The eruption is comprised of discrete papules and pustules. No areas other than those seen in the photos are involved. Hair growth in the area is unaffected.
Lab: Culture grew out only Coagulase Negative Staph 1+
Pathology: The specimens exhibit a dense perifollicular neutrophilic infiltrate forming abscesses and infiltrating follicular epithelium, with admixed lymphocytes, plasma cells, and histiocytes. The histologic differential diagnosis includes both inflammatory and infectious causes of folliculitis. GMS and PAS stains are negative for fungal organisms. Tissue gram stain is negative for bacteria.
Discussion: This is a healthy young man with a five year history of a localized folliculitis on his chest. If this was fungal, one would expect some hair loss or progression over five years. I found a similar case on PubMed that fit the history, clinical and pathological findings (see below); but still have some questions. Any suggestions will be appreciated.
Diagnosis: Folliculitis, etiology unclear. Consider Majocci.
Tinea corporis gladiatorum presenting as a majocchi granuloma.