O/E: There are erythematous crusted papules and pustules mid upper chest. No other cutaneous lesions.
Clinical Photos:
Deon Wolpowitz, M.D. of B.U. Skin Pathology provided these impressive microscopic photographs.
Lab: Two bacterial cultures taken from a pustules a year apart show only coagulase negative staph.
Diagnosis: Chronic Localized Folliculitis. Simplistically, I am thinking about Majocci's granuloma or an atypical form of acne.
The patient is reluctant to try isotretinoin or systemic antibiotics. He is a healthy person in all other respects and has fears about messing with is microbiome and has read about isotretinoin and is worried.
from Khalifa Sharquie (Baghdad): "This is chronic folliculitis which should respond quickly to Septrin tag 2tab twice a day for two weeks then 2tah for at least 2 months together with topical dalacin c lotion and there is no need at all to give isotretinoin
ReplyDeleteThe clinical and histological findings do not support diagnosis of malassezia folliculitis ( a.k.a pitysporum folliculitis). Oral minocycline once daily is quite effective for truncal acne together with topical sulphur 3% in calamine lotion. Beware of steroid induced folliculitis in male body builders.
ReplyDeleteAgree with Henry. Could also use benzoyl peroxide topically.
ReplyDelete