How is tinea diagnosed. What are the most effective treatments for ringworm. Which antifungal medications are recommended for different types of tinea infections. How long does it typically take to cure ringworm.

Understanding Tinea: The Fungal Infection Behind Ringworm

Tinea, commonly known as ringworm, is a superficial fungal infection that affects various parts of the body. Despite its name, ringworm is not caused by a worm but by dermatophytes – fungi that thrive on keratin, a protein found in skin, hair, and nails. These infections can occur on different body parts, leading to various clinical presentations and specific names based on the affected area.

The most common causative agents of tinea infections include species from the genera Trichophyton, Microsporum, and Epidermophyton. These fungi can be transmitted through direct contact with infected individuals, animals, or contaminated objects. Understanding the nature of these infections is crucial for accurate diagnosis and effective treatment.

Common Types of Tinea Infections

• Tinea corporis (ringworm of the body)
• Tinea capitis (ringworm of the scalp)
• Tinea pedis (athlete’s foot)
• Tinea cruris (jock itch)
• Tinea faciei (facial ringworm)
• Tinea unguium (onychomycosis – nail infection)

Each type of tinea infection presents with unique characteristics and may require specific treatment approaches. For instance, the case mentioned in the original text describes tinea faciei on the right eyebrow caused by Trichophyton interdigitale, highlighting the diverse manifestations of these fungal infections.

Diagnosis of Tinea Infections: Challenges and Approaches

Accurate diagnosis of tinea infections is crucial for effective treatment. However, misdiagnosis is not uncommon, particularly in primary care settings. A prospective survey by Pariser and Pariser revealed significant errors in handling cutaneous disorders by primary care physicians, emphasizing the need for improved diagnostic techniques and awareness.

How can healthcare providers improve the accuracy of tinea diagnoses? The following approaches can be beneficial:

1. Thorough clinical examination
2. Microscopic examination of skin scrapings (KOH preparation)
3. Fungal culture
4. Wood’s lamp examination (for certain species)
5. Dermoscopy

In some cases, tinea infections may mimic other skin conditions, such as cutaneous lupus erythematosus. A population-based study by Durosaro et al. highlighted the importance of distinguishing between these conditions for appropriate management.

The Predictive Value of Symptoms in Tinea Capitis

Diagnosing tinea capitis, particularly in children, can be challenging. Hubbard’s study on the predictive value of symptoms in diagnosing childhood tinea capitis provided valuable insights. Which symptoms are most indicative of tinea capitis? The study found that scalp scaling, hair loss, and pruritus were significant predictors. However, it’s important to note that these symptoms can also be present in other scalp conditions, necessitating further diagnostic measures.

Lorch Dauk et al. conducted research on the predictive value of symptoms and time to cure with griseofulvin treatment in tinea capitis. Their findings emphasized the importance of considering both clinical presentation and response to treatment in managing this condition.

Treatment Options for Tinea Infections: A Comprehensive Overview

The management of tinea infections typically involves antifungal medications, which can be administered topically or systemically, depending on the severity and location of the infection. The choice of treatment should be based on the specific type of tinea, the causative organism, and individual patient factors.

Topical Antifungal Treatments

For localized, mild to moderate tinea infections, topical antifungal agents are often the first-line treatment. These medications include:

• Azoles (e.g., clotrimazole, miconazole, ketoconazole)
• Allylamines (e.g., terbinafine, naftifine)
• Ciclopirox
• Tolnaftate

Topical treatments are generally effective for tinea corporis, tinea cruris, and mild cases of tinea pedis. They are typically applied once or twice daily for 1-4 weeks, depending on the specific medication and infection severity.

Systemic Antifungal Medications

For more extensive or resistant infections, systemic antifungal drugs may be necessary. These are particularly important in cases of tinea capitis, extensive tinea corporis, and onychomycosis. Common systemic antifungals include:

• Terbinafine
• Itraconazole
• Fluconazole
• Griseofulvin

The duration of treatment with systemic antifungals can vary from a few weeks to several months, depending on the infection type and severity.

Tinea Capitis: Special Considerations in Treatment

Tinea capitis, or scalp ringworm, requires special attention due to its prevalence in children and the potential for scarring alopecia if left untreated. Systemic antifungal therapy is typically necessary for effective treatment of tinea capitis.

