Dermatophytes/Tinea Infections

Tinea infections are a group of diseases caused by fungi Fungi Fungi belong to the eukaryote domain and, like plants, have cell walls and vacuoles, exhibit cytoplasmic streaming, and are immobile. Almost all fungi, however, have cell walls composed of chitin and not cellulose. Fungi do not carry out photosynthesis but obtain their substrates for metabolism as saprophytes (obtain their food from dead matter). Mycosis is an infection caused by fungi. Mycology: Overview infecting keratinized tissue (hair, nails, and skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin). These infections are termed dermatomycoses and are caused by the dermatophyte fungi Fungi Fungi belong to the eukaryote domain and, like plants, have cell walls and vacuoles, exhibit cytoplasmic streaming, and are immobile. Almost all fungi, however, have cell walls composed of chitin and not cellulose. Fungi do not carry out photosynthesis but obtain their substrates for metabolism as saprophytes (obtain their food from dead matter). Mycosis is an infection caused by fungi. Mycology: Overview. There are approximately 40 dermatophyte fungi Fungi Fungi belong to the eukaryote domain and, like plants, have cell walls and vacuoles, exhibit cytoplasmic streaming, and are immobile. Almost all fungi, however, have cell walls composed of chitin and not cellulose. Fungi do not carry out photosynthesis but obtain their substrates for metabolism as saprophytes (obtain their food from dead matter). Mycosis is an infection caused by fungi. Mycology: Overview that are part of 3 genera, including Trichophyton, Epidermophyton, and Microsporum. These infections can affect any part of the body but occur most often in warm, moist regions like the groin and the feet. The diagnosis is clinical with characteristic skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin findings, but it can be confirmed with microscopy of skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin scrapings. The treatment depends on the site and magnitude of infection but typically begins with topical antifungals like the -azole drugs and terbinafine Terbinafine In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Terbinafine acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine, and it may progress to oral versions of these medications if topical treatment fails.

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Overview

General characteristics of dermatophytes

  • Dermatophytes are filamentous fungi Fungi Fungi belong to the eukaryote domain and, like plants, have cell walls and vacuoles, exhibit cytoplasmic streaming, and are immobile. Almost all fungi, however, have cell walls composed of chitin and not cellulose. Fungi do not carry out photosynthesis but obtain their substrates for metabolism as saprophytes (obtain their food from dead matter). Mycosis is an infection caused by fungi. Mycology: Overview that belong to the genera Trichophyton, Microsporum, and Epidermophyton.
  • Dermatophytes have septate hyphae with chains of conidia.

Classification of tinea infections

Tinea infections are classified and named by the body region affected. 

  • Tinea pedis: 
    • “Athlete’s foot” 
    • Infection of the interdigital webs of the feet
  • Tinea corporis: 
    • “Ringworm” 
    • Infection of the trunk or extremities (excluding hands/feet)
  • Tinea cruris: 
    • “Jock itch” 
    • Infection of the inguinal folds of the groin
  • Tinea unguium (onychomycosis): infection of the nails
  • Tinea capitis: infection of the hair and scalp
  • Tinea manuum: infection of the hands

Pathogenesis

Reservoir

  • Humans
  • Animals
  • Soil

Transmission

  • Direct contact with infected people or animals
  • Indirect contact through a fomite

Host risk factors

  • Walking barefoot in shared locker room
  • Diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Obesity
  • Immunodeficiency
  • Copious sweating
  • Occlusive footwear
  • Trauma
  • Shaving
  • Contact with animals

Pathophysiology

  • Infect keratinized human tissues (e.g., hair, skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin, and nails) 
  • Possess proteases that allow for penetration of the stratum corneum
  • Typically remain superficial, involving only the epidermis, because they cannot survive at the normal body temperature of 37℃
  • Metabolize keratin as a fuel source

Clinical Presentation

Signs and symptoms are similar between the tinea infections, with some minor differences depending on the body region affected. Lesions tend to be well-demarcated, annular, peripheral plaques with a rim of scale. They may also have associated erythema and/or maceration.

