A chronic disseminated dermatophytosis due to Trichophyton violaceum

A 48-year-old female had presented dandruff and breakable hair for more than 40 years, dry scaly erythema on bilateral palms and feet accompanying with nail destruction for 20 years, and scaling papules on the buttock for 5 years. Direct microscopic examination showed endothrix anthroconidia within broken hair and septate and branched hyphae within skin and nail lesion. Fungal cultures from all infected sites were examined by morphology, ITS sequencing, and random amplified polymorphic DNA fingerprinting, and were identified as Trichophyton violaceum from the same source. The patient was treated with oral terbinafine 0.25 g/day as well as with 1% terbinafine gel for external use and with 2% ketoconazole lotion for shampoo and bath. A follow-up after 4 weeks showed that the lesions decreased significantly.