Skin infection due to Trichophyton tonsurans

An 11-year-old healthy girl presented to the emergency department with a cutaneous circular plaque on her right leg. She lived with her parents and a healthy dog. The rash had started 6 days before as an erythematous scaly plaque with progressive developing of pustules. It was mildly pruritic and painful and had not improved with neither mupirocin ointment nor oral amoxicillin/clavulanic acid for 6 days. Physical examination showed a 5 × 4 cm erythematous circular plaque with peripheral pustules on the right leg (Fig. 1). Mycological culture of skin scraping confirmed a Trichophyton tonsurans skin infection, an anthropophilic dermatophyte more often isolated from the scalp but which may also cause dermatophytoses associated with skin and nails. The patient began oral terbinafine and topical hydrocortisone/miconazole cream with slowly improvement. As the pustules disappeared, the plaque began to turn cicatricial and keratin plugs appeared in the follicular orifices (Fig. 2). Our patient completed 8-week course of oral Terbinafine (150 mg per day) and after 2 months of topical retinoid, the keratin plugs have resolved leaving a cicatricial plaque.

Fig. 1

Fig. 2