CCE-CE-069

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including onset, progression, associated symptoms, previous treatments, and risk factors for dermatophytosis.

The competent candidate should:

• Obtain a structured dermatological history, including:
  • Onset and duration (three weeks of rash progression).
  • Symptoms (itching, burning after showering, central clearing of rash).
  • Previous treatments (hydrocortisone cream without improvement).
  • Impact on daily life (concern about work, spreading infection).
• Identify risk factors, including:
  • Gym environment (shared showers, tight clothing, sweating).
  • Hygiene factors (use of communal towels, delayed changing post-exercise).
  • Exposure history (pets, travel, known contact with similar rashes).
• Assess for differential diagnoses, including:
  • Intertrigo (friction-related, no raised border).
  • Candida infection (moist, satellite lesions, no scaling).
  • Contact dermatitis (related to new products, more widespread redness).

Task 2: Differentiate between types of dermatophytosis and rule out differential diagnoses.

The competent candidate should:

• Recognise classic signs of tinea cruris (groin fungal infection):
  • Annular rash with raised scaly border and central clearing.
  • Itching worsened by sweating and tight clothing.
• Differentiate from other dermatophyte infections:
  • Tinea pedis (athlete’s foot) – check for foot involvement.
  • Tinea corporis (ringworm) – check for other body lesions.
  • Tinea capitis (scalp involvement) – uncommon in adults.
• Consider investigations if uncertain or resistant to treatment:
  • Skin scraping with potassium hydroxide (KOH) test.
  • Fungal culture if unclear diagnosis or treatment failure.

Task 3: Provide a diagnosis and discuss an initial management plan, including topical or systemic antifungals, hygiene measures, and prevention strategies.

The competent candidate should:

• Explain the diagnosis of tinea cruris (groin fungal infection):
  • Caused by dermatophyte fungi thriving in warm, moist environments.
  • Not due to poor hygiene but exacerbated by gym environment and tight clothing.
• Recommend first-line treatment:
  • Topical antifungal cream (e.g., terbinafine or clotrimazole) for 2–4 weeks.
  • Avoid steroid creams (can worsen fungal infections).
  • Oral antifungals (fluconazole or terbinafine) if extensive, recurrent, or resistant to topical therapy.
• Advise hygiene measures to prevent recurrence:
  • Keep the area clean and dry.
  • Change into dry clothes immediately after exercising.
  • Avoid sharing towels and personal items.
  • Use antifungal powder to reduce moisture.
• Discuss when to seek further medical review:
  • If the rash worsens despite treatment.
  • If there is spreading to other body areas.
  • If symptoms persist despite completing treatment.

Task 4: Educate the patient on treatment adherence, expected recovery time, and when to seek further medical review.

The competent candidate should:

• Explain that tinea cruris is treatable but may take weeks to fully resolve.
• Reinforce the importance of completing the full antifungal course.
• Address concerns about gym use:
  • Can continue gym workouts but should maintain good hygiene.
  • Should avoid excessive sweating and wear breathable clothing.
• Provide safety-netting advice:
  • If no improvement in two weeks, reassessment may be needed.
  • Look for signs of secondary infection (redness, swelling, pus).

SUMMARY OF A COMPETENT ANSWER

• Takes a structured dermatological history, including risk factors, symptom progression, and previous treatments.
• Recognises tinea cruris as the likely diagnosis, differentiating it from intertrigo, candida, and other dermatological conditions.
• Recommends first-line antifungal treatment (topical or oral, depending on severity).
• Provides education on hygiene and prevention strategies to minimise recurrence.
• Explains when to seek further medical review if symptoms persist or worsen.

PITFALLS

• Failing to consider tinea cruris in the differential diagnosis, leading to misdiagnosis as eczema or bacterial infection.
• Prescribing steroid creams, which can worsen fungal infections (tinea incognito).
• Not addressing hygiene and lifestyle factors, increasing the risk of recurrence.
• Over-reliance on empirical treatment without considering fungal testing in uncertain cases.
• Not providing clear follow-up instructions, leading to non-adherence or incomplete treatment.

REFERENCES

• RACGP Guidelines for Skin and Fungal Infections
• Science Direct on Dermatophytosis Management
• Better Health Channel on Tinea (Ringworm) Prevention and Treatment
• Australian Prescriber on Antifungal Therapy
• GP Exams – Dermatophytosis

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured dermatological history, including risk factors, symptom progression, and response to prior treatments.
2.2 Identifies key clinical features of dermatophytosis and differentiates it from other dermatological conditions.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between types of dermatophytosis (e.g., tinea cruris, tinea corporis, tinea pedis).
3.2 Identifies when further investigations (e.g., skin scrapings, fungal cultures) or specialist referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an evidence-based treatment plan, including pharmacological and non-pharmacological strategies.
4.2 Educates the patient on treatment adherence, prevention of recurrence, and hygiene measures.

5. Preventive and Population Health

5.1 Identifies risk factors for dermatophytosis (e.g., communal showers, sports activities, immunosuppression).
5.2 Advises on strategies to prevent spread and reinfection.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and follow-up of dermatological infections.

8. Procedural Skills

8.1 Orders and interprets relevant investigations (e.g., potassium hydroxide [KOH] preparation, fungal culture).

9. Managing Uncertainty

9.1 Recognises when symptoms require escalation to a dermatologist for further management.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies severe or chronic dermatophytosis requiring systemic antifungal therapy.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD