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Phaeohyphomycosis is a rare fungal infection caused by melanized fungi which usually involve the skin and subcutaneous tissue. It is an infrequent cause of infection in human beings. Common clinical manifestations are subcutaneous cystic swellings, which is localized, characterized by subcutaneous asymptomatic nodular lesions that develop after traumatic implantation of fungus from contaminated soil, thorns or wood splinters, especially on extremities. We report a case of subcutaneous phaeohyphomycosis presenting as multiple cystic swellings over the left lower leg with unknown predisposing factors. At first, the patient was misdiagnosed as soft tissue tumor and subcutaneous tuberculosis, then got surgical and anti-tuberculosis therapy respectively, but there was no improvement. Further investigation revealed granulomatous inflammation on histopathology examination and black-coloured colonies identifed as Exophiala dermatitidis on fungal culture. This case of phaeohyphomycosis was successfully treated by itraconazole monotherapy without surgical excision and still under follow-up.

Melatonin an important immunomodulatory molecule in allergic diseases. Melatonin also plays a role in several body systems including to regulate circadian rhythms because of its role to cause drowsiness. Research shows in the case of atopic dermatitis (AD) circadian production of melatonin is reduced compared to healthy controls. This study aimed to investigate the differences of urinary melatonin levels between children with AD and healthy controls, and its relationship with disease severity. A cross sectional study was conducted in pediatric dermatology division of our outpatient clinic. Severity of AD was determined by using the instruments Scoring Atopic Dermatitis (SCORAD). Urinary melatonin levels were measured by Enzyme-linked immunosorbent assay (ELISA). The urinary melatonin levels in AD group were not significantly lower than in healthy controls (P =0.98 P 0.05) but there’s a tendency of decreased urinary melatonin with increased the severity of AD.