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The results of the general condition were all within the normal limits.
There were pruritic erythematous papular lesions located on his finger webs, wrist, axillary folds, and
scrotum. You found many canaliculies on Andi's interdigital areas of his hands. Skin scraping from
this area revealed an oval and ventrally flattened mite with 0.4 mm long, some eggs and scybala.
There were also hypopigmented macules with irregular borders on the patient’s back, shoulders, and
axilla. Diameter of the lesions were 0.5 cm to 3 cm. Some of the lesions were covered by fine-scales.
Examination of the patches under the Wood’s lamp, showed positive of yellow fluorescence. Direct
microscopic examination using 10% KOH on examination sample from the skin-scrapings of these
patches showed round spores and short hyphae which a “spaghetti/ziti and meat balls” appearance.
On the left groin there was a well-defined pruritic-erythro-papulo-skuamous patch, 5 x 7 cm, with
an irregular border. Papules and scales were more prominent on its border and the patch gave an
impression of being more active on its border area creating “central clearing” area. Satellite lesion
(-) Direct microscopic examination using 10% KOH on examination sample from the skin-scrapings
of this patch showed long branches septate-hyphae with some arthrospores.
Presently a culture examination for fungi was carried out. Liver function was being tested.

Skin scraping from finger webs

Direct microscopic examination using 10% KOH on examination sample from the skin-
scrapings of these patches on the back, shoulders, and axilla
 Direct microscopic examination using 10% KOH on examination sample
from the skin-scrapings of patch on the left groin

Instructions:
1. What is the diagnosis of this patient?
2. What is the cause and risk factor of the disease?
3. Explain the pathogenesis of the lesion in the finger web, wrist, axillae, and penis!
4. What are the complication of the lesion in the finger web, wrist, axillae, and penis!
5. In which layer of the skin does the disease occur? (Review DMS ) Learning Issue 3.
6. Why we should check liver function test?
7. Why the culture examination was carried?