約1年間ステロイド内服療法を受けた生毛部白癬の1例

TINEA GLABROSA TREATED WITH A CORTICOSTEROID FOR ABOUT ONE YEAR

　約1年近く，ステロイド内服療法を受けていた白癬の1例を経験した。本症例は白癬に対する副腎皮質ホルモンの影響という純医学的な面ばかりでなく，医療はどうあるべきかの問題をも内蔵しており，我々に教えるところが大であると考えるので，ここに報告する。

A 48-year-old housewife with tinea treated with a corticosteroid for one year by a generalpractitioner undcr the diagnosis of erythema exudativum multiforme on the extensor aspect of the left lower arm was reported.

For a short period after starting the steroid therapy the lasion faded, which soon made flare-up and dissemination. But the size of the primary lesion was the same as before the steroid therapy.

At her first visit, unlike usual tinea glabrosa, multiple lesions of erythemato-squamous macules without papules, vesicles and any tendency to central healing were noted on the hand, upper and lower arm. The nail of the left thumb was also suffered from the fungus infection.

Cultivation of Trichophyton rubrum was successful from the lesions.

After withdrawal of the steroid the lesions showd on acute inflammatory reaction with erythemato-edematous swelling, some of which had pustules on the margin of the macules.

Histological section from the inflamed area revealed edema in the papillary layer and in the lower part of the epidermis. Hyphae were proved in the hyperkeratotic and parakeratotic horny layer by McManus' stain.

By discontinuation of ingestion of the steroid and application of topical antifungal treatment, the glabrous lesions except for the nail lesion were cured after one month.

As side effectsof long-term steroid therapy, including moonf ace, she suffered from general malais and arthralgia after interruption of steroid ingestion.

This case of the iatrogenic complication presents not only medical interests in the immunological deficiency induced by a steroid, but also strongly indicates the necessity of diagnosis and treatment by a dermatological specialist.