The Best Ways to Treat Ringworm

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Jock Itch

Jock itch (known medically as tinea cruris) is a fungal infection of the groin. The fungus also can infect other areas of the body, such as the feet and the area between the toes, where it causes athlete's foot (see next page). The infection begins as small, red spots that enlarge to form rings. At the edge of the ring the skin is raised, red, and scaly. Jock itch is common in men who perspire heavily, who exercise vigorously in hot weather, or who are overweight. The infection can be transmitted to your groin from your feet if you have athlete's foot and you scratch both areas. Like all tinea infections, jock itch is somewhat contagious. You can get a tinea infection from wet surfaces (such as a shower stall), from another person, or even from an animal. Men who wear athletic protectors or equipment can develop a case of jock itch, especially in hot, humid weather. If you think that you may have jock itch, see your doctor. The condition may be hard to distinguish from other skin...

Tinea Corporis

Interdigital type Macerated, scaly plaques in toe web spaces, can be portal of entry for cellulitis of the foot, especially in diabetics. (Tip in recurrent leg cellulitis, look for tinea pedis ) 3. Vesicular type vesicles, pustules, or bullae on the feet. One hand, two feet disease Common clinical presentation of tinea pedis involving one hand and both feet. Tinea Cruris Inner thighs and inguinal folds tinea faciei face tinea manuum hands tinea barbae beard area. Tinea Capitis

Clinical Application Questions

A 25-year-old woman comes to you with a 1-week history of nonpruritic lesions on the upper right inner arm. Examination reveals three annular lesions with central scale. Treatment for tinea corporis is prescribed in the form of a topical antifungal agent. The patient returns 14 days later complaining of a generalized moderately pruritic eruption from the neck to the upper hips. 2. Is tinea corporis still part of the differential diagnosis, and if not, why not

List the disorders that should be considered in this patient Answer

Is tinea corporis still part of the differential diagnosis, and if not, why not Answer Tinea corporis enters the differential diagnosis when single or small numbers of lesions are present however, tinea corporis does not spread at this rate and does not produce large numbers of individual lesions. Also, topical antifungal agents are usually effective over a 2-week treatment period. A negative KOH preparation would have ruled out tinea corporis at the time of the initial visit and prevented unnecessary antifungal therapy.

How should this patient be treated

Answer After the presence of an active tinea pedis is confirmed by KOH preparation, initial treatment should consist of systemic treatment for the tinea pedis. In many instances, the lichen planus will remit when the fungal infection is eradicated. If drug-induced lichen planus is suspected, elimination of the suspect medication is the first measure. In idiopathic lichen planus, treatment may range from

Serious side effects

Tinea corporis Apply Loprox twice daily Apply Loprox twice daily Tinea cruris Apply Loprox twice daily Apply Loprox twice daily Tinea faciei Apply Loprox twice daily Apply Loprox twice daily Tinea pedis Apply Loprox twice daily Apply Loprox twice daily Tinea corporis Apply Loprox twice daily Apply Loprox twice daily Tinea cruris Apply Loprox twice daily Apply Loprox twice daily Tinea faciei Apply Loprox twice daily Apply Loprox twice daily Tinea pedis Apply Loprox twice daily Apply Loprox twice daily

Indicated Supporting Diagnostic Data

Certain dermatophytes of the genus Microsporum produce substances that cause hairs to fluoresce brilliant green when exposed to a Wood's lamp in a darkened room. Another scalp dermatophyte, T. schoenleinii, produces pale-green fluorescence. When positive, this test is very helpful. Unfortunately, most infections in North America are now caused by nonfluorescing Trichophyton dermatophytes. Therefore, a negative exam is not helpful. Prior use of coal-tar-based shampoos can give a false-positive result.

Answers To Clinical Application Questions

How would you distinguish tinea corporis from the other disorders in your differential diagnosis Answer Only tinea corporis has a positive KOH preparation. If KOH preparation is negative but you strongly suspect tinea corporis, a fungal culture should be done. Answer Tinea corporis is commonly associated with tinea pedis, tinea cruris, and nail infections. These sites should be examined.

Butenafine hydrochloride

Uses Treatment of interdigital tinea pedia (athlete's foot) due to Epider-mophyton floccosum, Trichophyton mentagrophytes, or T. rubrum. Special Concerns Use with caution in clients sensitive to allylamine antifungal drugs as the drugs may be cross-reactive. Use with caution during lactation. Safety and efficacy have not been determined in children less than 12 years of age.

