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Tinea corporis

Ringworm of the body. Epidemiology: - transmission is by direct skin to skin contact [4] - person to person or animal to person Pathology: - superficial skin infection, generally limited to epidermis Clinical manifestations: 1) well-defined, scaly, macular eruption 2) frequently forms annular lesions 3) expands in a centrifugal pattern [4] 4) erythematous border of small vesicles & scales 4) may appear on any part of the body 5) may be asymptomatic [4] 6) pruritus is common [3] 7) pruritic, peripheral annular, erythematous eruption with peripheral scaling, expanding outward as concentric rings [7] 8) pain, tenderness, erosions generally do not occur [3] 9) topical glucocorticoids may temporarily reduce inflammation & give the impression of improvement, but with rebound of symptoms with cessation of treatment [3] * Images [5] Laboratory: (see Tinea) Differential diagnosis: 1) psoriasis 2) nummular eczema - usually occur on the lower extremities - a scale or scaly eruption suggests Tinea corporis 3) pityriasis rosea (herald patch) - single annular salmon-colored patch with peripheral rim of scale - lesions more ovoid than Tinea corporis - generally on trunk (Christmas tree pattern) 4) secondary syphilis 5) erythema migrans (Lyme disease) - axilla, inguinal region, popliteal fossa, belt line - erythema migrans not associated with scale Management: 1) topical imidazole compound for 2-3 weeks a) continue for 1 week after clinical cure b) clotrimazole# (Lotrimin) c) miconazole# (Monistat) d) ketoconazole (Nizoral) e) econazole (Spectazole) f) sulconazole (Exelderm) g) oxiconazole (Oxistat) h) terconazole (Terazol) i) butenafine* (Lotrimin Ultra) [2] 2) oral antifungals a) extensive disease of lesions in beard b) griseofulvin (ultramicrosize) 250-375 mg BID for 4 weeks c) fluconazole 150 mg/week for 4 weeks d) itraconazole 100-400 mg/day for 2-20 weeks (mean 6.3 weeks) [6] - 400 mg/day results in higher cure rates & shorter treatment duration with a higher cost $$ [6] - relapse is common at all doses [6] * fungicidal # fungistatic

General

Tinea

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Prescriber's Letter 9(2):11 2002
  3. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Grim L 12 Rashes You Need to Know: Common Dermatologic Diagnoses Medscape. Feb 10, 2021 https://reference.medscape.com/slideshow/skin-rashes-6004772
  5. DermNet: Tinea corporis https://dermnetnz.org/topics/tinea-corporis
  6. Khurana A, Agarwal A, Agrawal D et al Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris. A Randomized Clinical Trial. JAMA Dermatol. 2022;158(11):1269-1278. Sept 14. PMID: 36103158 PMCID: PMC9475442 (available on 2023-09-14) https://jamanetwork.com/journals/jamadermatology/fullarticle/2795924
  7. NEJM Knowledge+ Dermatology