Download Fungal skin infections

Fungal skin infections
 Tinea / ringworm
Recommend
 Prevent transmission of ringworm/s. Always treat secondary infection
 Perform a skin scraping from the edge of an affected area for microscopy/mycology if there is any doubt
about the diagnosis
Background
 Tinea or ringworm can infect any part of the person’s skin, hair and nails [6]. It is caused by
dermatophytes – a fungus parasite and has a typical appearance which is described as annular
(forming a ring) or arcuate (bow shape). It is usually scaly and itchy with a definite edge and central
clearing as it expands [6]
 Transmission is fostered by overcrowding, shared bathroom facilities, poor hygiene, humid conditions
and malnourished state
 Can be transmitted by direct contact with others or by infected animals or by objects such as combs,
caps, clothing, footwear, linen and wet floors
Related topics:
 Bacterial skin infections, page 279
1.
May present with:
 Tinea corporis
 may be diverse in its presentation but most commonly presents as an itchy lesion or rash with an
advancing irregularly shaped raised red scaly border with central clearing. Excoriation from
scratching and secondary infection is common
 Tinea capitus
 also has a variable appearance ranging from small lumps about the hair shafts to a kerion, which
is an inflammatory boggy mass studded with broken hairs and oozing purulent material. It is
usually itchy or painful. Occurs almost exclusively in children [6]
 Tinea cruris
 predominantly occurs in males. Unlike candidiasis, satellite lesions are unusual. Often the inner
thigh is affected
 Tinea pedis
 usually occurs between the toes and is characterised by itching, scaling and fissuring. Secondary
infection is common and this may be a site of entry of streptococcal infection
2.
Immediate management: not applicable
3.
Clinical assessment:
 Obtain a complete patient history including
 environmental history
 past episodes
 is the skin itchy / painful?
 length of time condition has been present
 do any other members of their family / close contacts have the same skin lesions?
 ask if any measures have been used to treat, topical creams / ointments?
 medication history
 Perform standard clinical observations, + BGL
 Review nutritional status
 Perform physical examination (wear gloves)
 inspect all skin surfaces, nails and hair
 is there evidence of scaly lesions? with central clearing?
 are there scratches on the skin? broken skin from scratching?
 describe the shape are the lesions?
 describe the part of the body where they are present?
 is there signs of secondary infection?
o redness, pustules, heat, swelling?
4.
Management:
 Consult MO if there is widespread skin involvement or tinea capitus present
 Perform a skin scraping from the edge of an affected area for microscopy/mycology if there is any
doubt about the diagnosis
 Treat any secondary bacterial infection first (see Impetigo)


Efforts to decrease occlusion and moisture are helpful. This can be done by avoiding synthetics, and
wearing lighter and better ventilated clothing and footwear, and by the judicious use of an absorbent
powder
For isolated lesions treat with a topical agent such as Miconazole 2% or Clotrimazole 1%
Schedule
2
Miconazole
DTP
IHW / IPAP / NP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedics may proceed
Nurse Practitioners may proceed
Route of
Form
Strength
Recommended Dosage
Duration
Administration
Cream
2%
Topically
Apply topically 2-3 times daily Apply until lesion clears plus a few
days
Management of Associated Emergency: Consult MO
Or:
Schedule
2
Clotrimazole
DTP
IHW / IPAP / NP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedics may proceed
Nurse Practitioners may proceed
Route of
Form
Strength
Recommended Dosage
Duration
Administration
Lotion
1%
Topically
Apply topically 2-3 times daily Apply until lesion clears plus a few
days
Management of Associated Emergency: Consult MO
5.
Follow up:
 Review the patient in 2 weeks
 See next MO clinic if:

widespread skin involvement

tinea capitis

fingernails or toenails involved
(these patients usually require oral antifungal treatment (eg. Griseofulvin)
6.
Referral / Consultation: Consult MO as above