Alternative Ways to Treat Ringworm
Between the legs (jock itch) between the legs (jock itch) Most fungus infections grow in the form of a ring. They often itch. Ringworm of the head can produce round patches with scales and loss of hair. Finger and toe nails infected with the fungus become rough and thick. Creams and powders with salicylic or undecylenic acid, or tolnaftate ('Tinactin, p. 372) help cure the fungus between the fingers, toes, and groin. Ringworm and all other fungus infections are contagious (easily spread). To prevent spreading them from one child to others
Tinea cruris, a dermatophytosis infection of the anogenital skin, represents ringworm. Also called jock itch, this is a disease much more common in men than in women. Primarily caused by Epidermophyton floccosum, Trichophyton rubrum, and Trichophyton mentagrophytes, tinea cruris often represents infection that has spread from the great toe nails (onychomycosis) or the feet (tinea pedis), also infections that are much more common in men. Obesity also predisposes to tinea cruris (52). The predominant symptom of tinea cruris is that of itching. The rash occurs primarily on proximal, medial thighs, sometimes extending to the crural crease and hair-bearing labia majora. Because dermatophytes infect the stratum corneum of clinically hair-bearing skin, the modified mucous membranes are spared and the vagina is never affected. Classically, tinea cruris presents as well-demarcated, red, scaling plaques of the proximal, medial thighs, with the borders exhibiting more marked scale. Often, there...
Tinea corporis ( COMMON RINGWORM) occurs sporadically Trichophyton rubrum is the most common cause. The inflammatory form, which is usually localized to the limbs, chest, or back, is commonly caused by Microsporum canis or Trichophyton mentagrophytes. Ringworm of the scalp, known as tinea capitis, is commonly seen in children.
A child is brought to the clinic by his mother because he has patches of hair loss as well as knots in the back of his
Tinea capitis is a dermatophyte infection of the scalp usually caused by Trichophyton tonsurans, and at times Microsporum canis. Diagnostic Tests. The Wood's lamp may be helpful in the diagnosis of tinea capitis. Hairs infected with the Microsporum species fluoresce blue-green most Trichophyton species do not fluoresce. Cultures of the infected material and KOH preparations are also used. Treatment. Griseofulvin is the treatment of choice for all forms of tinea capitis. Treatment should continue until the fungal culture is negative and may be necessary for 2-3 months. Differential Diagnosis. Seborrheic dermatitis, alopecia areata, trichotillomania, and psoriasis may be mistaken for tinea capitis.
Table 16 Tinea Cruris Tinea cruris Pruritus versicolor, this is not a dermatophytosis, but rather an infection of yeast forms. Like tinea cruris, this is an infection much more common in men than in women. The differential diagnosis includes dermatoses with papulosquamous morphology. These include, primarily, secondary syphilis, tinea corporis, pityriasis rosea, and guttate psoriasis. The diagnosis is made by the identification of typical pityriasis versicolor on the trunk and confirmed by direct microscopic visualization of the hyphae pseudohyphae and budding yeast within the stratum corneum of skin scrapings. Treatment consists of either topical azoles as used for tinea cruris or a very short course of an oral azole such as ketoconazole 400 mg per week for two doses
Epidermophyton floccosum 330. There are three genera of dermatophytes Epidermophyton, Microspo-rum, and Trichophyton. Infections caused by these organisms, as shown in the figure below (dermatophytoses), are 343. The appropriate teleomorph for Trichophyton mentagrophytes is Fungal skin diseases may not be named according to the etiologic agent but rather are called tinea or a dermatophytosis. 353. Tinea corporis is caused by which of the following 354. Tinea cruris is caused by which of the following 355. Tinea pedis is caused by which of the following 356. Tinea capitis is caused by which of the following
The answer is b. (Levinson, pp 287-288.) Hairs infected with Microsporum canis and M. audouini both fluoresce with a yellow-green color under Wood's light, while Trichophyton rubrum, T. tonsurans, and Epidermo-phyton floccosum do not. But M. audouini is an anthropophilic agent of tinea capitis, whereas M. canis is zoophilic. M. canis is primarily seen in children and is associated with infected cats or dogs. 330. The answer is c. (Levinson, p 287.) The dermatophytes (see figure presented in the question) are a group of fungi that infect only superficial keratinized tissue (skin, hair, nails). They form hyphae and arthroconidia on the skin in culture, they develop colonies and conidia. Tinea pedis, or athlete's foot, is the most common dermatophytosis. Several topical anti-fungal agents, such as undecylenic acid, salicylic acid, and ammoniated mercury, may be useful in treatment. For serious infection, systemic use of griseofulvin is effective. (Howard, pp 543 560.) The...
