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Dermatophytosis
From WikEM
Contents
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)
- 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
Tinea unguium
- Mild to moderate
- 1st line
- Oral terbinafine
- Topical efinaconazole, amorolfine, tavaborole, and ciclopirox
- 1st line
- Moderate to severe
- Terbinafine, itraconazole
Disposition
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
