[quote]asymptomatic red plaque with pustules and some hair loss
small pustule that enlarged in size after trauma. The patient had taken an oral antibiotic (Cephalexin / Cyprofloxacin ) and had applied a topical antibiotic (Mupirocin) without any improvement. The man’s general condition was good and his past medical history was not significant.
Skin smears from follicular pustules were obtained for microscopic examination and culture. Smears obtained for KOH preparation and also stained with Gram’s stain did not show any evidence of a microorganism. The bacterial culture was negative.Biopsy specimens from the patient were obtained for histological examination. The biopsy shows a chronic deep folliculitis. An intrafollicular and perifollicular mixed infiltrate is noted with an area showing a ruptured follicule (Fig. 3 - H&E stain, x40). Hair shaft disruption by neutrophils, lymphocytes, histiocytes, and plasma cells that have spread into the dermis is also shown (Figure 4 - H&E stain, x100).
Based on the clinical appearance, the presence of folliculitis on histological examination, and the non-response to antibacterial therapy, we decided to start oral Griseofulvin 500 mg microsized once a day while awaiting the fungal culture result.After 24 days, the fungal culture performed at 25°C using Sabouraud Dextrose agar showed a downy colony with a white surface. The reverse of the colony was dark brown with a paler cream border. The microscopy showed small tear-shaped, clevate microconidia arranged along the sides of the hyphae, compatible with Trichophyton rubrum.
The diagnosis of tinea barbae caused by T. rubrum was confirmed and the treatment was completed in six weeks. After the treatment, the patient was completely cleared and there was no recurrence, scar, or cicatricial alopecia upon follow-up after six months (Fig. 6).