Case Report: Complex Fungal Rash and Arm Lesions in a 60-Year-Old Female | Katy & Houston, Texas
At Village Dermatology in Katy and Houston, Texas, we frequently evaluate rashes that are persistent, worsening, or unresponsive to initial treatments. Fungal infections can present in multiple ways and may be complicated by prior steroid use, making accurate diagnosis and targeted therapy essential.
Patient Presentation
A 60-year-old female presented as a new patient with a painful, itchy, blistering rash on the left arm, which had been present for several weeks. She also reported a chronic rash involving the inner thighs and a new lesion on the right forearm that she believed may be a spider bite. The severity of symptoms prompted further evaluation.
Clinical Examination
A focused dermatologic examination of the right and left forearms was performed using dermoscopy. The patient was alert, well-nourished, and in no acute distress.
Multiple distinct skin findings were identified, leading to several diagnoses.
Diagnosis #1: Tinea Cruris (Jock Itch)
The patient reported a long-standing rash in the inguinal folds, which had worsened after using topical corticosteroids.
Exam Findings
Erythematous, scaly plaques
Serpiginous borders
Located on the right anterior proximal thigh
A KOH preparation was performed and was positive for branching hyphae, confirming a fungal infection.
Treatment Plan
Ketoconazole 2% topical cream
Applied twice daily for two weeks
The patient was counseled that tinea cruris is a dermatophyte infection commonly seen in warm, humid climates like Houston and Katy, Texas. Cure rates are excellent, though recurrence is common.
Diagnosis #2: Majocchi’s Granuloma (Fungal Folliculitis)
The rash on the left forearm had failed to respond to topical steroids and showed features concerning for a deeper fungal infection.
Exam Findings
Peri-follicular pustules
Annular plaque formation
A KOH preparation was positive, supporting the diagnosis of Majocchi’s granuloma, a fungal infection that extends into hair follicles and often worsens with steroid use.
Treatment Plan
Oral terbinafine 250 mg daily for 4 weeks
The patient was counseled that Majocchi’s granuloma requires systemic antifungal therapy. A punch biopsy will be considered at follow-up if there is inadequate improvement.
Diagnosis #3: Suspected Spider Bite – Right Forearm
The patient also presented with a painful lesion on the right distal dorsal forearm, suspected to be a spider bite.
Exam Findings
Erythema with a central punctum
Treatment Plan
Daily wound care
Topical silver sulfadiazine (Silvadene) cream, applied twice daily until healed
The patient was counseled on signs of worsening infection or systemic symptoms that would require urgent medical evaluation.
Follow-Up
The patient is scheduled to return in four weeks to evaluate treatment response. Early improvement is expected, though fungal infections may require close monitoring.
Expert Rash Diagnosis & Treatment in Katy & Houston, Texas
At Village Dermatology, we specialize in diagnosing complex rashes, including fungal infections, steroid-modified eruptions, and inflammatory skin conditions. Accurate diagnosis using tools like KOH preparation and dermoscopy allows us to provide targeted, effective treatment.
📍 Serving Katy and Houston, Texas
