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USMLE vignette Maya Jingu
Maya Jingu
USMLE vigette
Clinical case
A 24 year old female police officer shows up with a pruritic rash on her breasts that causes discomfort.
She was laying in the sun for hours on a field assignment prior to the beginning of the symptoms.
Vital signs normal, she has no prior medical history.
Symptoms
Physical exploration reveals multiple circular, erythematous macular lesions beneath the breasts and adjacent to the axilla. Some lesions are hypopigmented and others are hyperpigmented. Scaling is also present. Rest of the physical exploration is normal.
Diagnosis
Fungi penetrates skin and inhibits tyrosinase in melanocytes causing hypopigmentation.
Diagnosis
Skin scraping is obtained, painted with KOH preparation Potassium hydroxide stain which disintegrates skin cells, leaving spores and hyphae behind.
A spaghetti and meatballs image is visible.
Diagnosis is tinea versicolor from Malasesszia furfur. Malassezia globosa is a differential diagnosis.
Discussion
First line treatment is topical selenium sulphide and ketoconazol.
Oral Fluconazol and Itraconazol can be used in refractory cases.
Recurrences are common.