Allergic Contact Dermatitis Induced by Lacquered Comb / 대한피부과학회지

No abstract available.

Randomized Clinical Trial to Evaluate the Efficacy and Safety of Combination Therapy with Short-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminium Garnet Laser and Amorolfine Nail Lacquer for Onychomycosis

BACKGROUND: Onychomycosis is one of the most prevalent fungal diseases in the general population. However, treatment is of limited effectiveness and must be administered for long periods of time. Systemic antifungal agents are associated with adverse effects. OBJECTIVE: We evaluated the clinical efficacy and safety of a 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser with amorolfine nail lacquer to treat onychomycosis. METHODS: The 128 patients were randomly divided to 2 groups: 64 in the experimental group were treated with 1,064-nm Nd:YAG laser therapy and amorolfine nail lacquer; the other 64 were in a control group treated with topical amorolfine lacquer monotherapy. The laser treatment was 4 sessions at 4-week intervals and amorolfine lacquer was applied once a week for 16 weeks. Efficacy was assessed as response rate from standardized photographs with ImagePro®Plus (Media Cybernetics, Inc., USA) analysis, microscopic examination, and subjective evaluation. RESULTS: At 16 weeks, the experimental group showed a significantly higher cumulative cure rate than the control group (71.88% vs. 20.31%, p<0.0001). Clinical therapeutic effects were linked to patient satisfaction. The percent of “very satisfied” or “satisfied” responses was higher in the test group than the control group (81.25% vs. 23.44%). The treatment regimen was well tolerated, with transient discomfort observed in the test group. CONCLUSION: The 1,064-nm Nd:YAG laser with amorolfine nail lacquer was effective and safe for treating onychomycosis. This therapy should be considered an alternative treatment, especially for patients with contraindications to systemic antifungal agents.

A Case of Toenail Onychomycosis Due to Aspergillus terreus / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus(A.) terreus is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. terreus in a 60-year-old male. The patient showed brownish yellow discoloration with hyperkeratotic change on the distal and lateral portion of both toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar showed the velvety, cinnamon brown colonies. Biseriate and compactly columnar phialides that cover upper vesicle with conidial structure were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. terreus strain ATCC 20542 (GenBank accession number GU256759.1). We confirmed A. terreus by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 200 mg oral itraconazole daily and topical 5% amorolfine nail lacquer for 3 months.

Acute Generalized Exanthematous Pustulosis with Hemodynamic Instability Induced by Ingestion of Lacquer Chicken / 대한피부과학회지

No abstract available.

A Case of Toenail Onychomycosis Due to Aspergillus sydowii Infection / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus sydowii is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. sydowii in a 65-year-old male. The patient showed yellowish discoloration with hyperkeratotic change on the distal and lateral portion of both great toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed dichotomous septate hyphae and repeated cultures on Sabouraud dextrose agar showed the same blue green velvety colonies. Biseriate phialides that cover entire vesicle with conidial structure resembling Penicillium were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. sydowii strain XWSFJJ1 (GenBank accession number FJ461692). We confirmed A. sydowii by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical 5% amorolfine nail lacquer for 3 months.

The use of the Er:YAG 2940nm laser associated with amorolfine lacquer in the treatment of onychomycosis / Uso do laser de Er:YAG 2940nm associado ao esmalte de amorolfina no tratamento da onicomicose

Onychomycosis is a common disease, accounting for up to 50% of all ungual pathologies. We have been developing a clinical trial (ClinicalTrials.gov: NCT01528813) using a 2940nm Er:YAG laser to fractionally ablate human nails in vivo, aiming to increase topical amorolfine lacquer delivery to the nail unit, increasing the efficacy of topical treatment of distal and lateral subungual onychomycosis. Partial results have shown an increase in areas of nail plate free of disease. We believe that ablative lasers can increase the efficacy of topical onychomycosis treatment.