Drugs Used in the Treatment of Fungal Infections

Mycoses are most commonly due to dermatophytes, which affect the skin, hair, and nails following external infection. Candida albicans, a yeast organism normally found on body surfaces, may cause infections of mucous membranes, less frequently of the skin or internal organs when natural defenses are impaired (immunosuppression, or damage of microflora by broad-spectrum antibiotics). Griseofulvin originates from molds and has activity only against derma-tophytes. Presumably, it acts as a spindle poison to inhibit fungal mitosis. Although targeted against local mycoses, griseofulvin must be used systemically. It is incorporated into newly formed keratin. Impregnated in this manner, keratin becomes unsuitable as a fungal nutrient. The time required for the eradication of dermatophytes corresponds to the renewal period of skin, hair, or nails. Griseofulvin may cause uncharacteristic adverse effects. The need for prolonged administration (several months), the incidence of side effects, and...

Differential Diagnosis at Particular Sites Discoid Lupus Erythematosus of the Scalp

Scutula Favus

Noninflammatory and epidemic types of tinea capitis (microsporia) begin with small erythemas or erythematous papules around hair follicles that subsequently spread centrifugally like DLE lesions of the scalp. In contrast to DLE, these lesions tend to be multiple, show little inflammation at early stages, and occur almost exclusively in children. Typically, hairs do not fall out but break close to the skin surface, and residual scarring is minimal. In contrast, scarring is pronounced in the favus type of tinea capitis. This rare type of mycosis can be distinguished from DLE by its typical focal crusting and scaling ( scutula ).

Conditions That May Simulate Tinea

Tinea Capitis Tinea Barbae Tinea Corporis Tinea Cruris Tinea Manuum and Tinea Pedis Dyshidrosis or contact dermatitis may be easily confused with vesicular fungal infections of the palms and soles. A KOH exam of an inverted blister roof is almost always positive if it is a dermatophytosis. Remember, active TP can cause a sympathetic id reaction (see Photo 19) on the hands, and those vesicles are KOH negative. Both areas should be tested.

Infection Of The Skin

Dermatophyte infection (ringworm) is restricted to invasion of the stratum corneum, nails, and hair. The dermatophytes, Trichophyton, Epidermophyton, and Microsporum species may infect humans. Microsporum species are usually acquired from infected cats or dogs (M. canis) and are a frequent cause of tinea capitis (ringworm affecting the head) in children. Infections from farm or other animals tend to cause more vigorous inflammation than those from other sources. The infection may be diagnosed from microscopy of skin, nail, or hair treated with potassium hydroxide. Alternatively, the fungus may be cultured. Tinea corporis (ringworm affecting the skin of the trunk or limbs) often presents as a pruritic, annular, erythematous, scaling plaque, which may resemble a patch of eczema or psoriasis, but is often solitary. Tinea cruris (ringworm affecting the groin) presents as a well-demarcated pruritic erythematous scaling rash affecting the groins. The rash may extend onto the thigh and...

Subacute Cutaneos Lupus Erythematosus Differential Diagnosis

Psoriasis Erythematosus

Tinea corporis and superficial trichomycosis may be confused with SCLE because they represent annular lesions with a peripheral erythematous scaly margin. Differences are in that the mycotic infections rarely arise in an exanthematic fashion on the trunk (except in immunodeficient individuals), and they are pruritic. Potassium hydroxide preparations quickly resolve diagnostic problems.

Discoid Lupus Erythematosus Lesions of Intermediate

Superficial dermatophytic infections typically present as nummular lesions with raised erythematous, scaly borders and central clearing. Annular and semicircular lesions are often found. In contrast to DLE, there is no atrophy. In adults, superficial mycoses are mainly found in the context of tinea pedis and in the inguinal folds and only exceptionally on the trunk or face. Children are much more prone to develop superficial mycoses of the face, but they only rarely develop DLE. Potassium hydroxide examination of scales will quickly reveal the etiology.

Prevention of infectious disease

Bacteriologic culture for both respiratory and enteric pathogens. This can include the use of specialized media for the recovery of Salmonella, Mycoplasma, and other bacteria requiring enrichment or selective growth conditions. Fungal cultures for dermatophytes are not routine unless skin lesions are present.

