Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5 cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. There may be multiple spots. The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. : 311  Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size.Most cases are caused by Hortaea werneckii, a pigmented fungus, which is a dark yeast found in sewage, soil, rotting vegetation and wood and in places with a high salt content such as moldy salted fish and on beaches, where contact with sand may result in transmission. Infection is by direct contact and the fungus enters and remains in the outer dead layer of skin with little or no skin inflammation. The infection does not invade deeper tissues.Diagnosis is by visualisation, dermoscopy, and microscopy and culture of skin scrapings. Differential diagnosis includes Addisons disease, syphilis, pinta, yaws, melanoma, lentigines, lichen planus of the palms, and junctional melanocytes nevus. Treatment is with topical Whitfields ointment or salicylic acid ointment. Topical antifungals or oral itraconazole are other options. Scraping the lesion can be curative.
For affected girls who wish (or whose parents wish) to have their hymens preserved, surgical techniques to excise of a central flange of the hymen can be used. The timing of surgical hymen repair is controversial: some doctors believe it is best to intervene immediately after the neonatal period, while others believe that surgical repair should be delayed until puberty, when estrogenization is complete. Epidemiology
Imperforate hymen is the most common vaginal obstruction of congenital origin. Estimates of the frequency of imperforate hymen vary from 1 in 1000 to 1 in 10,000 females. References

Glavan, N; Haller, H; Brnčić-Fischer, A; Glavan-Gačanin, L; Miletić, D; Jonjić, N (2016). "Imperforate hymen presenting as vaginal cyst in a 16-month-old child - considerations for an early diagnosis". Scottish Medical Journal. 61 (1): 48–50. doi:10.1177/0036933015615263. PMID 26659454. S2CID 27077599. Imperforate hymen at Medscape


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