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• W2518101064 abstract "A 27-year-old healthy, Caucasian woman was referred to the dermatology clinic with a 1.5 × 1.5 cm uniformly, hyperpigmented, light brown patch with irregular borders on her right palmar hand (Fig. 1A ) that has been increasing in size for approximately one year. The patient did not endorse any scaling, blistering, or bleeding from the lesion. Furthermore, the patient did not report any itching, pain, and burning from the involved area. No prescribed or over-the-counter treatments were used prior to presentation. The patient did not have a history of any similar appearing lesions in the past or anywhere else on her body. No personal or family history of melanoma and non-melanoma skin cancers was reported. The patient described an extensive travel history over the preceding year which included Central America, Mexico's Yucatán Peninsula, California, and North Carolina. Moreover, the patient endorsed an extensive exposure to wooded areas in her work as a wilderness therapist. What is the diagnosis? Tinea nigra palmaris was suspected and confirmed by examining scrapings of the lesions, prepared with potassium hydroxide, microscopically revealing hyphae (Fig. 1B). The patient was prescribed ketoconazole 2% cream; at a two-week follow-up the lesion had decreased in size with this therapy. Tinea nigra palmaris is an uncommon and harmless superficial dermatomycosis most commonly due to Hortaea werneckii, previously termed Phaeoannellomyces werneckii [[1]Schwartz R.A. Superficial fungal infections.Lancet. 2004; 364: 1173-1182Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar]. It is most commonly acquired in tropical areas such as Central and South America, Africa, and Asia; however, it may be acquired in coastal areas of the United States and Europe [[2]Perez C. Colella M.T. Olaizola C. Hartung de Capriles C, Magaldi S, Mata-Essayag S. Tinea nigra: Report of twelve cases in Venezuela.Mycopathologia. 2005 Oct; 160: 235-238Crossref PubMed Scopus (52) Google Scholar]. Infection occurs following inoculation from soil, sewage, wood, or compost sources and the clinical lesion develops after an incubation period of 2–7 weeks, although it can be much longer [[1]Schwartz R.A. Superficial fungal infections.Lancet. 2004; 364: 1173-1182Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar]. Although the palm is the most common location, the soles and other parts of the body may be afflicted. It is typically asymptomatic, though itching may occur. The characteristic dark macule or patch results from a melanin-like substance in the fungus infecting the superficial layers of the stratum corneum [1Schwartz R.A. Superficial fungal infections.Lancet. 2004; 364: 1173-1182Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar, 3Dummer R. Meyer J. A growing brownish macule on the sole of a doctor's spouse.Dermatology. 2000; 200: 368-369Crossref PubMed Scopus (2) Google Scholar]. This case highlights the importance of taking a detailed travel and exposure history, as well as the diagnostic value of a potassium hydroxide preparation. Awareness of tinea nigra palmaris as a possible diagnosis when confronted with new-onset pigmented lesions can help avoid unnecessary biopsies to rule-out cutaneous melanoma. Jameson Loyal, BA – writing of manuscript; photographs. Joseph C. Pierson, MD – writing of manuscript." @default.
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• W2518101064 date "2016-12-01" @default.
• W2518101064 modified "2023-09-27" @default.
• W2518101064 title "Hyperpigmented hand lesion – A woodland's souvenir" @default.
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• W2518101064 doi "https://doi.org/10.1016/j.ejim.2016.08.005" @default.
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