Which antifungal medication is most effective for tinea capitis? Several studies have compared the efficacy of different antifungal agents:

• Gan et al. compared ketoconazole and griseofulvin in the treatment of tinea capitis, finding both to be effective options.
• Elewski et al. conducted randomized, investigator-blinded trials comparing terbinafine hydrochride oral granules with oral griseofulvin suspension in children with tinea capitis. The results showed comparable efficacy between the two treatments.
• A Cochrane review by González et al. evaluated systemic antifungal therapy for tinea capitis in children, providing comprehensive insights into treatment efficacy and safety.

In addition to systemic therapy, adjunctive treatments such as antifungal shampoos can be beneficial. Chen et al. compared the efficacy of selenium sulfide shampoo 1% and ciclopirox shampoo 1% as adjunctive treatments for tinea capitis in children, finding both to be effective options.

Managing Kerion in Tinea Capitis

Kerion, an inflammatory form of tinea capitis, may require additional management strategies. Ginsburg et al. conducted a randomized controlled trial comparing intralesional corticosteroid and griseofulvin versus griseofulvin alone for the treatment of kerion. The study found that the combination therapy led to faster clinical improvement, although both approaches were ultimately effective.

Onychomycosis: Challenges in Treatment and New Approaches

Onychomycosis, or fungal nail infection, presents unique challenges in treatment due to the slow growth of nails and the difficulty in delivering antifungal agents to the infection site. Traditional treatment options include:

• Topical antifungal nail lacquers (e.g., ciclopirox)
• Systemic antifungal medications (e.g., terbinafine, itraconazole)

Gupta et al. evaluated the efficacy of ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis, demonstrating its potential as a topical treatment option. However, systemic antifungal agents often remain necessary for more severe or resistant cases.

A cumulative meta-analysis by Gupta et al. assessed the efficacy of systemic antifungal agents for onychomycosis treatment, providing valuable insights into the comparative effectiveness of different medications.

Emerging Therapies for Onychomycosis

Recent years have seen the development of new approaches to onychomycosis treatment. Gupta and Simpson reviewed device-based therapies for onychomycosis, exploring innovative options such as laser therapy and photodynamic therapy. These emerging treatments offer potential alternatives or adjuncts to traditional antifungal therapies, particularly for cases resistant to conventional treatments.

Prevention and Management of Tinea Infections: Best Practices

Preventing the spread of tinea infections is crucial, especially in communal settings such as schools, gyms, and households. What are the most effective prevention strategies for tinea infections? Consider the following best practices:

• Maintain good personal hygiene
• Keep skin clean and dry, especially in areas prone to sweating
• Avoid sharing personal items such as towels, combs, and clothing
• Wear breathable footwear and change socks regularly
• Use antifungal powders or sprays in shoes and on feet if prone to athlete’s foot
• Regularly clean and disinfect shared spaces such as locker rooms and swimming pools

For individuals diagnosed with a tinea infection, adherence to treatment regimens is crucial for effective management. This includes completing the full course of prescribed medications, even if symptoms improve before the treatment is finished.

Managing Recurrent Tinea Infections

Some individuals may experience recurrent tinea infections. In these cases, identifying and addressing underlying risk factors is essential. Potential contributors to recurrent infections include:

• Immunosuppression
• Diabetes
• Excessive sweating
• Frequent exposure to contaminated environments
• Close contact with infected individuals or animals

Healthcare providers should work with patients to develop comprehensive management plans that address both treatment and prevention strategies for recurrent infections.

Special Populations: Tinea Infections in Children and Immunocompromised Individuals

Certain populations require special considerations in the diagnosis and management of tinea infections. Children, in particular, are prone to tinea capitis and may present unique challenges in treatment adherence and prevention.

How should healthcare providers approach tinea infections in pediatric populations? Consider the following guidelines:

• Use age-appropriate diagnostic techniques
• Select antifungal medications with established safety profiles in children
• Provide clear instructions to parents or caregivers on medication administration and hygiene practices
• Implement preventive measures in schools and daycare settings

Immunocompromised individuals, such as those with HIV/AIDS or undergoing chemotherapy, may be more susceptible to tinea infections and may experience more severe or atypical presentations. Management in these cases often requires:

• Longer duration of treatment
• Higher doses of antifungal medications
• Close monitoring for potential drug interactions
• Aggressive preventive strategies

Healthcare providers should tailor their approach to the specific needs and circumstances of these special populations to ensure optimal outcomes.

