Case of the Month

A 41-year-old woman presents with pruritic tiny papules and pustules on her lips for. The condition has been present for three years. She has seen seven doctors (4 dermatologists) without relief. She has used multiple topical steroids, antibiotics (mupirocin), antifungals (ketoconazole), and Protopic. Orally, she has failed prednisone and an oral dose of Diflucan (150 mg).

Diagnosis: Cutaneous Candidiasis

I performed a cutaneous biopsy and, below left, is the dermatopathologic (PAS staining, 400X) findings. (courtesy of Erick Jacobson-Dunlap, MD, dermatopathologist)

I give credit to one of my mentors, Cindy Olson, MD, who told me to strongly consider candidiasis before the pathology results were known. As Dr. Olson recommended, I employed high dose oral antifungals. I used a Sporanox pulse pack, 2 (100 mg capsules) twice daily for seven days (28 pills total). The patient returned ten days after treatment, completely clear and absolutely thrilled. The after photo is below, right..