Tinea

In the case of tinea corporis, treatment may last longer than six weeks. The treatment of onychomycosis may last up to twelve months, certainly if the toenails are involved. Caution is required in patients with impaired kidney or Hver function or hematological disorders. Also, use is contraindicated during pregnancy. 

The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nail fungus), and yeast infections, such as those caused by Candida albicans. Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult to control. Women who are at increased risk for vulvovaginal yeast infections are those who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. 

Researchers have identified several antifungal herbs that are effective against tinea pedis (athlete s foot), such as tea tree oil (Melaleuca alternifolia) and garlic (Allium sativum). 

Tea tree oil comes from an evergreen tree native to Australia. The herb has been used as a nonirritating, antimicrobial for cuts stings wounds burns and acne. It can be found in shampoos soaps and lotions. Tea tree oil should not be ingested orally but is effective when used topically for minor cuts and stings. Tea tree oil is used as an antifungal to relieve and control the symptoms of tinea pedis Topical application is most effective when used in a cream with at least 10% tea tree oil. Several commercially prepared ointments are available. The cream is applied to affected areas twice daily for several weeks... 

Miconazole (Micatin), ciclopirox (Loprox), and econazole (Spectazole)—used for treatment of tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), and superficial candidiasis... 

The differential diagnosis for PIH includes the following fixed drug eruption, systemic drug-induced hyperpigmentation, macular amyloid, ashy dermatosis, melasma, and tinea versicolor. Medications such as tetracyclines, antimalarial drugs, arsenic, bleomycin, and doxorubicin can result in hyperpigmentation of the skin. 

The synthetic thiocarbamates, of which tolnaftate (Fig. 5.20J) is an example, also inhibit squalene epoxidase. Tolnaftate inhibits this enzyme from C. albicans, but is inactive against whole cells, presumably because of its inability to penetrate the cell wall. Tolnaftate is used topically in the treatment or prophylaxis of tinea. 

Cellulitis and erysipelas are bacterial infections of the skin. Although separate entities, there is some clinical difficulty in distinguishing the two. 0 Cellulitis is a bacterial infection of the dermis and subcutaneous tissue, whereas erysipelas is a more superficial infection of the upper dermis and superficial lymphatics. Although both can occur on any part of the body, about 90% of infections involve the leg.8,9 Another 7.5% of cases involve the arm or face. Erysipelas is most common in the young and the elderly. Typically, both infections develop after a break in skin integrity, resulting from trauma, surgery, ulceration, burns, tinea infection, or other skin disorder. 

Tinea infections are superficial fungal infections in which the pathogen remains within the keratinous layers of the skin or nails. Typically these infections are named for the affected body part, such as tinea pedis (feet), tinea cruris (groin), and tinea corporis (body). Tinea infections are commonly referred to as ringworm due to the characteristic circular lesions. In actuality, tinea lesions can vary from rings to scales and single or multiple lesions. 

Tinea infections are second only to acne in frequency of reported skin disease.35 The common tinea infections are tinea pedis, tinea corporis, and tinea cruris. Tinea pedis, the most prevalent cutaneous fungal infection, afflicts more than 25 million people annually in the United States. 

Fungal skin infections are primarily caused by dermatophytes such as Trichophyton, Microsporum, and Epidermophyton. Trichophyton rubrum accounts for more than 75% of all cases in the United States.36 To a lesser extent, Candida and other fungal species cause skin infections. With tinea infections, the causative dermatophyte typically invades the stratum corneum without penetration into the living tissues, leading to a localized infection. 

Treatment is typically initiated based on symptoms, rather than on microscopic evaluation. Since several species can cause tinea infections, the choice of antifungal agent is not always clear. For infections accompanied by inflammation, combination therapy with a topical steroid can be considered. 

Tinea manuum Infection of the interdigital and palmar surfaces Presents as white scales in palmar folds may also develop scales on remainder of palm may present as singular plaque More commonly affecting only one hand Presents with hyperkeratotic skin... 

Tinea corporis Presents with circular, scaly patch with enlarged border Lesions may have red papules or plaque in center that clears, leaving hypopigmentation or hyperpigmentation Itching may be present Commonly referred to as ringworm of the body... 

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