LAUSR

number of factors, including the body site affected, but may include the following: osteomyelitis, cutaneous tuberculosis (scrofuloderma), atypical mycobacterial infection, botryomycosis, sporotrichosis and cutaneous leishmaniasis. Mini-mycetoma in particular may be confused with skin cancer or benign lesions such as a cyst or abscess. Dermoscopy can help to differentiate these. Mycetoma is endemic in tropical countries belonging to the ‘mycetoma belt’, between latitudes 15°S and 30°N. Infection cannot be acquired in the UK, but the condition may be encountered in patients entering the UK from an endemic country. It is therefore important for clinicians to understand the epidemiology of the disease and be able to recognize the clinical features. The diagnosis can be confirmed easily by direct examination, allowing treatment to be initiated. The predominant species causing actinomycetomas is Nocardia brasiliensis; however, this case was caused by N. asteroides, which is more often a cause of nocardiosis, an opportunistic infection without tissue grains. Actinomycetoma due to Nocardia spp. frequently responds well to prolonged antibiotic therapy; however, for eumycetoma, the response to antifungal agents is less favourable and surgery is often required.