Integumentary System
Lesson 4: Common Skin Diseases
4-5
4-5. FUNGAL INFECTIONS OF THE SKIN
a. Tinea Capitis (Scalp Ringworm).
(1) Description/characteristics. Tinea capitis is ringworm of the scalp. It is practically never seen in adults. There are usually no symptoms except itching. Lesions, undetectable to the naked eye, are small, grayish patches in which hairs are broken, scant, and lusterless.
(2) Treatment. Skin lesions can be treated effectively with microcrystalline griseofulvin until the skin is clear. It is no longer necessary to shave the patient's head. Advise the patient to use Kwell® shampoo and to take griseofulvin orally.
b. Tinea Corporis or Tinea Circinata (Ringworm of the Body).
(1) Description/characteristics. All species of dermatophytes (fungus capable of causing skin disease) may cause body ringworm, but some fungi are more common than others. Skin lesions can appear on the trunk, face, upper extremities, and in skin folds. Exposed skin areas are the most common place for lesions. The lesions are uncommon in temperate climates. The lesions have raised borders that spread from the outside and clear in the middle of the lesion. They must be distinguished from dermatoses such as pityriasis rosea, seborrheic dermatitis, annular psoriasis, and so forth. Intensive itching helps distinguish these lesions as tinea corporis/circinata.
(2) Treatment. These skin lesions can be effectively treated with griseofulvin if the lesions are severe, but you should check first with the medical officer. Vioform® three percent may be used, and tolnaftate is effective. Miconazole (Micatin®) 2 percent cream (Rx 38) is the most effective topical antitineal agent currently available in the United States.
c. Tinea Cruris (Jockstrap Itch).
(1) Description/characteristics. Tinea cruris may be caused by a variety of ringworm organisms and is very similar to tinea corporis. It is complicated by miliaria (skin eruption caused by sweat in the glands), secondary bacterial or candidal infection, and reaction to treatment. Both sides of the upper thighs may be affected, but eruption is usually asymmetrical (not identical on both sides of a central line). Typical lesions are usually confined to the groin and gluteal cleft (buttocks skin folds). Recurrence is common. Athletes (persons who perspire a lot), tight clothing, and obesity tend to favor growth of the organisms. Severe itching occurs in areas where skin rubs together; for example, between the scrotum and the thigh. Macules in such areas will be red with sharp margins, cleared centers, and the macules will be very active.
(2) Treatment. Give sitz baths (bath in which hips and buttocks of patient are the only parts under water) for infection in the genital area. If the area is acutely inflamed, use cool Burow's solution 1:10,000 for several days before applying any ointments. Any one of these medications can be used: Desenex® ointment applied twice daily; Tinactin®; or Halotex® 1 percent solution or cream. When bathing, rinse away all soap and dry the skin thoroughly. Use drying powder two or three times daily and be sure not to wear any rough clothing.
d. Tinea Pedis (Athlete's Foot)(Epidermophytosis).
(1) Description/characteristics. Tinea of the feet, an extremely common acute or chronic skin problem, occurs on the palms of the hands and soles of the feet. Two clinical forms of this skin problem are seen: filaments that are vegetative organs and spores that do not contain chlorophyll and are parasitic. Classic lesions are weeping vesiculations. There is also a noninflammatory type of lesion with small, nonweeping vesicles in the plantar surface of the foot and the sides of the toes, both very similar to dyshidrosis (deep eruption of blisters occurring primarily on the hands and feet accompanied by intense itching). Some people appear to be more susceptible than others to athlete's foot; however, the organisms that cause this disease are probably present on most people's feet all the time. The disease usually begins on the third and fourth interdigital spaces of the foot and then spreads to the planter surface of the arch. The lesions are softened areas with scaling borders. Maceration and moisture due to excessive sweating cause more skin lesions than fungi. Involved toenails
become thickened and distorted. Acute flare-ups are common during warm weather. Tinea pedis may be confused with softening due to hyperhidrosis (excessive sweating) or occlusive (obstructive) footgear and other skin eruptions.
(2) Treatment. To treat tinea pedis, begin by maintaining good foot hygiene. Dry the skin between the toes thoroughly after bathing and rub away any macerated skin. Routinely, use a bland powder on the affected area. Place cotton between the toes at night. Aluminum chloride 30 percent concentration can be used to dry the area and for its antibacterial properties. Other medications that can be used include tolnaftate solution or cream (the best single topical agent), clotrimazole one percent cream or solution, haloprogin one percent solution or cream, miconazale two percent cream or one-half percent Whitfields ointment.
e. Tinea Versicolor.
(1) Description/characteristics. Tinea versicolor is a mild superficial infection of the skin usually found on the body trunk. This skin infection is caused by fungus. The affected area will not tan. This disease is not particularly contagious. It is apt to occur frequently in patients who wear heavy clothing and perspire a great deal. Epidemics may occur in athletes. Symptoms include mild itching, usually not uncomfortable enough to bother most people. The lesions are velvety, chamois-colored macules which may vary from 4 to 5 mm. The lesions are easily scraped off using a fingernail. The lesions appear on the trunk, upper arms, neck, and face. They may persist for years without notice. You should distinguish them from vitiligo and seborrheic dermatitis.
(2) Treatment. Lather in Selsun® daily. Wash affected areas in diluted vinegar or apply plain vinegar, which should be left on 24 hours a day for 7 days. Use medications that can be applied topically including tolnaftate (Tinactin®) solution (RX 21) and acrisorcin (Akrinol®) cream. Other medications that control this fungal disease include miconazole, clotrimazole, and haloprogin applied to the affected area. Encourage good skin hygiene. If the condition is not properly treated, it will usually recur.
f. Moniliasis (Candidiasis).
(1) Description/characteristics. Moniliasis is an infection of the skin or mucous membranes by a yeast-like fungus. Individuals usually affected include diabetics, obese persons who perspire freely, and pregnant women. Oral contraceptives, antibiotics, severe illness, and moist, hot skin also cause moniliasis. The lesions appear in moist skin fold areas and are bright red macules. Red moist lesions develop in the crotch without central clear zones. On the penis, the areas will be red and white. On the vagina or mouth (thrush), there will be a whitish thick coat (curds with flecks). Satellite or advance lesions will appear outward from the border of the main lesion.
(2) Treatment. Initial management of moniliasis includes washing the area frequently, keeping the area dry, and using nystatin cream or powder. Then, follow these procedures: Keep the area as dry as possible. Use nystatin cream or ointment every 4 hours topically; use nystatin oral suspension for thrush. The brand name for nystatin is Mycostatin®. Neomycin contains nystatin plus a steroid, neomycin sulfate, and gramicidin. Mycolog® cream or gentian violet can be applied. Check the patient's urine for glucose or fasting blood sugar to check for diabetes. If the patient does not respond to conservative therapy, refer him to a physician. Ask males if the wife is having a thick, white vaginal discharge. Nystatin vaginal suppositories can also be used.
