History:

Patient of Dr P Barua

A 27-yrs lady presented to me with a lesion on her anterior chest-neck wall. she stated that- the lesion does not look like as the original.
she had developed the original ring-worm like itchy lesion nearly a month ago. Since than she had been using Dermovate Oint ( Clobetasole proprionate-the most potent fluorinated steroid ) .As feeling cured, stopped using the ointment 2 days ago and after that she had developed the peculiar lesion. She said that she had collected the ointment from her father-which was prescribed for his leg eczema by a GP.

No other medication. No h/o major illness. No drug/contact allergy. Mother atopic and diabetic.

O/E : Well demarcated lesion consists of multiple pustules with erythematous base.

I can assume- it is Post-Steroid Flare-up, used topically over a Tinea Infection on the Face. Could super imposed Candida be a cause of pustulosis?
How do I name it ? TINEA INCOGNITO ??

Rx : Oral Fluconazole and Topical Clotrimazole

                      This is a pustular rash Therefore II Infective (viral, bacterial or fungal) or Inflammatory either drugs or pustular psoriasis but sometimes rare conditions such as Sweet's syndrome, Eosinophilic pustular folliculitis or Reiters or Becets.
From the history this is acute pustular reaction to a steroid modified animal fungus when the steroid has been withdrawn. I doubt there is any superimposed candida here. I would have used Terbinafine , Itraconozole or Griseofulvin rather than Fluconazole and a topical. (Submitted By: Dr Ian McColl)