A onicomicose é afecção frequente, representando até 50% do total das doenças ungueais. Um ensaio clinico (ClinicalTrials.gov: NCT01528813) em atual desenvolvimento usa o laser de Er:YAG 2940nm para realizar ablação fracionada in vivo de unhas humanas visando aumentar a permeabilidade ungueal ao esmalte de amorolfina, visando aumentar a eficácia do tratamento tópico da onicomicose subungueal distal lateral. Resultados parciais tem demonstrado um aumento na área ungueal livre de doença nas unhas tratadas com o laser, em comparação ao uso isolado do esmalte. Acreditamos que lasers ablativos possam aumentar a eficácia do tratamento tópico da onicomicose.

Differences in Antigen-presenting Cells between Normal and Systemic Contact Dermatitis Skin due to Rhus Lacquer / 대한피부과학회지

BACKGROUND: Urushiol is a widely known potent allergen that causes severe contact dermatitis through the epidermis or blood vessels. The role of antigen presenting cells (APC) in allergic contact dermatitis (ACD) is well known, but the role of APC in systemic contact dermatitis (SCD) is not yet fully evaluated. OBJECTIVE: The aim of this study is to observe the changes of APC in thenormal and SCD skin and to discuss their possible roles in the disease process. METHODS: Immunohistochemical differences of the Langerhans cells (LC) and dermal dendritic cells (DDC) were investigated in cases of the normal and SCD skin (Ed note: keep uniformity as above). Immunohistochemical staining with anti-CD1a, S-100 protein, HLA-DR, and factor XIIIa antibodies were performed. The number of CD1a, S-100 protein, and HLA-DR positive cells per mm2 of the epidermis was counted. The number of HLA-DR and Factor XIIIa-positive DDC per mm2 was also evaluated. RESULTS: The LC positive for CD1a and S-100 in the epidermis were slightly higher in SCD, but their difference was not statistically significant. HLA-DR and Factor XIIIa-positive DDC in the dermis weresignificantly increased in the skin of SCD than normal. HLA-DR positive LC in the epidermis was also increased. CONCLUSION: Our results suggest that DDC plays a more important role than that of epidermal LC in urushiol-induced SCD. Increased HLA-DR-positive LC in the epidermis suggests that antigen delivery through the blood also affects the epidermal Langerhans cell beside the dermal dendritic cells.

Onychomycosis Caused by Chaetomium globosum

Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. The genus Chaetomium is a dematiaceous nondermatophytic mold found in soil and plant debris as a saprophytic fungus. We report the first Korean case of onychomycosis caused by Chaetomium globosum in a 35-year-old male. The patient showed brownish-yellow discoloration and subungual hyperkeratosis on the right toenails (1st and 5th) and left toenails (1st and 4th). Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide slants showed the same fast-growing colonies, which were initially velvety white then turned to dark gray to brown. However, there was no growth of colony on SDA with cycloheximide slants. Brown-colored septated hyphae, perithecia and ascospores were shown in the slide culture. The DNA sequence of internal transcribed spacer region of the clinical sample was a 100% match to that of C. globosum strain ATCC 6205 (GenBank accession number EF524036.1). We confirmed C. globosum by KOH mount, colony, and light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical amorolfine 5% nail lacquer for 3 months.

Comparative clinical evaluation of efficacy and safety of a formulation containing ciclopirox 8% in the form of a therapeutic nail lacquer in two different posologies for the treatment of onychomycosis of the toes / Avaliação clínica comparativa da eficácia e da segurança de formulação contendo ciclopirox a 8% na forma de esmalte terapêutico em duas diferentes posologias no tratamento de onicomicoses dos pododáctilos

