Dermatophytosis, commonly known as ringworm, is a fungal infection of the skin, hair, or nails. It’s caused by a group of fungi known as dermatophytes that feed on keratin, a protein found in skin, hair, and nails.
Causes:
- Fungal Species: The most common causative agents are fungi from the genera Trichophyton, Microsporum, and Epidermophyton.
- Human-to-Human Transmission: Direct contact with an infected person.
- Animal-to-Human Transmission: Contact with infected animals, often pets like cats and dogs, or livestock.
- Object-to-Human Transmission: Using contaminated objects or surfaces, such as clothing, towels, and shower floors.
- Environmental Factors: Warm, moist environments promote fungal growth, making places like locker rooms and public showers common sites of infection.
- Personal Risk Factors: Immunocompromised individuals, athletes (especially wrestlers), children, and people living in crowded conditions are at higher risk.
Diagnosis:
- Clinical Examination: Dermatophytosis typically presents as a red, circular, and scaly rash with a clearer center, giving a ring-like appearance.
- Microscopic Examination: Skin scrapings from the affected area are examined under a microscope after being treated with a KOH solution to identify fungal elements.
- Culture: Skin, hair, or nail fragments are cultured on a medium conducive to the growth of dermatophytes.
- Wood’s Lamp Examination: Some types of fungi fluoresce under ultraviolet light, which can be detected using a Wood’s lamp.
- Dermoscopy: A handheld device used to examine the skin with magnification and illumination can assist in diagnosis.
Differential Diagnosis:
It’s essential to distinguish dermatophytosis from other skin conditions such as:
- Eczema: Can resemble ringworm but usually has a different distribution pattern and history.
- Psoriasis: Red, scaly patches can mimic ringworm, but psoriasis has distinct features and distribution.
- Pityriasis Rosea: Presents with a herald patch followed by a distinct pattern of skin lesions.
- Nummular Eczema: Round patches like ringworm but without central clearing.
- Tinea Versicolor: Caused by yeast, not dermatophytes, and presents differently.
- Impetigo: A bacterial skin infection that can mimic some features of ringworm.
Management:
- Topical Antifungals: For most cases of dermatophytosis, topical antifungals (e.g., terbinafine, clotrimazole, miconazole) are effective.
- Oral Antifungal Therapy: Required for more extensive, severe, or difficult-to-treat infections. Commonly used oral antifungals include terbinafine, itraconazole, and fluconazole.
- Skin Care: Keeping the affected area clean and dry helps prevent the spread and exacerbation of the infection.
- Avoiding Contamination: Avoid sharing personal items and maintain good hygiene to prevent spreading the fungus to others or to other body parts.
- Monitoring and Follow-up: Monitoring the response to treatment and potential side effects of antifungal medications is important.
- Treating Comorbid Conditions: Managing conditions like diabetes or immunosuppression can help in the effective treatment of dermatophytosis.
- Education: Educating patients about the condition, its transmission, and prevention strategies is crucial.
Prevention:
- Maintain hygiene, keep skin dry.
- Avoid sharing personal items.
- Wear footwear in communal areas.
- Treat pets if they are infected.
Management should be tailored to the individual’s specific symptoms and health status. For persistent, recurrent, or complicated cases, referral to a dermatologist may be necessary.
eTG
1 terbinafine 1% cream or gel topically, once or twice daily for 7 to 14 days
OR
2 bifonazole 1% cream topically, once daily for 2 to 4 weeks
OR
2 clotrimazole 1% cream topically, two to three times daily for 2 to 4 weeks
OR
2 econazole 1% cream topically, two to three times daily for 2 to 4 weeks
OR
2 ketoconazole 2% cream topically, once or twice daily for 2 to 4 weeks
OR
2 miconazole 2% cream topically, twice daily for 2 to 4 weeks.