Dermatophytosis: Difference between revisions
| Line 9: | Line 9: | ||
**Clinical manifestation: | **Clinical manifestation: | ||
***Pruritic, circular scaly patch or plaque --> central clearing --> annular plaque | ***Pruritic, circular scaly patch or plaque --> central clearing --> annular plaque | ||
*Tinea pedis | *Tinea pedis (athlete's foot) | ||
**Foot | **Foot | ||
**Clinical manifestation: | **Clinical manifestation: | ||
| Line 17: | Line 17: | ||
***Scales | ***Scales | ||
***Bullous | ***Bullous | ||
*Tinea cruris | *Tinea cruris (jock itch) | ||
**Groin | **Groin | ||
**Clinical manifestation: | **Clinical manifestation: | ||
Revision as of 22:16, 7 October 2016
Background
- Common fungal infection of the skin, hair and nails
- Mode of transmission via direct contact to the organisms (eg. using unwashed wrestling mats)
- These dermatophytes are filamentous fungi that live off the keratin
Clinical Features
Subtypes of infections include:
- Tinea coporis (ringworm)
- Body except for feet, groin, face, scalp hair or beard hair
- Clinical manifestation:
- Pruritic, circular scaly patch or plaque --> central clearing --> annular plaque
- Tinea pedis (athlete's foot)
- Foot
- Clinical manifestation:
- Between digit spaces
- Pruritic
- Erosions
- Scales
- Bullous
- Tinea cruris (jock itch)
- Groin
- Clinical manifestation:
- Erythematous patch on proximal inner thigh --> central clearing with sharp borders and vesicles
- Scrotum typically spared
- Tinea capitis
- Scalp hair
- Clinical manifestation:
- Scaly patches with alopecia
- Tinea unguium (Dermatophyte onchomycosis)
- Nail
- Clinical manifestation:
Differential Diagnosis
Tinea pedis
- Interdigital Candida infection
- Erythrasma
- Atopic dermatitis
- Chronic contact dermatitis
- Acute palmoplantar eczema
- Palmoplantar psoriasis
- Pitted keratolysis
- Juvenile plantar dermatosis
- Keratolysis exfoliativa
- Keratodermas
- Acute palmoplantar eczema
- Acute contact dermatitis
- Palmoplantar pustulosis
- Scabies
Tinea cruris
- Inverse psoriasis
- Erythrasma
- Seborrheic dermatitis
- Candidal intertrigo
Tinea corporis
- Subacute cutaneous lupus erythematosus (SCLE)
- Granuloma annulare
- Erythema annulare centrifugum
Evaluation
KOH prep for diagnosis
Management
Tinea coporis
- Topical antifungals (azoles, allylamines, butenafine, ciclopirox, and tolnaftate)
- Oral antifungals for those who fail topical treatment
Tinea pedis
- Topical antifungals
- Oral antifungals (terbinafine, itraconazole, or fluconazole)
Tinea cruris
- Topical antifungals
Tinea capitis
- 1st line
- Griseofulvin
- Terbinafine
Tinea unguium
- Mild to moderate
- 1st line
- Oral terbinafine
- Topical efinaconazole, amorolfine, tavaborole, and ciclopirox
- 1st line
- Moderate to severe
- Terbinafine, itraconazole