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THROUGH THE LENS
Year : 2015  |  Volume : 6  |  Issue : 3  |  Page : 230-231  

Brownish macule on the palm


Department of Dermatology and Venereology, Government Medical College, Trivandrum, Kerala, India

Date of Web Publication6-May-2015

Correspondence Address:
Dr. S Pradeep Nair
Department of Dermatology and Venereology, Government Medical College, Trivandrum - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.156439

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How to cite this article:
Nair S P. Brownish macule on the palm. Indian Dermatol Online J 2015;6:230-1

How to cite this URL:
Nair S P. Brownish macule on the palm. Indian Dermatol Online J [serial online] 2015 [cited 2020 Aug 9];6:230-1. Available from: http://www.idoj.in/text.asp?2015/6/3/230/156439

A 22-year-old female patient presented with a brown colored macule on the left palm of seven weeks duration. The lesion began as a tiny brown macule on the left palm and gradually grew in size over a period of seven weeks. The lesion was asymptomatic. There was no history of vesiculation or scaling of the lesion. She did not give a history of coming in contact with any exogenous chemicals or dyes. The patient was not in the habit of excessively using soap and water to wash her hands. However, the patient gave a history of hyperhidrosis of the palms and soles for the past 2 years. There was no other significant past history. On examination, the patient had a uniformly brown colored macule of about 2× 3 cm on the left palm with irregular margins, distributed on the thenar eminence just above the wrist joint [Figure 1]. The dermatoglyphics were preserved over the macule and there was hyperhidrosis of the palms. The brown macule could not be removed even after rubbing with a cotton ball soaked with alcohol. Scrapings of the macule were mounted on 10% potassium hydroxide (KOH) and observed under the microscope. Brown colored, short, closely septate hyphae along with spores were observed under the microscope [Figure 2]. The classical clinical presentation of brownish macule resembling a stain on the palms along with the observation of brown closely septate hyphae on KOH mount enabled us to make a diagnosis of tinea nigra (TN). However, culture could not be done due to lack of facilities. The patient showed prompt response to topical terbinafine.
Figure 1: Brown colored macule over the left palm. Note the hyperhidrosis

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Figure 2: Brown colored short, closely septate hyphae (arrow), potassium hydroxide mount ×100

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Tinea nigra is a very rare superficial fungal infection caused by a pigmented fungus, Hortaea werneckii, while in some South American countries; it is caused by another species, Stenella araguata. This superficial mycosis is mainly reported from tropical countries, suggesting that hot humid climate favors its growth. [1],[2] The predisposing factors for TN have not been clearly elucidated; it is more commonly seen in females, especially housewives who frequently come in contact with soap and water. Hyperhidrosis has been noted as another risk factor as observed in our patient. [2] TN usually presents as a brownish macule on the palms and less frequently on the soles resembling stains caused by silver nitrate. Other sites reported are the face, axilla, and chest. The brown color is due to a melanin like material produced by the fungus. The pigmentation may be more in the periphery than the center. The lesions may be clinically confused with post inflammatory hyperpigmentation, junctional nevi, exogenous stains, melanoma, Addisonian pigmentation and the hyperpigmentation seen in syphilis and pinta. However, KOH mount and fungal culture clinch the diagnosis. KOH mount shows brown short, closely septate hyphae about 5 μm in diameter with branching and budding cells. Culture on Sabouraud's dextrose agar shows brown to black velvety colonies with many aerial hyphae. Skin biopsy may show fungal filaments close to the acrosyringium, indicating that sweat may be a nutrient for this fungus. [3] This benign rare superficial mycosis shows good response to topical terbinafine, ketoconazole, econazole, ciclopirox olamine, benzoic acid ointment, and thiabendazole. [4],[5] TN should be considered in the differential diagnosis of pigmented lesions on the palms, since it can mimic several dermatoses.

 
   References Top

1.
Tilak R, Singh S, Prakash P, Singh DP, Gulati AK. A case report of tinea nigra from North India. Indian J Dermatol Venereol Leprol 2009;75:538-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Castellani A. Tinea nigra in the far east. A historical note. Dermatol Int 1965;4:159-63.  Back to cited text no. 2
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3.
Gnanaguruvelan S, Janaki C, Sentamilselvi G, Boopalraj JM. Tinea nigra. Indian J Dermatol Venereol Leprol 1998;64:91-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Hemashettar BM, Patil CS, Siddaramappa B, Thammayya A. A case of tinea nigra from South India. Indian J Dermatol Venereol Leprol 1985;51:164-6.  Back to cited text no. 4
  Medknow Journal  
5.
Shannon PL, Ramos-Caro FA, Cosgrove BF, Flowers FP. Treatment of tinea nigra with terbinafine. Cutis 1999;64:199-201.  Back to cited text no. 5
    


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