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The dermatophytes metabolize the keratin of the skin, hair, and nails. Hydration and occlusion of the skin facilitate infection. Although dermatophyte infections routinely affect persons who are otherwise healthy, immunocompromised patients are particularly susceptible. Bizarre presentations and failure to respond to ringworm.
Diagnostic Evaluation of Dermatophyte Infections
Potassium Hydroxide Exam. Accurate diagnosis of dermatophyte infections requires a potassium hydroxide (KOH) examination. Scrapings from involved skin or nail are placed in a drop of 20% potassium hydroxide (KOH) solution on a glass slide.
Tinea Pedis (athlete's foot)
The acute form of tinea pedis is characterized by Treatment of Dermatophyte Infections, ringworm ring worm, tinea sudden onset of an erythematous vesicular or bullous eruption, which is intensely pruritic and sometimes painful. It occurs interdigitally and soles of the feet..
Onychomycosis (tinea unguium)
Onychomycosis affect the fingernails and toenails. Nail lesions of psoriasis, eczematous eruptions and ischemic arterial disease can mimic onychomycosis. The KOH test or a culture.
Onychomycosis is cause by T rubrum, and some degree of tinea pedis is usually also present.
Tinea Cruris
This condition is typically known as jock itch or crotch rot. It is common in men and rare in women. Tinea cruris affects the crural fold and inner aspect of one or both thighs. The source of the infection is the patient's own feet, and some degree of tinea pedis.
Tinea capitis
Tinea capitis usually is a disease of children; however, tinea corporis may develop in adults in the same household. The disease appears as patchy scalp hair loss in one or more slightly erythematous, scaly, maculopapular lesions, reaching sizes of 4 to 6 cm or larger. Hairs within the patches fracture, leaving frosted stumps that are 1 to 2 mm in length. Lesions may become tender, inflammatory nodules (kerion). Lesions are often secondarily infected.
KOH examination of infected hair shows many small spores.
Management of Tinea Capitis. Ring Worm, and Tinea Corporis
Griseofulvin microsize by mouth is the medication of choice. Itraconazole and terbinafine are effective alternative treatments ring worm, tinea, fungal infections of the nail, jock-itch.
Recommended griseofulvin dosage: Adults: 250 mg twice daily for 6 to 12 weeks. Children: 11 mg/kg for the same length of time. When griseofulvin ultramicrosize is used, doses can be reduced 30%. Both medications should be taken with a glass of milk or a meal to enhance gastrointestinal absorption.