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A 65-year-old woman presented with painful nodules on her back after returning to Switzerland from Congo. The nodules were furunculoid in nature and had central ulceration. Dermoscopically, erythematous lesions with a central larval breathing hole, resembling a periscope, were observed. The larvae were identified as Cordylobia anthropophaga. Furuncular myiasis is rare in Switzerland and is often seen in patients returning from regions where these flies are prevalent. The authors suggest using the "periscope sign" as a dermatoscopic finding to aid in the diagnosis of this condition. [Extracted from the article]

Background: Dermatophytosis is one of the most common infections affecting 3%-17% of the population. Resistance to antifungals so far was not of concern in the therapeutic management. However, recent reports of terbinafine-resistant strains in several countries are worrisome making antifungal susceptibility testing inevitable., Objectives: We aimed to develop and evaluate an optimised broth microdilution assay for antifungal drug susceptibility testing of dermatophytes., Methods: We first studied the effect of different inocula, incubation temperatures and incubation times to establish an optimised assay. Subsequently, we tested 79 clinical strains of 11 dermatophyte species with 13 antifungals., Results: We found inoculating with 0.5-5 × 10 4 colony forming units (CFU) and incubating at 29°C ± 1°C for 4 days to be appropriate. Terbinafine was the most active antifungal agent with minimum inhibitory concentration (MIC) values ≤ 0.06 µg/mL, expect for one resistant T mentagrophytes strain, which was isolated from an Indian patient. Also, a majority of MICs of other antifungals that are commonly used to treat dermatophytosis were low, except those of fluconazole. Fluconazole MICs do not correlate with the good efficacy in the clinical management., Conclusions: Our assay enables fast and reliable susceptibility testing of dermatophytes with a large panel of different antifungals. This helps to improve the therapeutic management of dermatophytosis by detecting resistant strains., (© 2020 Wiley-VCH GmbH.)