Nursing Continue Education

FUNGAL 真菌 (Reading & Sharing)

Fungal infections can affect millions of people worldwide. Dermophytes 皮真菌 are the most common cause of fungal infections and can spread very easily, especially in the right environment with warmth and high humidity (Sahoo & Mahajan, 2016). Tinea corporis is a type of dermatophyte fungal infection that is caused by Trichophyton or Microsporium (Ferri, 2018). This highly contagious, mildly pruritic infection is also known as ringworm because of its well-demarcated plaques that may be accompanied by pustules or papules and often has to scale at the edges with central clearing (Fenstermacher & Hudson, 2016). Some predisposing factors can put a person at higher risk of catching a dermphyte infection such as diabetes mellitus, immunocompromised status, Cushing’s, older age or lymphomas (Shoo & Mahajan, 2016). Tinea corporis can be found anywhere on the body but is usually below the trunk distributed with either single or multiple lesions presents (Ferri, 2018). Warm areas that are sweaty such as the groin or armpits are most often affected in part because of their more alkaline pH (Shoo & Mahajan, 2016). It is important to educate patients that tinea corporis can spread very easily with the skin to skin contact. This highly contagious infection can often spread through daycares or wrestling teams before lesions are even noticed. It is important to keep all areas effected clean and dry as well as to teach the importance of hand washing.

The diagnosis of tinea corporis can usually be made by inspection and appearance alone. A potassium hydroxide preparation or culture can be made to diagnose if the appearance is atypical or antifungals are not working (Ely, Rosenfeld & Searbury, 2014). Differential diagnoses would include Atopic dermatitis, Lupus erythematosus, Seborrheic dermatitis, Annular psoriasis, Pityriasis rosea, Tinea versicolor, Lyme disease, Granuloma annulare, Eczema, and Secondary syphilis (Ely, Rosenfeld & Seabury, 2014; Ferri, 2018).

Treatment of tinea corporis can usually be accomplished with antifungal creams. Butenafine cream QD for 14 days or Terbinafine cream for 7-14 days can be prescribed as well as sulconazole, miconazole, clotrimazole, ketoconazole, niftifine, ciclopirox olamine or efinaconazole (Ferri, 2018). These creams can be used as prescribed and usually resolve the infection within three weeks. Cream-based treatment is best for one or two lesions, if more tinea corporis lesions are present, or if topical cream is not effective an oral antifungal can be prescribed. Fluconazole 150 mg weekly for 4 weeks, Terbinafine 250 mg QD for 7-14 days or Itravanazole 200 mg daily for 1 week are often prescribed (Ferri, 2018). If oral antifungals are ineffective or infection reoccurs a referral to a dermatologist is recommended.

 

References:

Ely, J., Rosenfeld, S., & Seabury, S. (2014). Diagnosis and management of tinea infections. American Academy of Family Physicians, 90(10), 702-711.

Fenstermacher, K. & Hudson, B. (2016). Practice guidelines for family nurse practitioners (4th ed.). St. Louis, MO: Elsivier.

Ferri, F. (2018). Ferri’s clinical advisor. Philadelphia, PA: Elsevier.

Sahoo, A., & Mahajan, R. (2016). Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatology Online Journal, 7(2), 77-86.

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