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Dermatophytosis - Causes, Symptoms and Treatment

What is Dermatophytosis?

Also called tinea or ringworm, dermatophytosis is a disease that can affect the scalp (tinea capitis), body (tinea corporis), nails (tinea unguium), feet (tinea pedis), groin (tinea cruris), and bearded skin (tinea harbae).

Tinea infections are quite prevalent in the United States and are usually more common in males than in females. With dfective treatment, the cure rate is very high, although about 20% of persons with infected feet or nails develop chronic conditions.

What are the Causes of Dermatophytosis?

Tinea infections (except for tinea versicolor) result from dermatophytes (fungi) 0f the genera Trichophyton, Microsporum, and Epidermophyton.

Transmission can occur directly (through contact with infected lesions) or indirectly (through contact with contaminated articles, such as shoes, towels, or shower stalls). Some cases come from contact with animals or soil.

What are the Signs and Symptoms of Dermatophytosis?

Lesions vary in appearance and duration with the type of infection.

Tinea capitis, which mainly affects children, is characterized by round erythematous patches on the scalp, causing hair loss with scaling. In some children, a hypersensitivity reaction develops, leading to boggy, inflamed, often pus-filled lesions (kerions).

Tinea corporis produces flat lesions on the skin at any site except the scalp, bearded skin, groin, palms, or soles. These lesions may be dry and scaly or moist and crusty; as they enlarge, their centers heal, causing the classic ring-shaped appearance.

Tinea unguium (onychomycosis) infection typically starts at the tip of one or more toenails (fingernail infection is less common) and produces gradual thickening, discoloration, and crumbling of the nail, with accumulation of subungual debris. Eventually, the nail may be destroyed completely.

Tinea pedis causes scaling and blisters between the toes. Severe infection may result in inflammation, with severe itching and pain on walking. A dry, squamous inflammation may affect the entire sole.

Tinea cruris (jock itch) produces red, raised, sharply defined, itchy lesions in the groin that may extend to the buttocks, inner thighs, and the external genitalia. Warm weather and tight clothing encourage fungus growth.

Tinea barbae is an uncommon infection that affects the bearded facial area of men.

Diagnosis for Dermatophytosis

Microscopic examination oflesion scrapings prepared in potassium hydroxide solution usually confirms tinea infection. Other diagnostic procedures inclnde Wood's light examination (which is useful in only about 5% of cases oftinea capitis) and culture of the infecting organism.

Treatment for Dermatophytosis

Tinea infections usually respond to topical agents such as imidazole cream or to oral griseofulvin, which is especially effective in tinea infections of the skin and hair. Oral terbinafine or itraconazole is helpful in nail infections. However, topical therapy is ineffective for tinea capitis; oral griseofulvin for 1 to 3 months is the treatment of choice. Griseofulvin is contraindicated in the patient with porphyria, and it may necessitate an increase in dosage during anticoagulant (warfarin) therapy.

In addition to imidazole, other antifungals include naftifine, ciclopirox, terbinafine, haloprogin, and tolnaftate. Topical treatments should continue for 2 weeks after lesions resolve.

Supportive measures include open wet dressings, removal of scabs and scales, and application ofkeratolytics such as salicylic acid to soften and remove hyperkeratotic lesions of the heels or soles.

Special Considerations and Prevention Tips for Dermatophytosis

1) For all tinea infections except those of the hair and nails, apply topical agents, watch for sensitivity reactions and secondary bacterial infections, and provide patient teaching.

2) Monitor liver function of patients on long-term griseofulvin therapy.

3) For tinea capitis, use good hand-washing technique, and teach the patient to do the same. To prevent spreading infection to others, advise washing towels, bedclothes, and combs frequently in hot water and to avoid sharing them. Suggest that family members be checked for tinea capitis.

4) For tinea corporis, use abdominal pads between skin folds for the patient with excessive abdominal girth; change pads frequently. Check the patient daily for excoriated, newly denuded areas of skin. If the involved area is moist, apply open wet dressings two or three times daily to decrease inflammation and help remove scales.

5) For tinea unguium, keep the patient's nails short and straight. Gently remove debris under the nails with an emery board.

6) For tinea pedis, encourage the patient to expose feet to air whenever possible and to wear sandals or leather shoes and clean cotton socks. Instruct the patient to wash the feet twice daily and, after drying them thoroughly, to apply the antifungal cream followed by antifungal powder to absorb perspiration and prevent excoriation.

7) For tinea cruris, instruct the patient to dry the affected area thoroughly after bathing and to evenly apply antifungal powder after applying the topical antifungal agent. Advise wearing loose-fitting clothing, which should be changed frequently and washed in hot water.

8) For tinea barbae, suggest that the patient let his beard grow. (Whiskers should be trimmed with scissors, not a razor.) If the patient insists that he must shave, advise him to use an electric razor instead of a blade.

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