Hypochromic macules without alteration of sensitivity in a health worker.

Spanish woman aged 44 who, in May 2011, went to the dermatologist with 2 hypochromic macules with slightly erythematous borders, on both forearms, showing centrifugal spread, but no signs of altered sensitivity or pruritus (Fig. 1). The patient went to the dermatologist and was diagnosed with eczema and treated with hydrocortisone. At that time, histopathology was ordered and, upon microscopic examination, epidermal atrophy with orthokeratotic hyperkeratosis and the presence of a small infundibular plug was observed. Vacuolar degeneration of the basal layer with some necrotic keratinocytes. Abundant interstitial mucin deposits were observed in the dermis. Some lymphocytes and plasma cells with superficial perivascular distribution. Isolated melanophages. Using PAS staining, 2 small fungal spores were observed on the surface of the keratin laminae. The final laboratory diagnosis was: compatible with lupus, with presence of surface fungi. The antinuclear antibody test (Anti-Ro/SSA) was negative. The patient was then treated for 2 months with itraconazole 400 mg/day.