Table: Comparison of common dermatophyte infections
Name Body region Etiology Epidemiology and risk factors Clinical features
Tinea pedis (“athlete’s foot”) Feet, interdigital spaces of toes
  • Trichophyton rubrum
  • T. interdigitale
  • Epidermophyton floccosum
  • Most common tinea infection
  • Adolescents and adults
  • ↑ Risk from public locker rooms
  • Interdigital: pruritic maceration and scaling
  • Hyperkeratotic: diffuse scaling in “moccasin” distribution
  • Vesiculobullous (inflammatory): pruritic, erythematous, bullous eruption on feet
Tinea corporis (“ringworm”) Trunk and extremities (excluding hands and feet)
  • T. rubrum (most common)
  • T. tonsurans
  • Microsporum canis
  • T. interdigitale
  • Direct contact with infected person or animal, usually cat or dog
  • Common among athletes
  • Pruritic, ring-shaped, erythematous, or hyperpigmented plaques with central clearing
  • Spreads centrifugally
  • Extensive involvement may indicate diabetes or HIV infection HIV infection Human immunodeficiency virus (HIV), a single-stranded RNA virus belonging to the Retroviridae family, is the etiologic agent of acquired immunodeficiency syndrome (AIDS). The human immunodeficiency virus is a sexually transmitted or blood-borne infection that attacks CD4+ T lymphocyte cells, macrophages, and dendritic cells, leading to eventual immunodeficiency. HIV Infection and AIDS.
Tinea cruris (“jock itch”) Groin, inguinal folds
  • E. floccosum
  • T. rubrum
  • T. interdigitale
  • Men > women
  • Often spreads from preexisting tinea pedis
  • ↑ Risk with obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity, diabetes, immunodeficiency, copious sweating
  • Involves inguinal folds
  • Erythematous patches spread centrifugally with partial clearing.
  • May spread to perineal and perianal regions
  • Spares scrotum
Tinea unguium (onychomycosis) Fingernails or toenails T. rubrum
  • Direct contact with dermatophytes
  • Nail injury
  • ↑ Risk with tinea pedis infection
  • Adults > children
  • Discoloration, hyperkeratosis, splitting of nail
  • Subungual debris
Tinea capitis Hair follicles and scalp
  • T. tonsurans
  • T. violaceum
  • T. verrucosum
  • M. canis
  • Direct contact with dermatophytes
  • Trauma from an object (i.e., a comb)
  • Scaly plaques with alopecia Alopecia Alopecia is the loss of hair in areas anywhere on the body where hair normally grows. Alopecia may be defined as scarring or non-scarring, localized or diffuse, congenital or acquired, reversible or permanent, or confined to the scalp or universal; however, alopecia is usually classified using the 1st 3 factors. Alopecia ± black dots
  • Endothrix infection: fungal spores within the hair shaft
  • Ectothrix infection: fungal spores surrounding the hair shaft
  • Favus infection: fungal spores and air pockets within the hair shaft
Majocchi granuloma (fungal folliculitis) Hair follicles on the body T. rubrum
  • Trauma to skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin
  • Occlusion of hair follicles
  • Shaving hair
  • ↑ Risk with immunosuppression and corticosteroid use
  • Localized perifollicular papules
  • Erythema or hyperpigmentation
  • Pustules
  • Abscesses or dissemination in immunocompromised patients
Tinea corporis

Tinea corporis, “ringworm” on a child:
Infection is most commonly due to Trichophyton rubrum, which presents with pruritic, erythematous, circular plaques with peripheral scales and central clearing.

Image: “Tinea corporis” by Mohammad3021. License: CC0

Diagnosis and Management

Diagnosis

  • Primarily diagnosed clinically
  • Confirmed by KOH prep:
    • Scale from the periphery of a lesion is scraped onto a glass slide.
    • KOH is applied to the scale.
    • Dermatophytes are identified by visualizing septate hyphae.
  • Fungal cultures are an additional alternative for definitive diagnosis.
  • Onychomycosis can be diagnosed with a PAS stain of nail clippings.
Trichophyton rubrum

Trichophyton rubrum: This 475× magnification of T. rubrum shows centrally grouped, elongated macroconidia with septations. There are also many microconidia in the shape of teardrops.

