Dermatophytosis: Difference between revisions
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==Background== | ==Background== | ||
*Also known as ringworm | *Also known as ringworm | ||
*Common fungal infection of the skin, hair and nails | *Common [[fungal infection]] of the skin, hair and nails | ||
*Mode of transmission via direct contact to the organisms (eg. using unwashed wrestling mats) | *Mode of transmission via direct contact to the organisms (eg. using unwashed wrestling mats) | ||
*These dermatophytes are filamentous fungi that live off the keratin | *These dermatophytes are filamentous fungi that live off the keratin | ||
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**Body except for feet, groin, face, scalp hair or beard hair | **Body except for feet, groin, face, scalp hair or beard hair | ||
**Clinical manifestation: | **Clinical manifestation: | ||
***Pruritic, circular scaly patch or plaque → central clearing → annular plaque | ***[[Pruritus|Pruritic]], circular scaly [[rash|patch]] or plaque → central clearing → annular plaque | ||
*[[Tinea pedis]] (athlete's foot) | *[[Tinea pedis]] (athlete's foot) | ||
**Foot | **Foot | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
Tinea pedis | ===[[Tinea pedis]]=== | ||
*Interdigital [[candida]] infection | *Interdigital [[candida]] infection | ||
*Erythrasma | *Erythrasma | ||
*Atopic dermatitis | *[[Atopic dermatitis]] | ||
*Chronic contact dermatitis | *Chronic [[contact dermatitis]] | ||
*Acute palmoplantar eczema | *Acute palmoplantar [[eczema]] | ||
*Palmoplantar psoriasis | *Palmoplantar [[psoriasis]] | ||
*Pitted keratolysis | *Pitted keratolysis | ||
*Juvenile plantar dermatosis | *Juvenile plantar dermatosis | ||
*Keratolysis exfoliativa | *Keratolysis exfoliativa | ||
*Keratodermas | *Keratodermas | ||
*Acute palmoplantar eczema | *Acute palmoplantar [[eczema]] | ||
*Acute contact dermatitis | *Acute [[contact dermatitis]] | ||
*Palmoplantar pustulosis | *Palmoplantar pustulosis | ||
*Scabies | *[[Scabies]] | ||
Tinea cruris | Tinea cruris | ||
*Inverse psoriasis | *Inverse psoriasis | ||
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*Seborrheic dermatitis | *Seborrheic dermatitis | ||
*Candidal intertrigo | *Candidal intertrigo | ||
Tinea corporis | ===Tinea corporis=== | ||
*Subacute cutaneous lupus erythematosus (SCLE) | *Subacute cutaneous [[lupus]] erythematosus (SCLE) | ||
*Granuloma annulare | *Granuloma annulare | ||
*Erythema annulare centrifugum | *Erythema annulare centrifugum | ||
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KOH prep for diagnosis | KOH prep for diagnosis | ||
==Management== | ==Management== | ||
Tinea | ===Tinea corporis=== | ||
*Topical [[antifungals]] (azoles, allylamines, butenafine, ciclopirox, and tolnaftate) | *Topical [[antifungals]] (azoles, allylamines, butenafine, ciclopirox, and tolnaftate) | ||
*Oral antifungals for those who fail topical treatment | *Oral antifungals for those who fail topical treatment | ||
Tinea pedis | ===Tinea pedis=== | ||
*Topical antifungals | *Topical antifungals | ||
*Oral antifungals (terbinafine, itraconazole, or fluconazole) | *Oral antifungals ([[terbinafine]], [[itraconazole]], or [[fluconazole]]) | ||
Tinea cruris | ===Tinea cruris=== | ||
*Topical antifungals | *Topical antifungals | ||
Tinea capitis | ===Tinea capitis=== | ||
*1st line | *1st line | ||
**[[Griseofulvin]] | **[[Griseofulvin]] | ||
**[[Terbinafine]] | **[[Terbinafine]] | ||
Tinea unguium | ===Tinea unguium=== | ||
*Mild to moderate | *Mild to moderate | ||
**1st line | **1st line | ||
***Oral terbinafine | ***Oral [[terbinafine]] | ||
***Topical efinaconazole, amorolfine, tavaborole, and ciclopirox | ***Topical efinaconazole, amorolfine, tavaborole, and ciclopirox | ||
*Moderate to severe | *Moderate to severe | ||
**Terbinafine, itraconazole | **[[Terbinafine]], [[itraconazole]] | ||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
Revision as of 20:52, 27 September 2019
Background
- Also known as ringworm
- 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 corporis (ringworm)
- 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 corporis
- 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
Tinea unguium
- Mild to moderate
- 1st line
- Oral terbinafine
- Topical efinaconazole, amorolfine, tavaborole, and ciclopirox
- 1st line
- Moderate to severe
Disposition
- Discharge
See Also
External Links
References
- https://www.uptodate.com/contents/dermatophyte-tinea-infections?source=search_result&search=dermatophytosis&selectedTitle=1~150#H68628070
- https://www.uptodate.com/contents/onychomycosis-epidemiology-clinical-features-and-diagnosis?source=search_result&search=tinea%20unguium&selectedTitle=2~15#H522098449
- https://www.uptodate.com/contents/onychomycosis-management?source=search_result&search=tinea%20unguium&selectedTitle=1~15
- https://www.uptodate.com/contents/tinea-capitis?source=search_result&search=tinea%20capitis&selectedTitle=1~39