Tinea Infection

Question 1

Which tinea is most common during childhood?

Answer 1

Tinea capitis

In children of African descent

Question 2

Tinea differentials

Answer 2

Priority:

1. atopic dermatitis
2. contact dermatitis
3. folliculitis
4. psoriasis

Tinea corporis - nummular eczema (central clearing)

Question 3

Which tinea is characterized by scaly, patchy nonscarring areas of hair loss? Lesions can become inflamed, boggy and pustular.

Answer 3

Tinea capitis

Question 4

Which tinea appears on the skin as erythematous plaques and papules in an annular or arciform patter? Lesions can have an elevated border with central clearing.

Answer 4

Tinea corporis (ringworm)

Question 5

Which tinea is dry, diffuse, scaly eruptions of the palms with sharply marginated plaques on the dorsum of the hands?

Answer 5

Tinea manuus (hand)

Question 6

Which tinea can occur as interdigital scaling, maceration, and fissuring?

Answer 6

Tinea pedis (athlete’s foot)

Question 7

Which tinea appears on the groin and upper/inner thigh and extends to the gluteal folds?

Answer 7

Tinea cruris (jock itch)

Question 8

Which tinea affects the nail beds?

Answer 8

Onychomycosis

Question 9

What is the best method to diagnose tinea?

Answer 9

KOH - look for hyphae

Question 10

What is the best method to diagnosis tinea versicolor?

Answer 10

Wood Lamp - fluoresces a pale white yellow color or erythrasma which produces a bright coral red.

Question 11

When do you prescribe oral treatment for tinea?

Answer 11

When it is widespread or involves the scalp or nails.

Question 12

What is the preferred systemic treatment for long standing tinea capitis?

Answer 12

Griseofulvin
Take w/ high fat food
PG X

OR

Itraconazole

Question 13

What is the preferred treatment for onychomycosis?

Answer 13

Terbinafine 6 wks for fingernails / 12 wks for toenails.

Question 14

Monitoring for terbinafine

Answer 14

LFTs Q6wks

CBC if sx of neutropenia

Question 15

Patient education for tinea

Answer 15

Use TCS w/ caution
Powders help reduce moisture and prevent reinfection
T. capitis -
Shaving head will reduce duration of tx.
Return to school when systemic tx has begun
Clean objects touched by the head thoroughly
Onychomycosis
Tx may take 12-18 months to see visual improvement
Keep feet dry

Question 16

Which tinea is caused by heat/exercise, exposure to sunlight or own skin flora?

Answer 16

Tinea versicolor (pityriasis versicolor)

Question 17

Which tinea are characterized by hypopigmented scaly and round or oval coalescing papules and plaques on the sternal region, sides of chest, abdomen or back?

Answer 17

Tinea versicolor

Question 18

What method is used to diagnose tinea versicolor?

Answer 18

1. KOH - look for spaghetti and meatballs configuration. This can be false negative if the patient has just showered.
2. Wood Light

Question 19

What is used to treat tinea versicolor?

Answer 19

Apply topical imidazole to entire torso.

Selenium sulfide shampoos or suspensions - refrain from bathing for 12 hr after application

Question 20

When evaluating scalp lesions in a patient suspected of having tinea capitis, the provider uses a Wood’s lamp and is unable to elicit fluorescence. What is the significance of this finding?

a. The patient does not have tinea capitis.
b. The patient is less likely to have tinea capitis.
c. The patient is positive for tinea capitis.
d. The patient may have tinea capitis.

Answer 20

ANS: D

Although some fungal species causing tinea capitis are fluorescent with a Wood’s lamp, Trichophyton tonsurans, the most common cause of tinea capitis, does not, so lack of fluorescence does not rule out the infection, make it less likely, or diagnose it.

Question 21

Which medication will the provider prescribe as first line therapy to treat tinea capitis?

a. Oral griseofulvin
b. Oral ketoconazole
c. Topical clotrimazole
d. Topical tolnaftate

Answer 21

ANS: A

Systemic antifungal medications are used for widespread tinea and always with infections that involve the nails or scalp. Oral ketoconazole should be avoided due to risks of hepatotoxicity and serious drug interactions.

Question 22

What is the systemic treatment for tinea capitis?

Answer 22

Griseofulvin 6-8 weeks or itraconazole 2-4 weeks

Question 23

What is the only tinea to use oral therapy first line?

Answer 23

Tinea capitis

Question 24

Tinea versicolor differential

Answer 24

Vitiligo (continuous where versicolor is blotchy)

Ask about family history of autoimmune and thyroid disease

Question 25

When collecting a specimen to determine a diagnosis of tinea corporis, the provider will scrape which portion of the lesion?

a. The active, leading border
b. The area of central clearing
c. The erythematous plaque
d. The papular lesions

Answer 25

ANS: A
The key to a reliable KOH preparation is properly obtaining an adequate specimen by scraping the active, leading border of a lesion. The other areas do not yield a reliable specimen.

Question 26

An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this
condition?

A. 1% hydrocortisone cream to affected areas for 1 to 2 days
B. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days
C. Topical keratolytics and topical antibiotics for 7 to 10 days
D. Topical nystatin cream applied several times daily

Answer 26

ANS: D

Question 27

A school­ age child is brought to clinic after a pediculosis capitis infestation is reported at the child’s school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?

A. Excoriated macules along the child’s collar and underwear lines
B. Inflammation and pustules on the face and neck
C. Itching of the scalp, with skin excoriation on the back of the head
D. Linear or S ­shaped lesions in webs of fingers and sides of hands

Answer 27

ANS: A

Question 28

An African American child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?

A. Monitor CBC, LFT, and renal function during therapy.
B. Order oral prednisone daily for 5 to 14 days.
C. Perform fungal cultures on family members and pets.
D. Prescribe oral itraconazole or terbinafine.

Answer 28

ANS: C