Image: “Trichophyton rubrum” by CDC/Dr. Lucille K. Georg. License: Public Domain

Management

All variants of tinea are treated with antifungals.

  • Tinea pedis:
    • Topical terbinafine Terbinafine In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Terbinafine acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine: Terbinafine is an allylamine and works by inhibiting squalene epoxidase.
    • Oral terbinafine Terbinafine In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Terbinafine acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine for recalcitrant cases
  • Tinea corporis:
    • Topical azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles (e.g., ketoconazole) as initial therapy ( azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles work by inhibiting ergosterol synthesis → impair cell wall production)
    • Oral azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles (e.g., fluconazole) for recalcitrant cases
  • Tinea cruris: topical azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles
  • Tinea unguium (onychomycosis):
    • Oral terbinafine Terbinafine In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Terbinafine acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine
    • Oral fluconazole
  • Tinea capitis:
    • Oral terbinafine Terbinafine In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Terbinafine acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine for Trichophyton species
    • Oral griseofulvin Griseofulvin In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Griseofulvin acts within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails. Flucytosine, Griseofulvin, and Terbinafine (inhibition of microtubules) for Microsporum species
  • Majocchi granuloma: oral azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles

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Differential Diagnosis

  • Erythrasma: bacterial skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin infection caused by Corynebacterium Corynebacterium Corynebacteria are gram-positive, club-shaped bacilli. Corynebacteria are commonly isolated on tellurite or Loeffler's media and have characteristic metachromatic granules. The major pathogenic species is Corynebacterium diphtheriae, which causes a severe respiratory infection called diphtheria. Corynebacterium minutissimum. The presentation of erythrasma is characterized by regions of scaly, pruritic, broken skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin. The infection most commonly occurs in the spaces between the toes but may also present in intertriginous areas. It may co-infect with Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis or dermatophytes, making the diagnosis more difficult. Areas of infection appear fluorescent red under a Wood’s lamp. Treatment is with topical antibiotic therapy.
  • Candidal skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin infection/intertrigo: infection and inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of intertriginous regions, including the folds of an abdominal pannus. Candidal skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin infection may be fungal or bacterial, and it typically presents with moist, erythematous patches within skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin folds. This condition may eventually lead to skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin breakdown. Diagnosis is clinical, and treatment is with topical antifungal therapy.
  • Atopic dermatitis Atopic Dermatitis Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema)/ eczema Eczema Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema): inflammatory skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disease that most frequently affects children but can also be present in adults. Eczema is a chronic condition that presents with dry, crusted, erythematous plaques that may be intensely pruritic. The dermatitis most often affects the flexor surfaces and is associated with other types of atopy, including asthma Asthma Asthma is a chronic inflammatory respiratory condition characterized by bronchial hyperresponsiveness and airflow obstruction. The disease is believed to result from the complex interaction of host and environmental factors that increase disease predisposition, with inflammation causing symptoms and structural changes. Patients typically present with wheezing, cough, and dyspnea. Asthma. The mainstay of therapy is gentle skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin care and the application of topical steroids.
  • Contact dermatitis: local inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin that is a result of direct contact with an irritant or allergen. The etiologies of contact dermatitis include allergic contact dermatitis (delayed type IV hypersensitivity reaction Type IV hypersensitivity reaction Type IV hypersensitivity reaction, or delayed-type hypersensitivity, is a cell-mediated response to antigen exposure. The reaction involves T cells, not antibodies, and develops over several days. Presensitized T cells initiate the immune defense, leading to tissue damage. Type IV Hypersensitivity Reaction) or irritant dermatitis, which results from mechanical or chemical irritation of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin. Lesions present with well-demarcated erythema and edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema and may be pruritic or develop bullae with oozing. Treatment is with trigger avoidance and topical corticosteroids.
  • Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis: multisystem inflammatory disease that includes skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin findings. There are several subtypes of psoriasis. The most common subtype, chronic plaque psoriasis, presents with scaly, erythematous plaques that are intensely pruritic. These plaques most commonly affect extensor surfaces, which can distinguish it from other papulosquamous disorders. Treatment is focused on managing symptoms.
  • Scabies Scabies Scabies is an infestation of the skin by the Sarcoptes scabiei mite, which presents most commonly with intense pruritus, characteristic linear burrows, and erythematous papules, particularly in the interdigital folds and the flexor aspects of the wrists. Scabies: local skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin infection caused by the mite Sarcoptes scabiei. The clinical presentation of scabies usually includes small erythematous papules that are very pruritic and may have a linear distribution, which is evidence of mite movement underneath the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin. Common sites of infection are the extremities, classically the hands, and interdigital webs. Lesions may also appear as crusted, erythematous patches. Diagnosis is made clinically or with the detection of mites, eggs, or feces on microscopy of skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin scrapings. Treatment is with topical permethrin.
  • Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid "herald patch." This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a "Christmas tree" distribution on the back) and extremities. Pityriasis Rosea: skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disease that results in oval-shaped salmon-colored patches. An initial “herald” patch is followed by the emergence of multiple additional patches within 1–2 weeks after the initial patch. Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid "herald patch." This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a "Christmas tree" distribution on the back) and extremities. Pityriasis Rosea may be associated with a prodrome of generalized malaise, headache, and pharyngitis Pharyngitis Pharyngitis is an inflammation of the back of the throat (pharynx). Pharyngitis is usually caused by an upper respiratory tract infection, which is viral in most cases. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and hoarseness. Pharyngitis. The disease course is typically mild and self-limited.
  • Seborrheic dermatitis Seborrheic dermatitis Seborrheic dermatitis is a common chronic, relapsing skin disorder that presents as erythematous plaques with greasy, yellow scales in susceptible areas (scalp, face, and trunk). Seborrheic dermatitis has a biphasic incidence, occurring in two peaks: first in infants, then in adolescence and early adulthood. Seborrheic Dermatitis: relapsing skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disorder that has an unclear pathogenesis and presents with yellow-tinged scales on well-demarcated, pruritic, erythematous plaques. These lesions are distributed in regions of the body with numerous sebaceous glands, including the scalp, face, and chest. Seborrheic dermatitis Seborrheic dermatitis Seborrheic dermatitis is a common chronic, relapsing skin disorder that presents as erythematous plaques with greasy, yellow scales in susceptible areas (scalp, face, and trunk). Seborrheic dermatitis has a biphasic incidence, occurring in two peaks: first in infants, then in adolescence and early adulthood. Seborrheic Dermatitis commonly presents as dandruff in adults and as “cradle cap” in infants. Some evidence suggests that Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi proliferation may be the etiology. Treatment includes topical antifungals and corticosteroids.
  • Subacute cutaneous lupus erythematosus (SCLE): form of skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lupus that is not usually associated with systemic lupus erythematosus Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus ( SLE SLE Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus). Subacute cutaneous lupus erythematosus presents with annular, erythematous, scaly plaques and usually appears on sun-exposed skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin, including the neck, torso, and upper extremities. Counterintuitively, the face is usually spared. Subacute cutaneous lupus erythematosus can be drug-induced, with common offenders being antihypertensive agents, antihyperlipidemic agents, proton-pump inhibitors, antifungals, and tumor necrosis factor Tumor necrosis factor Tumor necrosis factor (TNF) is a major cytokine, released primarily by macrophages in response to stimuli. The presence of microbial products and dead cells and injury are among the stimulating factors. This protein belongs to the TNF superfamily, a group of ligands and receptors performing functions in inflammatory response, morphogenesis, and cell proliferation. Tumor Necrosis Factor (TNF) α inhibitors.
  • Granuloma annulare and erythema annulare centrifugum: benign, inflammatory conditions that present with annular, erythematous plaques. Granuloma annulare and erythema annulare centrifugum often do not have scales, which can be the factor distinguishing them from tinea infections.

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  8. Centers for Disease Control and Prevention. Ringworm. Retrieved May 2, 2021, from https://www.cdc.gov/fungal/diseases/ringworm/index.html

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