167, 169-170 Dermatophytosis, 97 Desmin, 140 Dysplasia cervical, 74 vulvar, 9 (ELND), 124 Endometriosis, 139-141 Epidermophyton floccosum, 97 Epithelial lesions Tinea cruris, 99 diagnosis of, 97 Tinea cruris symptoms, 97 treatment, 98 Trauma, 6 Treponema pallidum, 77 Trichoepitheliomas, 143-145 Trichomonas vaginalis, 100 Trichomonas vaginitis, 3, 100-101 Trichophyton mentagrophytes, 97 Trichophyton rubrum, 97 Trimethoprim-sulfamethoxazole, 88 Tuberculin skin test, 83 Tuberculosis (TB), genital, 83 Tumors cystic, 4 genital, 6 Figure 4.14 Erythrasma resembles tinea cruris, but the color is often more tan than red, and there is no peripheral accentuation of scale. (See p. 91) Figure 4.14 Erythrasma resembles tinea cruris, but the color is often more tan than red, and there is no peripheral accentuation of scale. (See p. 91) Figure 4.19 Classic tinea cruris shows a red plaque on the proximal, medial thighs with accentuation and scale at the periphery of the plaque. (See p. 97)
Dermatophytosis, especially tinea capitis, tinea corporis and tinea cruris, occurs worldwide but is very common in tropical countries. Ninety-eight percent of tinea capitis is seen in children there are occasional cases in adult women. From 3-28 of children from low social-economic groups have tinea capitis. Fa-vus is a tinea found only in Africa and South America. Tinea imbricata is endemic in the Pacific Islands, some parts of Malaysia, India and Latin America. Tinea cruris and tinea pedis are frequently seen in adult men with a range of 17 -20 and 70 , respectively. Tinea pedis is not common in children (1.5 ). In som reports onychomycosis occurs in 54-70 of adult men. It occurs in 18 -60 of onychopathies and in 30 of dermatophytosis. The most frequent causal agent is T rubrum it is reported in 36-52 and even up to 80 of dermatophitic infections. In tinea pedis it has been found in 79 and in onychomycosis in 76.2 of cases. M. canis is isolated in 14-24 and T tonsurans in 15-18...
The school nurse refers a student to your clinic because of an annular rash that has scaling and central clearing Other
Tinea corporis is a fungal infection of the skin that excludes the palm, the soles, and the groin. Risk Factors Etiology. Tinea corporis may be caused by most dermatophyte species, but Trichophyton rubrum and Trichophyton mentagrophytes are the most prevalent agents. Physical Examination. An annular lesion that has a raised border, scaling, and central clearing, i.e., ringworm is found on inspection. Diagnostic Tests. The diagnosis is confirmed by the presence of hyphae on KOH preparation of epidermal scrapings and cultures. Tinea corporis should not fluoresce with a Wood's lamp. Tinea capitis
That form rows that coalesce into circular lesions or irregulars lesions of geographic appearance. Their color is gray, greenish, or brownish, and they appear filthy (Fig. 7.1). Rarely there are erythematoses, and painful lesions or tinea pedis. There is a rare hyperkeratotic form (keratoma plantare sulcatum). Its existence is moot. It appears as circinated zones of hyperkeratosis on the plantar arc of the feet, and it can be observed as small depressions. It can be associated with other forms of palmoplantar keratoderma.
Erythrasma is a superficial bacterial infection of skin folds that mimics tinea cruris. Caused by Corynebacterium minutissimum, this medically insignificant disease occurs primarily in men. genital area, occur on the proximal, medial thighs with sparing of the vulva proper (Fig. 14). Unlike tinea cruris, there is no accentuation of peripheral scale, and a microscopic examination of scrapings of the stratum corneum does not show fungal elements. The differential diagnosis includes, in addition to tinea cruris, lichen simplex chronicus (eczema localized atopic dermatitis) and psoriasis. The diagnosis is made by the absence of fungal elements on a microscopic examination, or by illumination with a Wood's lamp, which produces a coral fluorescent color. The diagnosis is confirmed by response to therapy.
Skin cultures include samples taken from the skin, nail, and hair. Although many microorganisms exist in low numbers on the skin of a healthy person, skin cultures are used to identify organisms that cause integumentary infections such as cellulitis, pyoderma, impetigo, folliculitis, furuncles, and carbuncles. Fungal diseases such as athlete's foot, ringworm, rashes with well-defined borders, and tinea cruris (jock itch) are often evaluated via skin culture. Specimen collection methods are dependent on the sample site, but generally include a scraping, swabbing, or actual clipping of the specimen and its lesions placement of the specimen in a growth medium, on a slide, or in an appropriate transport container and laboratory incubation and examination of the specimen. The fungi Microsporum, Trichophyton, and Epidermophyton are associated with ringworm, athlete's foot, and tinea cruris and are cultured from the skin, hair, or nails. Trichophyton is a fungal pathogenic microorganism...