BACKGROUND: The use of topical antifungal agents in the treatment of onychomycosis is of great value in clinical practice as there are different limitations regarding the use of systemic treatment. OBJECTIVE: To evaluate the efficacy and safety of a nail lacquer formulation containing ciclopirox 8% in two different posologies: the traditional regimen (3/2/1) and a regimen of weekly use. METHODS: A blind, randomized, comparative trial which included 41 patients divided into 02 groups, with Group I using the nail lacquer once weekly and Group II using the traditional regimen (3/2/1). Both groups applied the medication for 06 months. RESULTS: The species most frequently found in groups I and II were Trichophyton rubrum (55% and 61.9%) and Trichophyton mentagrophytes (30% and 19%). There was a tendency to a higher level of treatment resistance by T. mentagrophytes infection in both groups, without any predilection for sex, age, proportion of the nail affected at the beginning of the study, duration of the clinical disease and quantity of nails affected per person. Both groups had significant levels of mycological cure, clinical response and therapeutic success and there was no statistically significant difference between groups I and II (p >0.05). CONCLUSION: The nail lacquer containing ciclopirox 8% was equally effective at a weekly dose when compared to the traditional dosing (3/2/1), allowing a more comfortable regimen.

FUNDAMENTOS: A utilização de antifúngicos tópicos na terapêutica da onicomicose é de grande valor na prática clínica, visto que há diferentes limitações ao uso das opções terapêuticas sistêmicas. OBJETIVO: Avaliar comparativamente a eficácia e a segurança de uma formulação de esmalte de ciclopirox a 8% em dois diferentes esquemas posológicos: o esquema tradicional (3/2/1) e um esquema posológico de uso semanal. MÉTODOS: Foi realizado um estudo cego, comparativo e randomizado que incluiu 41 pacientes, divididos em dois grupos, sendo o grupo I submetido ao esquema posológico de uma vez por semana e o grupo II submetido ao esquema posológico tradicional (3/2/1). Os grupos utilizaram a medicação por 180 dias. RESULTADOS: As espécies mais frequentemente encontradas nos grupos I e II foram Trichophyton rubrum (55% e 61,9%) e Trichophyton mentagrophytes (30% e 19%). Houve tendência de maior resistência ao tratamento pelo T. mentagrophytes nos dois grupos estudados, sem predileção por sexo, idade, proporção de acometimento ungueal inicial, tempo de evolução do quadro ou número de unhas acometidas por indivíduo. Ambas as modalidades apresentaram índices significativos de cura micológica, resposta clínica e sucesso terapêutico, e não houve diferença estatisticamente significante entre os grupos I e II (p > 0,05). CONCLUSÃO: O esmalte contendo ciclopirox a 8% mostrou-se igualmente eficaz na posologia de uma vez por semana quando comparada à posologia tradicional (3/2/1), permitindo um esquema posológico mais confortável.

Clinical Features of Systemic Contact Dermatitis Due to the Ingestion of Lacquer in the Province of Chungcheongnam-do

BACKGROUND: Lacquer contains an allergen, which can cause severe contact dermatitis. Systemic dermatitis resulting from the ingestion of lacquer is quite common in Korea, until now. OBJECTIVE: The purpose of this study is to elucidate the clinical features and laboratory findings of systemic contact dermatitis (SCD), due to the ingestion of lacquer in Chungcheongnam-do. METHODS: We retrospectively reviewed the medical records of 33 patients with SCD, after ingestion of lacquer from Soonchunhyang University Hospital in Cheonan, over a 6-month period. RESULTS: In this study, 33.3% of patients ate lacquer, as a health food, and some (15.2%) by encouragement of friends or spouse. The most common way of ingestion was the lacquer-boiled chicken (48.5%), but many also ate lacquer tree sprouts (42.4%). The skin lesions developed as erythematous maculopapular eruptions, erythema multiforme, erythroderma, purpura, wheals and vesicles. On laboratory findings, 13 patients (52%) exhibited leukocytosis and 11 patients had elevated eosinophil counts. CONCLUSION: The general public is becoming more aware of the toxic effects of lacquer ingestion, but still does not fully understand the dangers of lacquer tree sprouts, and this ignorance is frequently causing SCD in Chungcheongnam-do.

