Derm - Ringworm Flashcards
What is ringworm?
Fungal infection of the skin
AKA tinea and dermatophytosis
What is tinea affecting the scalp, feet, groin, body and nails called?
Scalp
Tinea capitis
Feet
Tinea pedis
Groin
Tinea cruris
Body
Tinea corporis
Nails
Onychomycosis
What is the most common type of fungus causing ringworm?
Trichophyton
Spread by contact with infected individuals, animals or soil
How does ringworm present?
Itchy, erythematous, scaly and well demarcated rash
Often one or several rings that spread outwards
Edge more prominent and red the centre is more faint
How does tinea capitis present?
Well demarcated hair loss
Itching
Dryness
Erythema
More common in children than adults
How does tinea pedis present?
AKA athletes foot
White or red, flaky, cracked, itchy patches between toes
The skin may split and bleed
Often caused by sharing changing rooms
More likely to occur when feet and sweaty and damp for prolonged periods
How does onychomycosis present?
Thickened, discoloured and deformed nails
How is ringworm managed?
Diagnosis is critical
Usually good response to anti-fungals
Can scrape off scales and send for microscopy and culture
How is ringwormed treated?
Anti-fungal creams
Clotrimazole
Miconazole
Anti-fungal shampoo
Ketoconazole for tinea capitis
Orals
Fluconazole
Griseofulvin
Itraconazole
How are fungal nail infections treated?
Amorolfine nail lacquer for 6-12 months
Resistant cases may need
Oral terbinafine, patient will need LFTs monitored before and while taking
What can be used to help inflammation and itching with ringworm?
Daktacort
Combination of miconazole 2% and hydrocortisone 1%
What advice should be given to the patient?
- Wear loose breathable clothing
- Keep affected area clean and dry
- Avoid sharing towels, clothes and bedding
- Use a separate towel for feet
- Avoid scratching and spreading to other areas
- Wear clean dry socks every day
What is tinea incognito?
More extensive and less well recognised fungal skin infection from use of steroids to treat an initially fungal infection
How does tinea incognito present?
When initial ringworm was misdiagnosed as dermatitis and topical steroid prescribed
Steroid improves itching and inflammation but accelerates growth of fungal infection
When steroid is stopped itchy rash returns and is much worse
May be less recognisable due to less well-demarcated border and few scales
Why does steroid use increase fungal infection growth?
Dampens the immune system in the local area
