trichophyton schanleinii?

Dr. Rockoff,

My orange crust turned out to be a very atypical superficial yeast/spore forming fungal infection. My dermatologist is very stumped. His notes state that it most closely resembles clinically scutulae of trichophyton schanleinii, which is rare. Also that there were very many numerous spore forms in concretion.
Since my doctor does not know exactly what this thing is, he is uncertain how to treat it. He has consulted many other dermatologist. I am living in Japan and cannot get a second opinion.
At present I am applying Nizoral 2% cream to the pubic area twice daily-- for 21 days. If this does not work, as he assumes, I will then take something orally, (Sporanox).
I had just begun to try and conceive and we have put that on hold. I don't have the answers I need and am unsure of how to get them. I don't know if this is contagious, if my husband should be treated, if I need to specially launder sheets and underwear or how.  I especially don't want to take something as harsh as Sporanox with out knowing what I have and if it can help.
Under these circumstaces, where can I find much needed information on my own? Since these treatments are only a gamble, do you think they might work? Do you know the cure rate for things simular to this rare fungi?
(I do not have bald patches as is a symptom and it is pubic rather than scalp. I do lose much pubic hair when bathing)

Thank you Dr. Rockoff for any information you can send my way.

[Alan Rockoff, MD]

Your question is very perplexing indeed.  Trichophyton schoenleinii, despite its imposing name, is a superfical fungus infection.  Even if that's what it is, treatment should be simple: applying a cream like the Nizoral you are already using, or taking a couple of weeks' worth of an oral antifungal like Sporanox or Lamisil if topical treatment fails.  You speak of Sporanox as though it is a powerful and dangerous drug.  It is neither.  Superfical fungus infections are usually not contagious, and laundering sheets and treating contacts is not generall helpful or needed.

I must say that I remain skeptical that this is a fungus.  Your symptoms--intermittent swelling of the pubic bone--are not those of any groin fungus I've ever seen.  In any case, fungi live no deeper than the hair follicles, and thus have no relevance to childbearing.

Has your dermatologist performed a skin biopsy?  Perhaps he should.

Finally, I don't see why your being in Japan is a bar to getting a second opinion.  Ther are many fine dermatologists in Japan, some of whom are members of the American Academy of Dermatology.  You can contact that organization at www.aad.org.

Best.

Dr. Rockoff

[basilbasil]

Thank you very much for this information.  There is not much information about this fungis on the net--( that I could find) and what I did was pretty technical. My dermatologist did not perform a skin biopsy. I will request this. He only scraped of the orange crust pockets, top layer of skin and some hair. It is in the hair folicles and this is why he thinks topical is not going to do the trick.
All the things I read about Sporanox scared me...(warnings) and it stated could also effect fertility and a small chance of birth defects long after meds have stopped. But your reply has given me much peace of mind if I need to take it.
We only have one Dermtologist here and it is extremely difficult to see outside doctors. We usually are sent back to the States if we can't get needed medical attention here. Thank you again for this information. You are right, Trichophyton schoenleinii does sound very imposing, especially with 'atypical' writen with it!
Have a great weekend!!!!