Tinea: Difference between revisions
Elcatracho (talk | contribs) |
Ostermayer (talk | contribs) |
||
| Line 29: | Line 29: | ||
==Management== | ==Management== | ||
{{Tinea management}} | |||
==Disposition== | ==Disposition== | ||
Revision as of 06:46, 12 February 2023
Background
- Fungal infection caused by dermatophytes that feed on keratin
Tinea Types
- Tinea capitis (head)
- Tinea corporis (body)
- Tinea pedis (foot)
- Tinea cruris (groin)
Clinical Features
- Scaly, with variable pruritus
- Corporis: ring appearance with central clearing
- Capitis: patchy alopecia
Differential Diagnosis
Evaluation
- Clinical diagnosis with Wood's lamp
- Kerion
- Painful, itchy, eczematous
- Hair loss
- Fever, malaise
- Lymphadenopathy
Management
Coverage for Trichophyton and Epidermophyton and all treatment should be at lease 1 week past resolution of lesions
Topical Therapy
Applies to Tinea corporis, pedis, cruris, and manus
Must use a topical therapy for 7-10days beyond resolution of lesions
- Topical antifungal treatment for all except tinea capitis
- Terbinafine 1% BID x2-3weeks or
- Clotrimazole 1% BID x2-3weeks or
- Ketoconazole 1% BID x2-3weeks
Capitis
- Griseofulvin 500mg-1000mg PO once daily (20-25mg/kg/d)
- Usually requires 8wk of treatment
- Terbinafine for 2-4 weeks is as effective of 6-8 weeks of griseofulvin[1]
- 62.5mg/day in children <20kg
- 125mg/day in children 20-40kg
- 250mg/day in children >40kg[2]
- Selenium sulfide or ketoconazole shampoos are adjunct treatment
- Children can return to school during treatment
Kerion
- Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks[3]
- Cephalexin 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
- Ketoconazole shampoo, isolated towels decrease spread to household members
Tinea corporis
First line should be topical therapy. For refractory cases or severe bullous disease the below anti-fungals are all equivalent options.
- Fluconazole 150mg (6mg/kg) PO once a week x 2 weeks or
- Itraconazole 200mg (5mg/kg) PO daily q12hrs for 1 week or
- Griseofulvin 500-1000mg (20mg/kg) PO daily for 2-4 weeks
Disposition
- Discharge
See Also
References
- ↑ Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428
- ↑ Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.
- ↑ Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html