Fingernail Onychomycosis Due to Aspergillus niger

Onychomycosis is usually caused by dermatophytes, but some species of nondermatophytic molds and yeasts are also associated with nail invasion. Aspergillus niger is a nondermatophytic mold which exists as an opportunistic filamentous fungus in all environments. Here, we report a case of onychomycosis caused by A. niger in a 66-year-old female. The patient presented with a black discoloration and a milky white base and onycholysis on the proximal portion of the right thumb nail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. No colony growth occurred on SDA with cycloheximide slants. Biseriate phialides covering the entire vesicle with radiate conidial heads were observed on the slide culture. The DNA sequence of the internal transcribed spacer region of the clinical sample was a 100% match to that of A. niger strain ATCC 16888 (GenBank accession number AY373852). A. niger was confirmed by KOH mount, colony identification, light microscopic morphology, and DNA sequence analysis. The patient was treated orally with 250 mg terbinafine daily and topical amorolfine 5% nail lacquer for 3 months. As a result, the patient was completely cured clinically and mycologically.

A Case of Acute Generalized Exanthematous Pustulosis with Patterns of Septic Shock / 대한내과학회지

Acute generalized exanthematous pustulosis (AGEP) is a rare disease characterized by multiple acute, small, non-follicular, sterile pustules on an erythematous background, usually accompanied by fever and leukocytosis. AGEP is attributed to systemic drugs, mainly beta-lactam and macrolide antimicrobials, in more than 90% of cases. Systemic contact dermatitis is not rare after ingesting lacquer broth, but few reported cases of AGEP have occurred after the ingestion of lacquer chicken broth without a past history of drugs, viral infection, or contact allergy to mercury. Here, we report a rare case of AGEP with a pattern of septic shock induced by the intake of lacquer chicken in a 40-year-old male patient. He developed a generalized pustular lesion with high fever and hypotension. Histologic examination showed subcorneal neutrophilic pustules, papillary dermal edema, and lymphohistiocytic perivascular infiltrates with some eosinophils and neutrophils. The patient was treated with empirical antibiotics and systemic steroids, and the pustular lesions improved 2 weeks later without recurrence.

Epidemiologic Survey of Onychomycosis in Koreans: Multicenter Study / 대한의진균학회지

BACKGROUND: Although there have been many studies about onychomycosis, no study about Koreans in onychomycosis has been reported in Korea. OBJECTIVE: The purpose of this study was to investigate the onychomycosis in Koreans. METHODS: From April, 2009, to March, 2010, 1,893 patients with onychomycosis who visited the department of dermatology at 10 university hospitals were evaluated. RESULTS: Of 1,893 patients with onychomycosis, 93.8% were toenail onychomycosis, 2.2% fingernail onychomycosis, and 4.0% onychomycosis in both toenails and fingernails. Among the age groups, the incidence rate was highest over the sixties (35.6%). The ratio of male to female patients was 1.3:1. Distal and lateral subungual onychomycosis (80.3%) was the most common clinical type of onychomycosis. Combination therapy of oral terbinafine or itraconazole and topical amorolfine nail lacquer was most common in the treatment of onychomycosis. The most common reasons for combination therapy in onychomycosis were higher cure rate due to synergistic activity (40.2%), followed by shortened treatment duration (12.8%), patient compliance (12.3%), and prevention of recurrence and reinfection (1.7%). CONCLUSION: Because of the increase in onychomycosis, we suggest the need of standard treatment guidelines for Korean patients with onychomycosis.

Onychomycosis with Dermatophytoma Completely Cured after Treatment of Regular Subungual Application of Antifungal Solution with Systemic Antifungal Therapy and Topical Nail Laquer Application / 대한의진균학회지

