Wednesday, March 11, 2015

TINEA CORPORIS

TINEA CORPORIS:


Definition
■ Tinea corporis, also known as “ringworm,” is a dermatophyte fungal infection caused by the genera Trichophyton or Microsporum.


Etiology
■ T. rubrum is the most common pathogen.

The borders of tinea corporiscan extend at variable rates, causing a lesion thatis more ovoid than annular

Annular lesion with a raised,scaly border on the forearm.


Clinical Manifestation(s)

■ Th e disease typically begins as an isolated lesion with subsequent development of satellite lesions . Vesciculation may develop if the lesion is covered.


Physical Examination

■ Annular red scaly plaques with active border are seen with some crusting and
central clearing .
■ In some cases the borders of tinea corporis can extend at variable rates, producing
a lesion that is more ovoid than annular .

Diagnostic Tests

■ Diagnosis is usually made on clinical grounds. It can be confi rmed by direct
visualization under the microscope of a small fragment of the scale using wet
mount preparation and potassium hydroxide solution; dermatophytes appear
as translucent branching fi laments (hyphae) with lines of separation appearing
at irregular intervals.
■ Biopsy is indicated only when the diagnosis is uncertain and the patient has
failed to respond to treatment.
Differential Diagnosis
■ Pityriasis rosea
■ Erythema multiforme
■ Psoriasis
■ Cutaneous SLE
■ Secondary syphilis
■ Nummular eczema
■ Eczema
■ Granuloma annulare
■ Lyme disease
■ Tinea versicolor
■ Contact dermatitis

Treatment

First Line
■ Various creams are eff ective; the application area should include normal skin about 2 cm beyond the aff ected area:
● Betenafine cream, applied QD for 14 days
● Terbinafine cream applied BID for 14 days

Second Line
■ Systemic therapy is reserved for severe cases and is usually given up to 4 weeks;
commonly used agents include the following:
● Fluconazole 200 mg QD
● Terbinafine 250 mg QD


Clinical Pearl(s)
■ Th e majority of cases resolve without sequelae within 3 to 4 weeks of therapy.

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