, SSanjayanjay SSinghingh1, PPradyotradyot PPrakash,rakash, These features were consistent with Hortaea werneckii. DDharmendraharmendra P.P. Singh,Singh, AnilAnil K.K. GGulatiulati Departments of Microbiology and 1Dermatology, Institute of Medical Tinea nigra is more frequently reported in females, Sciences, Banaras Hindu University, Varanasi - 221005, India probably due to frequent household work and hand AAddressddress fforor correspondence:correspondence: Dr. Ragini Tilak, Department of washing. Palms and soles are said to be the most common Microbiology, Institute of Medical Sciences, Banaras Hindu affected sites, although other sites such as face, axilla, University, Varanasi - 221 005, India. and chest may also be affected. Pigmented patches E-mail: [email protected] of tinea nigra may be confused with junctional nevi, DDOI:OI: 10.4103/0378-6323.55422 - PPMID:MID: ** postinflammatory pigmentation, malignant melanoma, RREFERENCESEFERENCES and melanosis of syphilis and pinta. The routine mycological and mycopathological investigations 1. Perez C, Colella MT, Olaizola C, Hartung de Capriles C, Magaldi help in diagnosis of this condition. Hortaea werneckii S, Mata-Essayag S. Tinea Nigra: report of twelve cases in receives nourishment from decomposed lipids. The Venezuela. Mycopathologia 2005;160:235-8. 2. Kamalam A, Thambiah AS. Tinea nigra: first case report from hyperpigmented macules result from the accumulation Madras. Mykosen 1982;25:626-8. of a melanin-like substance present in the fungus. 3. Gnanaguruvelan S, Janaki C, Sentamilselvi G, Boopa. Tinea nigra. Indian J Dermatol Venereol Leprol 1998;64:91-2. In a study of 12 patients during the period from 1972 4. Dasgupta LR, Agarwal SC, Bedi BM. Tinea nigra palmaris from South India. Sabouraudia 1975;13:41-3. to 2002, tinea nigra in Venezuela was found to be more 5. Hemashettar BM, Patil CS, Siddaramappa B, Thammayya A. A prevalent among young people with fair skin who case of tinea nigra from South India. Indian J Dermatol Venereol visited beaches.[1] It was noticed less frequently in the Leprol 1985;51:164-6. 6. Shannon PL, Ramos-Caro FA, Cosgrove BF, Flowers FP. black population. Out of these 12 patients, eight had Treatment of tinea nigra with terbinafine. Cutis 1999;64:199- H. werneckii as the causal agent and two had Stenella 201. Indian J Dermatol Venereol Leprol | September-October 2009 | Vol 75 | Issue 5 539.