Other nail dystrophies, most commonly associated with repeated low-grade trauma, psoriasis, or lichen planusĪppearance can be indistinguishable from onychomycosis may have other manifestations of alternate diagnosisĭo not use nystatin to treat any tinea infection because dermatophytes are resistant to nystatin. Onychomycosis (discolored, thickened nail with subungual keratinous debris and possible nail detachment often starting with great toe but can involve any nail) No scale commonly involves eyelashes and eyebrows hairs of varying lengths
Gray or silver scale nail pitting 70% of affected children have family history of psoriasis 2 involvement of other sitesĪlopecia uncommon lymphadenopathy uncommon greasy scale typical distribution involving nasolabial folds, hairline, eyebrows, postauricular folds, chest Personal history or family history of atopy less often annular lymphadenopathy uncommon alopecia less commonĪlopecia less likely hair pluck is painful Tinea capitis (one or more patches of alopecia, scale, erythema, pustules, tenderness, pruritus, with cervical and suboccipital lymphadenopathy most common in children of African heritage)ĭiscrete patches of hair loss with no epidermal changes (i.e., no scale) total loss of hair or fine miniature hair growth exclamation point hairs no crusting no inflammation possible nail pitting Involvement of other sites gray or silver scale nail pitting 70% of affected children have family history of psoriasis 2
Best jock itch medicine skin#
Shiny taut skin involving great toe, ball of foot, and heel usually spares interdigital skin May have atopic history usually spares interdigital skin “Tapioca pudding” vesicles on lateral aspects of digits often involves hands Tinea pedis (rare in prepubertal children erythema, scale, fissures, maceration itching between toes extending to sole, borders, and occasionally dorsum of foot may be accompanied by tinea manuum or onychomycosis)ĭistribution may match footwear usually spares interdigital skin Red and sharply demarcated may have other signs of psoriasis such as nail pitting Red-brown no active border coral red fluorescence with a Wood lamp examination Involves scrotum satellite lesions uniformly red without central clearing Tinea cruris (usually occurs in male adolescents and young men spares scrotum and penis) Greasy scale on erythematous base with typical distribution involving nasolabial folds, hairline, eyebrows, postauricular folds, chest annular lesions less common
Best jock itch medicine Patch#
Typically an adolescent with a single lesion on neck, trunk, or proximal extremity pruritus of herald patch is less common progression to generalized rash in one to three weeks More confluent scale less likely to have central clearing Sun-exposed areas multiple annular lesions female-to-male ratio 3:1 3 No scale, vesicles, or pustules nonpruritic smooth commonly on dorsum of hands or feet Target lesions acute onset no scale may have oral lesionsĭusky erythematous usually single, nonscaly lesion most often triggered by sulfa, acetaminophen, ibuprofen, or antibiotic use Personal or family history of atopy less likely to have active border with central clearing lesions may be lichenified Gray or silver scale nail pitting 70% of affected children have family history of psoriasis 2 Tinea corporis (annular lesions with well-defined, scaly, often reddish margins commonly pruritic)
Failure to treat kerion promptly can lead to scarring and permanent hair loss. However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen.
Oral terbinafine is first-line therapy for tinea capitis and onychomycosis because of its tolerability, high cure rate, and low cost. Tinea corporis, tinea cruris, and tinea pedis generally respond to inexpensive topical agents such as terbinafine cream or butenafine cream, but oral antifungal agents may be indicated for extensive disease, failed topical treatment, immunocompromised patients, or severe moccasin-type tinea pedis. Physicians should confirm suspected onychomycosis and tinea capitis with a potassium hydroxide preparation or culture. For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toe-nails from repeated low-level trauma. The clinical diagnosis can be unreliable because tinea infections have many mimics, which can manifest identical lesions. The most common infections in prepubertal children are tinea corporis and tinea capitis, whereas adolescents and adults are more likely to develop tinea cruris, tinea pedis, and tinea unguium (onychomycosis). Tinea infections are caused by dermatophytes and are classified by the involved site.
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