Common Dermatophyte Infections Long-Standing Tinea Corporis

For more than 20 years, a 55-year-old man had a faintly erythematous, papulosquamous rash with arciform borders on his groin and waistline. The rash had been treated with a variety of medications. Topical and oral antifungals and antibiotics and topical corticosteroids had been used but to no avail. No laboratory tests had been performed. A potassium hydroxide preparation demonstrated abundant hyphae; tinea corporis was diagnosed. Oral terbinafine, 250 mg/d for 2 weeks, and terbinafine spray, used twice daily for 1 month, controlled—but did not cure— the condition. The patient apparently was very susceptible to the fungal organisms, which had contaminated his environment, including clothes, bedding, and carpet, for more than 2 decades. The patient was advised to use miconazole powder daily and occasional applications of terbinafine spray indefinitely to control the infection.