Dermatophytes
Dermatophytes are a common label for a group of three types of fungus that commonly causes skin disease in animals and humans. Anthropophilic dermatophytes are restricted to human hosts and produce a mild, chronic inflammation.
The RCEM states knowledge of the following is needed:-
Management: Athlete's foot and Tinea corporis
Management of both conditions is usually via self help measures and topical treatments. Terbinafine cream or an imidazole such as clotrimazole, or miconazole are typically used. Topical cortcosteroids may be used in combination if there is marked inflammation but courses should be limited to 7 days whilst antifungal cream is continued for 1-4 weeks depending on antifungal used and patient factors.
Confirmation of diagnosis involves skin scrapings for mycology culture. These tests typically take weeks so treatment is often initiated whilst awaiting results.
In extensive or severe disease oral antifungal therapy may be used. Oral terbinafine is first line. Second line agents include oral itraconazole or oral griseofulvin.
Management: Tinea capitis (Scalp ringworm)
Ringworm of the scalp is managed differently to dermatophyte infection of the body and feet. Scalp skin and hair samples may be sent for microsccopy and mycology culture. First line treatment is usually with oral antifungals as shown below:
A topical antifungal shampoo or cream is often co-prescribed to reduce the risk of transmission to others. Shampoos such as selenium sulfide or ketoconazole shampoo can be used at least twice weekly for 2-4 weeks. Imidazole cream may be used in children <5 years of age once daily for 7 days.
The RCEM states knowledge of the following is needed:-
- Tinea corporis (Ringworm of the body)
- Tinea pedis (Athlete's foot)
- Tinea capitis (Scalp ringworm)
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Tinea corporis (Ringworm). Note the classic annular lesion with thickened peripheral border and central clearing
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Tinea pedis (Athlete's foot). Similar lesion characteristics to those above. Lesions often starts between digits. May spread and involve large areas of the foot. Skin cracking between toes is common.
Management: Athlete's foot and Tinea corporis
Management of both conditions is usually via self help measures and topical treatments. Terbinafine cream or an imidazole such as clotrimazole, or miconazole are typically used. Topical cortcosteroids may be used in combination if there is marked inflammation but courses should be limited to 7 days whilst antifungal cream is continued for 1-4 weeks depending on antifungal used and patient factors.
Confirmation of diagnosis involves skin scrapings for mycology culture. These tests typically take weeks so treatment is often initiated whilst awaiting results.
In extensive or severe disease oral antifungal therapy may be used. Oral terbinafine is first line. Second line agents include oral itraconazole or oral griseofulvin.
Self help measures for managing fungal infections:
- Wear loose-fitting clothes made of cotton or a material designed to keep moisture away from the skin.
- Maintain good hygiene by washing affected skin areas daily.
- After washing dry thoroughly, especially in the skin folds.
- Avoid scratching affected skin, as this may spread infection to other sites.
- Do not share towels, and wash them frequently, to reduce the risk of transmission.
- Wash clothes and bed linen frequently to eradicate fungal spores.
- If a child is affected, it is not necessary to exclude them from school or nursery
Management: Tinea capitis (Scalp ringworm)
Ringworm of the scalp is managed differently to dermatophyte infection of the body and feet. Scalp skin and hair samples may be sent for microsccopy and mycology culture. First line treatment is usually with oral antifungals as shown below:
- If the person lives in an urban area, start treatment with terbinafine for 4 weeks.
- If the person lives in a rural area, start treatment with griseofulvin for 4-8 weeks
A topical antifungal shampoo or cream is often co-prescribed to reduce the risk of transmission to others. Shampoos such as selenium sulfide or ketoconazole shampoo can be used at least twice weekly for 2-4 weeks. Imidazole cream may be used in children <5 years of age once daily for 7 days.