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Dermoscopy Aids in the Diagnosis of Discoid Lupus Erythematosus
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Tinea nigra showing a parallel ridge pattern on dermoscopy.

Hiromitsu Noguchi1, Masataro Hiruma, Yuji Inoue

  • 1Noguchi Dermatology Clinic, Kumamoto, Japan; Department of Immunology, Allergy & Vascular Biology, Kumamoto University, Kumamoto, Japan.

The Journal of Dermatology
|March 14, 2015
PubMed
Summary

A rare fungal infection, Hortaea werneckii, mimicked melanoma on a young woman's palm. Topical antifungal treatment successfully resolved the brown macule, highlighting the importance of considering fungal causes in palm lesions.

Keywords:
Hortaea werneckiidermoscopypalmparallel ridge patterntinea nigra

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Area of Science:

  • Dermatology
  • Mycology
  • Medical Diagnostics

Background:

  • Melanoma is a serious skin cancer that can present as a brown macule.
  • Dermoscopy is a crucial tool for differentiating benign and malignant skin lesions.
  • Palm lesions require careful evaluation due to their potential for various etiologies.

Observation:

  • An 18-year-old female presented with a concerning brown macule on her palm.
  • Dermoscopic examination revealed features mimicking melanoma, including a parallel ridge pattern on high dynamic range imaging.
  • Microscopic examination identified brown mycelia, leading to fungal culture.

Findings:

  • Fungal culture isolated Hortaea werneckii, a fungus not typically associated with such dermoscopic findings.
  • The patient was diagnosed with superficial tangan (tinea nigra) caused by Hortaea werneckii.
  • Treatment with topical ketoconazole cream resulted in lesion resolution within one month.

Implications:

  • This case underscores the importance of considering fungal infections in the differential diagnosis of palm lesions, even when dermoscopic features are atypical.
  • High dynamic range dermoscopy can reveal subtle patterns, but correlation with clinical and microbiological findings is essential.
  • Prompt diagnosis and treatment of Hortaea werneckii can prevent unnecessary anxiety and invasive procedures for patients presenting with suspicious palm lesions.