Specific History

Patients frequently interpret the herald plaque as a ringworm lesion, so use of proprietary antifungal agents is common. Recently, self-treatment with proprietary hydrocortisone creams has increased. Fortunately neither has any significant effect and does not interfere with the diagnosis. When a solitary scaling plaque or small group of plaques are present, a KOH preparation may be needed to rule out tinea corporis. Tinea Corporis Early PR with a herald plaque or early cluster of lesions can be difficult to separate from tinea corporis. A simple KOH preparation will distinguish the two, provided the area has not been premedicated with proprietary antifungals.

Clinical Features

Men are more often affected than women (male female ratio, 2 1) (1). Most frequently, MF affects adults, usually in the 5th-6th decades, although any age group may be involved. In some cases, the disease starts with nonspecific scaly lesions resembling chronic dermatitis, parapsoriasis, tinea corporis, or other inflammatory dermatoses. In other instances, patients present with more distinctive irregular, well-circumscribed, scaling patches varying in size from 2-3 to 10-15 cm (Fig. 1). The number of lesions is also variable. In some cases, only a few patches could be observed, whereas in other instances, the lesions can be numerous and widely distributed. Pruritus is common and often severe. In some cases, the patches show a tendency to partial spontaneous remission that, in combination with peripheral growth, leads to the development of lesions with unusual configurations (annular, semicircular, serpinginous). It usually takes several years until the patches progress into plaques and...

Pruritus Itch

Periungual Pigmentation Nail

Candida, contact dermatitis, erythrasma, pediculosis pubis, scabies, tinea cruris Candidiasis, contact dermatitis, gonorrhea, hemorrhoids, pinworms, psoriasis, tinea cruris Contact dermatitis, dyshidrotic eczema, pitted keratolysis, tinea pedis Infections Onychomycosis, tinea pedis

Dosage form

Tinea capitis 200 mg PO daily for 1-3 weeks 5 mg per kg PO daily for 2-4 weeks Tinea corporis 200 mg PO daily for 1-3 weeks 5 mg per kg PO once daily for Tinea cruris Tinea faciei 200 mg PO daily for 1-3 weeks 5 mg per kg PO once daily for Tinea faciei 200 mg PO daily for 1-3 weeks 5 mg per kg PO once daily for Tinea pedis


Fissures Corner Mouth

Thrush Fordyce spots hairy leukoplakia lichen planus aphthous stomatitis pemphigus vulgaris herpes simplex virus infection Candida intertrigo tinea cruris contact dermatitis seborrheic dermatitis Inverse psoriasis mucocutaneous variant acrodermatitis enteropathica immunodeficiency diseases such as HIV infection, DiGeorge syndrome, Nezelof syndrome or

Generic available

Tinea capitis Apply daily for 3-6 weeks Tinea corporis Apply daily for 3-6 weeks Tinea cruris Apply daily for 3-6 weeks Tinea pedis Apply daily for 3-6 weeks Tinea capitis Apply daily for 3-6 weeks Tinea corporis Apply daily for 3-6 weeks Tinea cruris Apply daily for 3-6 weeks Tinea pedis Apply daily for 3-6 weeks


Uses Broad-spectrum antifungal effective against Malassezia furfur, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, C. albicans. Oral troche Oropharyn-geal candidiasis. Reduce incidence of oropharyngeal candidiasis in clients who are immunocompromised due to chemotherapy, radiotherapy, or steroid therapy used for leukemia, solid tumors, or kidney transplant. Topical OTC products Topically to treat tinea pedis, tinea cruris, and tinea corporis. Topical prescription products Same as OTC plus candidi-asis and tinea versicolor. Vaginal products Vulvovaginal candidiasis. Contraindications Hypersensitiv-ity. First trimester of pregnancy. Special Concerns Use with caution during lactation. Safety and effectiveness for PO use in children less than 3 years of age has not been determined.

Athletes Foot

Athlete's foot (known medically as tinea pedis) is a common fungal infection of the foot. It affects mainly adolescent and adult males. The tinea fungus readily grows in moist, damp areas such as shower stalls and floors. Sweating and inadequate ventilation of the feet provide ideal conditions for growth of the fungus. To diagnose athlete's foot, your doctor will examine the affected areas of your skin and may remove a small sample of skin to examine under a microscope. The doctor will prescribe an antifungal cream to be applied to your skin. If the athlete's foot is severe, he or she may prescribe oral antifungal medication. You will need to use all of the antifungal medication prescribed even if your skin looks and feels better to be sure that the infection has been completely eliminated.

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