Introduction: Dermatophytic granuloma is uncommonly seen on the leg as Majocchi’s granuloma and in scalp as kerion type of tinea capitis, but it is rare to occur on the face.
Case summary A 9 year-old Malay girl presented with itchy skin lesions over body, face and scalp since 1yr. On examination, multiple dry scaly annular patches with well defined border were seen over trunk and limbs. Multiple hyperkeratotic and verrucous papules and plaques were seen over face and scalp. Patches of scarring alopecia of scalp were also seen. Left middle finger nail showed dystrophic changes. Oral mucosa showed no lesions.
Scales from body skin scrapping with Potassium hydroxide preparation showed multiple septate hyphae. Culture of scales from skin lesion and hyperkeratotic lesion over face grown Microsporum canis. Biopsy of the granulomatous lesion over the face and skin lesion showed multiple hyphae on PAS staining confirmed the dermatophytic granuloma of the face and scalp and tinea corporis over the trunk. The girl was referred to Paediatric Department to assess her immunological status. The results were inconclusive. According to Paediatrician, the child appears to be immunocompetent. Injection Itraconazole 80mg were given twice a day as inpatient.
Within a week, the lesion over face and scalp almost resolved and the lesions over trunk and limbs totally cleared. Patient was discharged and asked to continue syrup Itraconazole 80mg bd. By 3rd week, scalp lesions almost cleared with few scarring alopecia patches.
Conclusion: This case has been reported for the rare presentation of verrucous dermatophytic granuloma of face and scalp in immunocompetent child.