Trichophyton rubrum Skin Folliculitis in Behçet's Disease

A 29-year-old patient with Behçet's disease based on three major criteria (i.e., oral ulceration, genital ulceration, and eye lesion) presented with intractable pruritus associated with pinpoint red nodules involving the hair follicles of the back along with steroid-refractory local treatment. Simple light microscopic examination of a skin scraping revealed fungal contamination, and culture on Sabouraud's medium confirmed Trichophyton rubrum as the agent of folliculitis. Behçet's disease is characterized by recurrent attacks of acute inflammation. Although the diagnosis of sterile folliculitis-like disorder is currently retained among patients with Behçet's disease, especially in the lower part of the body, it resembles dermatophytic folliculitis, which can be related to immunosuppressive therapy. Hence, patients with recalcitrant folliculitis predominating on the back who are receiving immunosuppressive treatment should be evaluated for fungal infection, as recognition of this disease may enable earlier diagnosis and treatment.