Abstract
ABSTRACT: A 73-year-old man was seen in dermatology for an erythematous dermatitis of the bearded portions of his face and neck. He had been seen 2 weeks prior in internal medicine and treated with cephalexin for a presumed facial cellulitis. The patient failed to respond to antibiotics, so he was seen in dermatology 2 weeks later, where a potassium hydroxide scraping (KOH) was positive for hyphae. He began treatment with fluconazole for tinea barbae and cephalexin for possible bacterial co-infection. Five days later, he returned with an acute dermatitis of the right extensor forearm and, to a lesser extent, the left. An allergic reaction to cephalosporins was considered in the differential diagnosis as well as an extension of the tinea infection, tinea corporis, and dermatophytid (id or ide) reaction. His shave biopsy showed an acute spongiotic dermatitis with a superficial perivascular infiltrate with red blood cell extravasation and rare eosinophils. He was treated for a dermatophytid reaction with a topical corticosteroid ointment. His peripheral dermatitis quickly improved with a topical corticosteroid ointment as his facial dermatitis responded to the oral antifungal medication treatment.