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Dermatophyte
(ringworm) (Risk factors (Hot, humid temperatures, Tight…
Dermatophyte
(ringworm)
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Pathophysiology
Ringworm
Dermatophyte Trichophyton rubrum or interdigitale
Grow in dead keratin, affecting skin, hair or nails
Transmission
Direct contact with human, animal, fomite, soil
Types
Tinea corporis (body)
Tinea faciei (face)
Tinea cruris (groin)
Tinea pedis (athletes foot)
Tinea capatis (scalp)
Tinea unguium (nails)
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Clinical
presentation
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Tinea cruris, faciei, corporis
Single or multiple
Flat or slightly raised
Varied sizes, asymmetrical
Active red, scaly, advancing edge and clear centre
May not have central clearing if in a moist flexure
Tinea pedis
White maculated/fissures, scaly
Toe clefts
Tinea capitalis
Diffuse, scaly lesions, hair loss
Tinea unguium
Asymmetrical white/yellow.black, thickened, crumbly
Diagnosis
Examination
Dermatological
Single/multiple annular lesions,
asymmetrical distribution
Investigations
Skin samples
Indication: confirm diagnosis in
extensive disease/uncertain diagnosis
MOA: Scrape from advancing edge with
a blunt scalpel blade, keep at room temp
Microscopy - hyphae/spores
History
DH
Current meds (immunosuppressants), allergies
FH
Skin disorders, ringworm
PMH
Previous ringworm, other dermatological disorder, immunocompromised (DM, HIV, etc.)
SH
Occupation, leisure activities (cycling),
alcohol, smoking
PC/HPC
Scaly, itchy skin, growing annular lesions,
multiple lesions, other people affected,
sites affected, treatments used so far
Complications
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Tinea incognito
Extensive spread due to inappropriate
use of topical corticosteroids (irregular lesions)
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Management
Medical
Topical antifungal
Indication: mild, non-extensive disease
E.g. terbinafine, clotrimazole, miconazole
Topical steroid
Indication: marked inflammation
E.g. hyrocortisone 1% cream 7d
MOA: use in addition to antifungal
to reduce excessive inflammation
Oral antifungal
Indication: severe, extensive disease; scalp disease; nail disease
E.g. PO terbinafine, itraconazole
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Conservative
Information and advice
Loose fitting cotton clothes
Daily washing and thorough drying
Avoid scratching
Do not share towels
Wash bed linen and clothes at high temp
Referral
Severe/extensive disease in child
Uncertain diagnosis
Unsuccesful treatment
Frequent recurrence