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Tinea (Dermatophytes): General Characteristics And Management

Tin-man
tantheman
8 KEY FACTS
Fungal Cutaneous Infection
Skin-suit guy with mushrooms

Tinea is caused by cutaneous infection by specific fungi known as dermatophytes. These fungal species metabolize and subsist upon keratin in the skin, hair, and nails. 

ORGANISMS
Trichophyton
Trucker-fightin

Trichophyton is one of the fungal dermatophytes known to cause tinea. 

Microsporum
Microscope-spore

Microsporum is one of the fungal dermatophytes known to cause tinea. 

Epidermophyton
e-pick-deer-mouse fightin

Epidermophyton is one of the known causes of tinea. 

CLINICAL FEATURES
Pruritic Rash
Prairie-dog-rash

Patients with tinea commonly present with a pruritic (itchy) rash. The exact appearance of the rash depends on the location of the body affected, but most commonly the rash appears as scaly erythematous rings with central clearing. 

Segmented Hyphae On KOH
scepter-hyphae

Diagnosis of tinea can be confirmed with a KOH prep, which will demonstrate segmented hyphae. This preparation can be done in minutes in the office and is therefore a relatively convenient and easy way to confirm clinical suspicion. 

MANAGEMENT
Topical Azole
cream-on-easel

Typical management for tinea consists of a topical antifungal agent, most commonly an azole such as  clotrimazole, though other topical agents may be used as well. Oral antifungals and nystatin are not generally recommended for uncomplicated tinea. 

Terbinafine For Tinea Unguium (Nails)
Turban-fan with toenails

Patients with tinea unguium, fungal infection of the nails, may require treatment with oral terbinafine. This is because topical creams such as azoles may not always reach the tissue under the nail where the infection is located. Oral medications, such as terbinafine, are distributed systemically and therefore do not have the same problem. 

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