Ringworm Flashcards
Facts about ringworm
Fungal infection of the scalp is also known as ‘tinea capitis’ or ‘scalp ringworm’, and it describes infection of scalp hair follicles and the surrounding skin caused by dermatophytes.
Clinical features of ringworm
Scaling and itch of the scalp, patches of hair loss.
Skin erythema, pustules, crusting, and lymphadenopathy.
Painful, pustular boggy masses, which may have a thick crust (kerion).
Associated fungal infection at other sites.
a rash that looks red, silvery or darker than surrounding skin.
scaly,dry,swollen and itchy rash
What to do when patient present with ringworm
Assessment of suspected fungal scalp infection should include skin and hair sampling for fungal microscopy and culture, to confirm the diagnosis and identify the underlying cause.
Management of Ringworm
Advice on self-care strategies including surface crust removal; discarding or disinfecting objects that can transmit infection; inspecting other family members or household pets for signs of infection.
In adults, starting oral antifungal treatment before or after fungal microscopy and culture results are back, depending on clinical judgement.
In children, starting oral antifungal treatment if there is a confirmed diagnosis and sufficient prescribing experience in primary care, or seeking specialist advice before initiating treatment.
Co-prescribing a topical antifungal agent to reduce the risk of transmission to other people.
Reviewing the person 4–8 weeks after completing the course of oral antifungal therapy to assess the response to treatment.
If oral antifungal treatment is initiated in primary care, either oral griseofulvin (licensed) or oral terbinafine (off-label) should be prescribed empirically, until culture results are available.
If the person lives in an urban area, terbinafine should be started (and continued if the infecting organism is Trichophyton tonsurans).
If the person lives in a rural area, griseofulvin should be started (and continued if the infecting organism is Microsporum species). Oral itraconazole use (off-label indication) can be considered if griseofulvin is not tolerated or is contraindicated.
Treatment option if living in a urban area
If the person lives in an urban area, terbinafine should be started (and continued if the infecting organism is Trichophyton tonsurans).
Treatment option if patient lives in a rural area
If the person lives in a rural area, griseofulvin should be started (and continued if the infecting organism is Microsporum species). Oral itraconazole use (off-label indication) can be considered if griseofulvin is not tolerated or is contraindicated.
when to refer
The person has a suspected kerion (urgent referral).
Oral antifungal treatment is being considered for a child, and there is insufficient experience and expertise to initiate this in primary care.
The diagnosis is uncertain.
Treatment in primary care is unsuccessful.
There is a suspected complication which is not responding to treatment in primary care.
Questions to ask
location? could be found on the scalp, groin or any part of the body appearance and colour of rash associated symptoms? such as itch tried any OTC HPC DHX PMH Age describe symptoms onset and duration of symptoms
