The Mystery of an Inflamed "Soul Patch"

Area of Science:

• Dermatology
• Mycology
• Infectious Diseases

Background:

• Facial dermatitis can present with varied etiologies, sometimes mimicking other conditions.
• Accurate diagnosis is crucial for effective treatment of skin infections.

Observation:

• A 20-year-old male presented with a month of scalp and 'soul patch' dermatitis.
• Initial treatments for presumed herpes simplex virus infection were ineffective.
• Physical exam revealed crusted plaques, erythema, edema, scaling, and hair loss, with cervical lymphadenopathy.

Findings:

• Fungal culture isolated *Trichophyton mentagrophytes*.
• Bacterial culture yielded no growth.
• The patient owned a dog, a potential source for zoophilic dermatophyte infection.

Implications:

• This case highlights the importance of considering fungal infections in refractory dermatitis.
• Prompt identification and targeted antifungal therapy, including terbinafine and ketoconazole, led to complete resolution.
• Dermatologists should consider dermatophytosis in the differential diagnosis of facial and scalp lesions, especially with exposure to animals.