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Two separate case reports involving older, immunocompromised women illustrate how the skin can become a battleground for strange, unseen invaders.

Flesh-Eating Flower

A woman in her 70s went to the dermatologist when the flesh on her right leg began bubbling and receding like a lit match. These necrotic ulcers pooled with bloody crusts and purulent discharge.

A tissue sample revealed long, branching structures indicative of fungi, and a culture confirmed the presence of a common plant fungus, Colletotrichum gloeosporioides, of National Cheng Kung University in Tainan, Taiwan, and colleagues, reported in .

The woman, who also reported long-term use of topical corticosteroids for stasis dermatitis, told her physicians she had a collection of orchids in her bedroom, one of which had traumatized her leg 3 months prior, piercing an entry point for the fungal intruder.

The patient was treated successfully with an oral anti-fungal.

Yang's team found only five other cases of this particular fungus developing a taste for human flesh, all of which occurred in immunocompromised patients. This research prompted the authors to warn physicians of this emerging, opportunistic, life-threatening pathogen, especially in immunocompromised gardeners.

Mitey Rough Patch

Another woman in her 70s went to the dermatologist complaining of "sandpapery" skin on her face, ears, neck, upper chest, and forearms. The patient had a history of acute myelogenous leukemia, which was treated with hydroxyurea 4 years earlier, and polycythemia vera. However, she claimed the rough skin began prior to these conditions.

Courses of several different topical treatments did nothing to soften the skin.

Two punch biopsy specimens were taken from the cheek and behind the ear, , of the University of Utah School of Medicine, reported in .

The lab results revealed Demodex folliculorum mites had burrowed into hair follicle cavities and caused the outer layer of skin to thicken with spinney eruptions.

A prescription of permethrin cream helped the roughness, but caused a burning sensation and prompted her to boost her hydroxyurea dosage. Ivermectin was substituted, which worked, and remains as the patient's go-to treatment for recurrent flare-ups.

Curtis cited three previous case reports of this type of skin eruption involving burrowed mites in patients with polycythemia vera who were being treated with hydroxyurea, and suggested increased age, diabetes, hemodialysis, and immunosuppression predisposed patients to this type of infestation.

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