Wednesday, October 26, 2005

19 year old student with acneiform eruption

History: 19 year-old man with a 5 year history of acneiform eruption predominately on torso and proximal extremitiesl Some facial involvement, but less than on torso. He is in good health, no history of diabetes or steroid use. No antibiotics for months. In the past he has used benzoyl preoxide ceams and washes, topical retinoids, topical antibiotics and tetracycline and its derivatives. Mome has ever helped.

Exam: Healthy young man with Type IV skin. On torso and proximal extremities he has discrete erythematous papules and an occasional pustule. No cysts. Face largely clear.

Lab: nil

Pathology: Initial reading showed marked perifollicular lymphoneutrophilic infiltrate c/w acute folliculitis. PAS negative.

Diagnosis: Probable Pityrosporon folliculitis

Discussion: Are the yeasts incidental or indicative of pityrosporum folliculitis. I asked for more cuts and this showed numerous PAS (+)"fungal spores" in the follicular ostia.
I have started him on itraconazole 200 mg per day and Nizoral 2% shampoo to torso. The literature does not have good guidelins for how to treat this; but I suspect 4 - 6 weeks woth oral meds.
Please suggest diagnostic and therapeutic alternatives.

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