Approach to Tinea

Approach to Tinea


Hi, learners. Today I will be taking you through common fungal infections that present to us in the primary care setting. We see this every day in different forms and severity whether as a presenting complaint or as by-the-way-doctor type of question. The aim of this lesson is to help you identify the different types of fungal infections, its differentials, and decide on the appropriate counseling to set expectations and treatment be it your family members or for patients under your care. What is this rash? Describe it. You may describe a rash based on its Morphology, Appearance, Distribution, and Special features. In short, MADS. The differentials for annular ring-like lesions include psoriasis. Look out for associated nail pitting and the distribution of the rash. Psoriasis tends to affect the hairline and extends to surfaces like the elbows, lower back, and buttocks, umbilicus, and knees. Pityriasis rosea is another common lesion commonly mistaken for tinea corporis and often wrongly treated with oral anti-fungals needlessly. Pityriasis rosea resolves by itself after a few months without treatment. Look out for a herald patch and fir-tree distribution of the rash over the back. Differentials of a growing rash would include erythrasma, which is a bacterial infection with corynebacterium minutissimum and treated with topical Clindamycin or oral Erythromycin. Inverse psoriasis may deceptively look like tinea cruris. In an infant, suspect irritant contact dermatitis if the rash spares the crural folds. This is otherwise known as onychomycosis. The nail changes are as described above. And these are the associated differentials. This is tinea manuum. And these are the associated differentials. This is tinea pedis. And these are the associated differentials. Be careful to wear gloves whenever you examine any rash as a secondary syphilis is contagious by contact. So these are the treatment options that you can consider. I know this is a busy slide, but the main treatments can be divided into topicals for localized involvement and oral anti-fungals for widespread disease. The duration of oral treatment is usually one to two weeks, but for nail disease, the treatment goes up to six months and possibly longer. In primary practice, most nail diseases are referred if orals are needed as we need fungal cultures to determine the correct anti-fungals to prescribe. Basic adjuncts are also very important to prevent recurrence and treatment failure. I tend to personally advise patients to apply topicals for at least a week after the rash disappears. In the case of tinea pedis, you may consider asking them to buy 100% cotton socks or toe socks and also to air their feet whenever possible. Thank you.

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