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Case 345

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Female patient, 27 years old, seeks for medical attention reporting unique lesion on the left flank, rounded, with a reddish contour, itchy, with 5 days of evolution (see picture above), with there was progressive increase of the itch and discrete growth. When she was questioned about recent habits, she reported sporadic goings to her club pool, where she shared towels and swimming suits. She denies comorbidities, use of medicines and similar cases in her family.

Considering the clinical history and the image, what is the most likely diagnosis?

a) Nummular eczema

25%

b) Pityriasis rosea

25%

c) Tinea corporis

25%

d) Contact dermatitits

25%
   

Image analysis

Image 1:  Picture of the patient’s left flank, showing unique and isolated skin lesion, ringed, erythematous, with elevated and scaly edges, compatible with tinea corporis diagnosis.

Highlights

- Tinea corporis is a common dermatophytosis of the trunk or extremities;

- Contamination occurs mostly by direct contact with infected animals or people, by fomites, soil or by sharing clothing in risky environments.

- It’s a ringed lesion, itchy, unique or multiple, with erythematous and scaly edges in a centrifugal progress;

- The diagnosis is clinical, and can be confirmed by mycological examination;

- The treatment is based on keeping the lesion clean and dry, and applying topical antifungal.

References

- DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. 113683, Tinea corporis; [updated 2016 Dec 13, cited place cited date here]; [about 7 screens]. Available in http://search.ebscohost.com./login.aspx?direct=true&db=dnh&AN=113683&site=dynamed-live&scope=site. (Acessed in June 15, 2018.).

- Goldstein AO, Goldstein BG. Dermatophyte (tinea) infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Available in: http://www.uptodate.com (Acessed in June 15, 2018.).

- Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine. United States: The McGraw-Hill Companies, 8th ed, 2012

Authors

Guilherme Carvalho Rocha, 4th year medical student at UFMG

E-mail: guilhermecarvalhorocha[at]gmail.com
Izabella Costa Neves Silva, 5th year medical student at UFMG

E-mail: izabellacosta15[at]hotmail.com

Supervisors

Dr. Marcelo Grossi Araújo, associated professor of the Department of Internal Medicine of UFMG

E-mail: mgrossi[at]medicina.ufmg.br

Reviewers

Luísa Bernardino, Vinícius Avelar, Thiago Ruiz, Gabriella Yuka and Amanda Lauar, Prof. José Nelson Mendes Vieira; Profa. Viviane Santuari Parisotto Marino.

Translated by

Leandra Prates Diniz, 4th year medical student at UFMG.

E-mail: leandraprates[at]hotmail.com

Test question

(Minas Gerais Military Police Hospital) A 5-year-old child is taken to the hospital due to the appearance two weeks ago of erythematous papules with a centrifugal growth in the trunk. On examination: circular lesion, well delimited 4cm in diameter in the chest, scaly in the periphery with clear center and local pruritus. Remainder of physical examination without changes. The main diagnostic hypothesis is:

a) Prurigo nodularis

25%

b) Tinea corporis

25%

c) Psoriasis

25%

d) Bullous Impetigo

25%

e) Nummular eczema

25%
   

Commentics

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