Systemic antifungal therapy is essential to cure onychomycosis but when used alone, its complete cure rate is less than 50%. Therefore, combination therapy is preferred to achieve higher cure rate of onychomycosis, especially severely infected onychomycosis. For effective treatment of onychomycosis, it is important how antifungal agents reach causative fungi in the nail lesion. If there are dermatophytoma or onycholysis, biofilms and space may disturb antifungal agent to reach the fungi in the nail lesion. If direct antifungal solution is applied to the space, it can be spread with capillary action to the space and fungi. A 57-year old male patient presented onychomycosis with infected nail matrix and dermatophytoma, which had recurred after combination therapy of oral and topical antifungal agents before. He had been treated with subungual antifungal solution added to systemic terbinafine (250 mg/day) and amorolfine nail lacquer for initial 3 months, and with subungual antifungal solution and nail lacquer for the next 4 months, and nail lacquer only for the rest period. After 3 months treatment, totally involved left great toe nail showed 50% of normal healthy nail growing from the proximal nail fold. His infected nails eventually showed complete normal nails 1 year after the initial treatment.

Clinicopathologic Manifestations of 36 Korean Patients with Acute Generalized Exanthematous Pustulosis: A Case Series and Review of the Literature

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a rare and severe subtype of drug eruption, characterized by acute, extensive, non-follicular, sterile pustules on an erythematous background, accompanied by fever and leukocytosis. OBJECTIVE: The purpose of this study was to characterize AGEP in Korean patients in terms of clinical, laboratory, and pathologic findings. METHODS: Thirty-six patients (M:F=17:19) with AGEP were identified from an extensive review of medical records over a 15 year period. All patient cases were confirmed by biopsy and fulfilled the diagnostic criteria. RESULTS: The patient ages ranged from 4~80 years (37.6+/-19.4). The incubation period was 1~23 days. The duration of disease was 5~14 days. Neutrophilia (36/36), high CRP (14/36), and eosinophilia (30/36) were common laboratory findings. A history of drug administration existed in 23 of 36 patients; herbal medications, lacquers and radiocontrast media were the unique causative drugs. Spongioform subcorneal or intraepidermal pustules in the epidermis was observed in all patients. Thirty-six patients were subdivided into 2 groups: group A (n=23) was strongly associated with known agents; and group B (n=13) had no identified causative agents. There was no significant difference between the 2 groups. CONCLUSION: Our results demonstrate the characteristic features of AGEP in Korean patients as follows: lower identification of causative agents; herbal medications, lacquers, and radiocontrast media were the main causative agents; and no significant differences existed between the 2 groups.

Effect of Polyurushiol Paint on Indoor Air Quality and Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Environmental factors can influence the pathogenesis of atopic dermatitis. In particular, a westernized residential environment that increases the density of house dust mites and gives rise to sick house syndrome could be a causative factor. Urushiol compounds extracted from Rhus verniciflua, a lacquer tree, have anti-insect and anti-microbial actions and reduce TVOC (total volatile organic compounds). OBJECTIVE: The purpose of this study was to elucidate the effects of paint containing a novel polyurushiol synthesized from the extract of Rhus verniciflua on indoor air quality and atopic dermatitis patients. METHODS: Nine patients with atopic dermatitis resistant to ordinary treatments were enrolled in this clinical trial. Patient rooms were painted with paint containing a novel polyurushiol extracted and synthesized from Rhus verniciflua. We measured TVOC before and after the painting. After a month, patients were evaluated with objective indices such as EASI score, serum IgE, eosinophil levels, and subjective satisfaction. RESULTS: even of nine patients showed objective or subjective improvements of clinical symptoms, and TVOCs were reduced after painting. The questionnaire indicated that many patients felt an improvement in air quality. CONCLUSION: Painting with a novel polyurushiol synthesized from the extract of Rhus verniciflua could improve indoor air quality and atopic dermatitis.

Psoriasis ungueal: experiencia con el tratamiento combinado de clobetasol al 8 por ciento en laca ungueal y calcipotriol / Combined clobetasol and calcipotriol treatment for nail psoriasis

La psoriasis ungueal es un problema común en los pacientes psoriáticos, con una incidencia de vida de 90%. A pesar de su alta incidencia y del gran impacto que produce en la calidad de vida, ha sido poco estudiada y el tratamiento óptimo aún no está bien dilucidado. Los corticoides tópicos y los análogos de la vitamina D son las terapias más usadas, pero no existe un esquema estándar para su uso. La combinación de estos agentes se ha estudiado en los últimos años para pacientes con afectación de la matriz y del lecho ungueal, mostrando muy buenos resultados. El caso que presentamos demuestra la sinergia entre estos agentes.