There are three groups of dermatophytes Trichophyton, Microsporum and Epidermophyton (there are 41 species, just 11 are common). The infections they cause are restricted to keratin-containing structures such as skin, hair and nails. There is a natural host defense to dermatophytes which depends on an antifungal serum factor whose existence is controversial, sebaceous secretion and acquired immune resistance. Dermatophytic infections can be transmissible from the environment (geophilic, M. gypseum), from infected animals zoophilic, M.canis (dogs and cats), rodents (T. mentagrophytes), bovine cattle (T. verrucosum), monkeys (T. simii) , or from infected people (anthropophilic). The severity and the course of the infection depends on the species of the dermatophyte and the host response. The granular colonies (zoophilic) generally cause an acute tinea and the anthropo-philic cause mild inflammation and a chronic course. Dermatophytes can infect humans when exposed to a contagious source....
On the dorsum of the foot, the toes appear square due to confinement of footwear, and the skin on the dorsum of the toes cannot be pinched due to subcutaneous fibrosis (Stemmer's sign). Lymphedema usually spreads proximally to knee level and less commonly affects the whole leg. In the early stages, lymphedema pits, and the patient reports that the swelling is down in the morning. This represents a reversible component to the swelling, which can be controlled. Failure to do so allows fibrosis, dermal thickening, and hyperkeratosis to occur. In general, primary lymphedema progresses more slowly than secondary lym-phedema. Chronic eczema, fungal infection of the skin (dermatophytosis) and nails (ony-chomycosis), fissuring, verrucae, and papillae (warts) are frequently seen in advanced disease. Ulceration is unusual except in the presence of chronic venous insufficiency.
The answer is d. (Fitzpatrick, 3 e, pp 22, 72-74, 76-79, 610, 704-709. Sapira, p 121.) The history is most consistent with tinea capitis due to either Trichophyton tonsurans or Microsporum canis. It is usually seen in school-age children and may be transmitted from person to person. Psoriasis is a hereditary disorder characterized by scaling patches and plaques appearing in specific areas of the body, such as the scalp, elbows, lumbosacral region, and knees. The lesions are salmon pink with a silver-colored scale that on removal produces blood (Auspitz sign). The Koebner phenomenon (with trauma, the lesion jumps to a new location) is also elicited in patients with psoriasis. Seborrheic dermatitis is a common chronic dermatosis occurring in areas with active sebaceous glands (face, scalp, and body folds) and may occur either in infancy or in people over the age of 20. The eczematous plaques of seborrheic dermatitis are yellowish red and are often greasy with a sticky crust....
A Wood's lamp is useful in the microsporic tinea capitis. There is a green fluorescence. Direct examination with KOH plus dimethylsulfoxide or with black chlorazol shows filaments and spores. In trichophytic tinea capitis, hair reveals endothrix spores (trichophytic and favic type) and on microscopy, ectoendothrix spores (microsporic, microide and megasporic types), which indicates filaments and spores are found inside and or outside the affected hair. An easy way to collect the parasitized hair is to rub the affected hairy skin area with saline-soaked gauze. Culture can be done with a sterile swab, a piece of floor carpet or with a tooth Fig. 1.7. Tinea manuum. Fig. 1.7. Tinea manuum.
Sweaty skin predisposes to or exacerbates many other skin disorders. An interesting example of this revolves around the disorder of inguinal hyperhidrosis. Dermato-logical disorders such as tinea cruris, folliculitis, erythrasma, and seborrheic dermatitis, all common in the inguinal region, may be helped by reducing local sweating perhaps by using botulinum toxin. The principle may extend to other areas afflicted by similar disorders.
Treatment of tinea capitis is oral griseofulvin, 10 to 30 mg kg day (20-25 mg of the micronized form and 15-20 mg of the ultramicronized) for 2-3 months. A practical regimen is to administer 125 mg in children younger than 3 years old, 250 mg in children 4 to 7 years old, 375 mg in 8 to 12 years of age and 500-1000 mg day in adults. The main side effects are nausea, headache, and photosensitiv-ity. In kerion, some authors recommend 0.5 mg kg day of prednisone for two weeks along with an antimycotic (Pediatr Dermatol 1994 11 69-71). In tinea capitis, terbinafin is also effective, 3-6 or even 10 mg kg day for 4-8 weeks. A practical regimen consists in 62.5 mg day in children weighing less than 20 kg, or 125 mg day in children that weigh 20-40 kg or are older than 5 years, respectively. In individuals of 40 kg and in adults, 250 mg day is recommended (Br J Dermatol 1995 132 683-89 Br J Dermatol 1995 132 98-105). In children who are able to ingest capsules, itraconazole is administrated,...
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