Failed Treatments (per mother):
Keflex 500 mg b.i.d. x 2 weeks
Scalp Biopsy read by Lynne Goldberg (Boston University Skin Path): was felt to be most compatible with psoriasis. Seborrhea was in the differential diagnosis but less likely.
Discussion: This 17 yo girl has suffered with what appears to be tinea aminatacea for almost a decade. It appears unlikely that this is psoriasis. Tinea capitis has been ruled out by culture. Her bacterial culture showed 3+ S. aureus but I suspect this is a secondary invader as she did not improve with cewplanexin. Since the fungal culture was negative and these approaches were not helpful, I may recommend isotretinoin. The use of this has been reported for T. aminatacea only and in a Korean case report.
Dr. Goldberg's rotocol for Scalp Psoriasis, Tinea amiantacea and Related disorders: