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Physical examination revealed one crusted lesion on the left parietal-temporal region of the scalp ( Fig. The patient had no fever or other symptoms.
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The perilesional erythema had resolved but the rest of the lesion had not improved. She had completed a 3-day treatment with topical corticosteroids and oral cloxacillin. The patient was a 72-year-old woman who presented with a 3-week history of 2 crusted, inflammatory lesions on her scalp. Eight weeks after oral treatment with terbinafine (250 mg/day) was initiated, there was still some evidence of scarring alopecia but no signs of inflammation, desquamation, or traction hair loss. Fungal culture was positive for T tonsurans. The crust concealed fleshy exophytic granulation tissue. Physical examination revealed a crusted lesion on the back of the head. She had received no prior topical or systemic treatment. The patient was a 69-year-old woman who presented with a crusted tumoral growth on her scalp that had appeared 6 weeks earlier. The treatment was therefore changed to oral terbinafine (250 mg/day), which resulted in complete resolution within 1 month. Clinical symptoms persisted and cultures were still positive 7 months after the start of treatment. After that, however, improvement slowed, despite the fact that the patient reported taking the drugs correctly. Oral treatment with itraconazole (200 mg/day) resulted in marked improvement in the lesions at 1 month. Skin-scale and hair samples were collected for direct microscopic examination using the potassium hydroxide technique, which revealed hyphae, and for culture, which was positive for Trichophyton tonsurans. 1), and hair fell out easily with traction. A large alopecic plaque with abundant whitish desquamation was present on the scalp ( Fig. Physical examination revealed a scaly, erythematous annular plaque covering the neck and the upper third of the back. The patient had not been in contact with animals. The pruritus had decreased slightly, but the alopecia had progressively worsened. The patient had been diagnosed with eczema and had received treatment with topical corticosteroids for several months. The symptoms had first appeared 3 months earlier. The patient was a 71-year-old woman who presented with hair loss and pruritic lesions on her back and scalp. El cultivo fúngico debería incorporarse en el estudio de las dermatosis del cuero cabelludo de curso atípico y persistente, especialmente en individuos de edad avanzada. La relativa infrecuencia de la tinea capitis en la edad avanzada y, por otra parte, su frecuente atipicidad clínica condicionan un diagnóstico tardío, circunstancia que puede condicionar secuelas irreversibles e incrementa la posibilidad de contagios.
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Los cultivos fueron positivos para Trichophyton tonsurans (2 pacientes), Trichophyton rubrum y Trichophyton mentagrophytes. Una de ellas presentaba placas alopécicas con descamación, mientras que en las otras tres las lesiones eran inflamatorias y costrosas. Se describen los casos de 4 mujeres mayores de 65 años diagnosticadas de tinea capitis. Sin embargo, en las últimas décadas se han observado algunos cambios en su perfil epidemiológico, tanto en lo que concierne a las edades de presentación como a los agentes responsables. La tinea capitis se ha considerado clásicamente como un proceso casi exclusivo de la infancia.