Tinea barbae due to Trichophyton verrucosum

A 25 year-old male, a dairy farmer, had noticed an annular scaly erythema on the left cheek since 3 weeks, and visited a dermatological clinic for the eruption. Diagnosis of tinea faciei was made and he was treated with oral anti-histamine medicine and by topical application of anti-fungal ointment. However, the eruption worsened and enlarged so that he visited the department of dermatology of Kumiai Hospital on October 19, 1997. He was in good general health. Physical examination disclosed papules and pustules with swelling and erythema on the chin and cheeks. The results of routine laboratory investigations were within normal limits except for white blood cell (9,800/mm(3)) and C reactive protein (2+). A small white-yellowish colony was grown on brain heart infusion agar culture of the biopsied specimen of the lower jaw. Histopathological features showed epidermal hyperplasia with elongation of rate ridges and granulomatous changes around hair follicles in the dermis with many mononuclear cells and giant cells, where many positive spores and fine filamentous structures with PAS and Grocott stains were seen. Based on clinical, histopathological and mycological findings, a diagnosis of Trichophyton verrucosum was made. The patient was treated with oral itraconazole (100 mg/day) for two months. There was a good clinical response and no recurrence during three years and six months.