Nail psoriasis is a common problem among psoriatic patients, with a lifetime incidence of 90%. Despite its high incidence and severe impact on the quality of life, it has not been fully studied and the optimal treatment is still unclear. Topical glucocorticosteroids and vitamin D analogues are the most used therapies, but there is no standard therapeutic regimen for their use. The combination of both of these agents has been studied during the last years for the treatment of patients with matrix and bed nail compromise, showing very good results. The case that we present shows the synergy between these agents.

Thinner intoxication manifesting as methemoglobinemia.

Lacquer thinner, commonly used for removing household paints is known to contain mixture of various arometic hydrocarbons; halogenated hydrocarbons and naptha, if ingested may rarely cause methemoglobinemia. We report a 3 year old child who presented to us with history of accidental ingestion of thinner, used for removing household paint. Child was having cyanosis with minimal tachypnoea & the colour of his blood was chocolate brown. Later methemoglibulin level estimations were also done, which were suggestive of this diagnosis. Child was managed conservatively with oxygen therapy & vital monitoring, which lead to complete recovery and discharge from hospital later.

The Biological Effects of Rhus (Japanese lacquer sap) on Rats / 대한피부과학회지

BACKGROUND: Exposure to Rhus (Japanese lacquer) can cause many adverse effects such as contact dermatitis, pruritus, rash and even hepatitis in human, and these effects can be caused by contact or ingestion of Japanese lacquer. Many Koreans currently eat Japanese lacquer boiled with chicken although it has many side effects. Koreans believe that Rhus will improve their health. However, they don't known its adverse effects, and there is no experimental report on this topic. OBJECTIVE: The principle objective of this study was to gather evidence on the toxicity and negative effects of Japanese lacquer through an experimental study with rats. METHODS: A total of 60 Sprague-Dawley rats were included in the study; 30 rats (experimental group) were given 0.1 ml of Japanese lacquer sap extract, water and food, and 30 rats (control group) were given only food and water. The WBC, the Hgb, ALT, AST, BUN and creatinine levels, the presence of pruritis and skin eruption, the skin biopsy findings and the liver biopsy findings were all checked at 5, 10, and 15 days. RESULTS: The rats that were given Japanese lacquer sap showed a higher WBC and higher ALT and AST levels and only these rats demonstrated erythroderma (5th day: 30%, 10th day: 40%, 15th day: 70%). In addition, they exhibited frequently scratching behavior. On histological examination of the skin of the rats given Rhus, dermal edema and mild inflammatory cell infiltration were found. On histological examination of the liver of the rats given Rhus, there was no significant change as compared with the rats that weren't given lacquer. CONCLUSION: In this experimental study, it was proven that Rhus could induce pruritis, erythroderma, skin inflammation and hepatotoxicity.

Multiple White Superficial Onychomycosis in a Child with Cerebral Palsy Caused by Trichophyton rubrum / 대한의진균학회지

White superficial onychomycosis (WSO) is defined as fungal infection of the nail plate from dorsal surface of the nail plate. In English literatures, prevalence of WSO in the general population is about 1% to 2%, and the most common causative organism of WSO in adults is Trichophyton mentagrophytes except AIDS patients. On the other hand, the prevalence in children is 0.3%. A 6-year-old boy presented with whitish patches on his ten toe nails which had developed 4 years previously. He had cerebral palsy with spastic tetraplegia and epilepsy, and had admitted eight times for systemic infections, such as pneumonia and pharyngitis. Trichophyton rubrum was revealed as a causative organism by slide culture and PCR test. The nails showed improvement after two months of topical treatment with amorolfine nail lacquer. Herein we report a case of childhood multiple WSO caused by Trichophyton rubrum.