L1 Tinea/Scabies

Question 1

Tinea Capitis

Answer 1

• Spaghetti and meatball under microscope (spore & hyphae)
• More prevalent in children, African-American pop, low socioeconomic
• Direct contact with infected individual, animal, object
• Scaly patches with alopecia, black dots, kerion (abscess, raised plaque), favus (honeycomb)
• look for cervical adenopathy (lymph node), dermophytid reaction, erythema nodosum
• koh prep, culture
• Griseofulvin x 6-12w, itraconazole (3-6w), pulse therapy (8-12w)

Question 2

Tinea corporis

Answer 2

• ring worm
• puritic, annular (round), erythematous plaque
• central clearing
• raised advancing border
• clotrimazole 2w topical
• itraconazole 1-4w oral

Question 3

what should you not treat tinea with?

Answer 3

steroids

Question 4

Tinea cruris

Answer 4

• jock itch
• starts in inguinal fold
• sweaty/humid,occlusive clothing, athletes foot, male, obesity/skin fold
• well marginated
• scaly
• annular plaque with raised border
• scrotum spared
• clotrimazole topical
• itraconazole oral

Question 5

Tinea pedis

Answer 5

• athletes foot
• occlusive footwear, communal baths showers
• itchy painful vesicles following sweating
• clotrimazole x4w topical
• itraconazole oral

Question 6

Distal subungal onychomycosis

Answer 6

• white/brown/yellow discoloration starts at distal corner
• distal end breaks and exposes nail bed
• terbinafine 6w for fingernails 12w toes oral
• itraconazole same duration oral

Question 7

proximal subungal onychomycosis

Answer 7

• starts near cuticle
• immunocomprimised
• terbinafine 6w finger 12w toes
• itraconazole same

Question 8

white superficial onychomycosis

Answer 8

• starts with dull white spots on surface of nail plate

- lesions can be scraped for lab sample

Question 9

fingernail onychomycosis

Answer 9

• yeast is most common cause from candida albicans
• thickening of nail with yellow/brown discoloration
• chronic paronychia
• terbinafine 6w finger 12w toes
• itraconazole same

Question 10

Candida intertrigo

Answer 10

• moisture, humidity
• skin friction
• immunocompromised
• groin, mammary/adb folds, web spaces, and axilla
• erosions, macerated (soggy), papules/pustules, scaling
• Nystatin x2-4w nystatin topical
• fluconazole x2-6w oral

Question 11

tinea versicolor

Answer 11

• normal fungal skin flora becomes pathologic when transformed into mycelial form
• not contageous
• macules, patches, plaques
• fine scale
• clotrimazole x 2w topical
• selenium sulfide shampoo lotion x 1w
• zinc pyrithione shampoos x 2w
• itraconazole x 5-7days oral

Question 12

scabies

Answer 12

• initial lesion
• burrow is pathognomonic
• severe pruritus, worse at night
• permethrin 5% cream initial tx + 2nd application 10-14 days later
• ivermectin oral single dose repeated two weeks
• itch can persist for up to two weeks after

Question 13

pubic lice

Answer 13

• itching in groin/axilla
• permethrin 1% cream, repeat/recheck in 10 days
• treat partners
• have an STI 30% of time (get sexual history)