Patient of Dr E Wee

Hx:
A gentleman from the Leprosy endemic Terai region of Nepal presented to a local hospital with the development of enlarging annular plaques on his face. These were slightly pruritic.

O/E:
Hypopigmented annular lesions, NOT hypo aesthetic, over R side of the face. No nerve palsies or thickening suggestive of leprosy.

Ix:
Scrapings and KOH - fungal elements
Skin slit smears from lesions - no acid fast bacilli.

Dx:
Tinea Faciei

Pt comenced on topical ketoconazole cream.

Interesting case demonstrating the difficulty of clinicians in this area of Nepal having to differentiate between benign infective dermatoses such as tinea and leprosy. No skin Bx pathology facilities available (only skin slit smears and scrapings).