Future Directions in Tinea Research and Management

As our understanding of tinea infections continues to evolve, several areas of research hold promise for improving diagnosis, treatment, and prevention. What are the most promising avenues for future tinea research?

• Development of rapid, point-of-care diagnostic tests
• Investigation of novel antifungal agents with improved efficacy and safety profiles
• Exploration of combination therapies for resistant infections
• Research into the role of the skin microbiome in tinea susceptibility and treatment
• Evaluation of new delivery methods for antifungal medications, particularly for onychomycosis

Additionally, ongoing surveillance of epidemiological trends and antifungal resistance patterns will be crucial for informing future management strategies. As global travel and climate change potentially impact the distribution of dermatophyte species, staying abreast of these shifts will be essential for healthcare providers.

The Role of Patient Education and Public Health Initiatives

Improving public awareness and patient education about tinea infections can play a significant role in prevention and early intervention. Future efforts may focus on:

• Developing engaging educational materials for various age groups
• Implementing school-based programs to teach children about fungal infections and hygiene
• Leveraging digital health technologies to improve treatment adherence and monitoring
• Collaborating with community organizations to reach underserved populations

By combining advances in medical research with robust public health initiatives, the future management of tinea infections holds the potential for significant improvements in patient outcomes and quality of life.

Diagnosis and Management of Tinea Infections

1. Pariser RJ,
Pariser DM.
Primary care physicians’ errors in handling cutaneous disorders. A prospective survey. J Am Acad Dermatol.
1987;17(2 pt 1):239–245….

2. Kelly BP.
Superficial fungal infections. Pediatr Rev.
2012;33(4):e22–e37.

3. Durosaro O,
Davis MD,
Reed KB,

et al.
Incidence of cutaneous lupus erythematosus, 1965–2005: a population-based study. Arch Dermatol.
2009;145(3):249–253.

4. Moriarty B,
Hay R,
Morris-Jones R.
The diagnosis and management of tinea. BMJ.
2012;345:e4380.

5. Athlete’s foot, ringworm of the feet. In: Pickering LK, Baker CJ, Kimberlin DW, et al. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, Ill.: American Academy of Pediatrics; 2012. http://www.r2library.com/Resource/detail/158110703X/ch0003s0338 (subscription required). Accessed February 26, 2014.

6. Tinea corporis, ringworm of the body. In: Pickering LK, Baker CJ, Kimberlin DW, et al. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, Ill.: American Academy of Pediatrics; 2012. http://www.r2library.com/resource/detail/158110703X/ch0003s0336 (subscription required). Accessed December 12, 2013.

7. Hubbard TW.
The predictive value of symptoms in diagnosing childhood tinea capitis. Arch Pediatr Adolesc Med.
1999;153(11):1150–1153.

8. Lorch Dauk KC,
Comrov E,
Blumer JL,

et al.
Tinea capitis: predictive value of symptoms and time to cure with griseofulvin treatment. Clin Pediatr (Phila).
2010;49(3):280–286.

9. Williams JV,
Eichenfield LF,
Burke BL,

et al.
Prevalence of scalp scaling in prepubertal children. Pediatrics.
2005;115(1):e1–e6.

10. Gan VN,
Petruska M,
Ginsburg CM.
Epidemiology and treatment of tinea capitis: ketoconazole vs. griseofulvin. Pediatr Infect Dis J.
1987; 6(1):46–49.

11. Ginsburg CM,
Gan VN,
Petruska M.
Randomized controlled trial of intra-lesional corticosteroid and griseofulvin vs. griseofulvin alone for treatment of kerion. Pediatr Infect Dis J.
1987;6(12):1084–1087.

12. Ali S,
Graham TA,
Forgie SE.
The assessment and management of tinea capitis in children. Pediatr Emerg Care.
2007;23(9):662–665.

13. Chen C,
Koch LH,
Dice JE,

et al.
A randomized, double-blind study comparing the efficacy of selenium sulfide shampoo 1% and ciclopirox shampoo 1% as adjunctive treatments for tinea capitis in children. Pediatr Dermatol.
2010;27(5):459–462.

14. Deng S,
Hu H,
Abliz P,

et al.
A random comparative study of terbinafine versus griseofulvin in patients with tinea capitis in Western China. Mycopathologia.
2011;172(5):365–372.

15. Elewski BE,
Cáceres HW,
DeLeon L,

et al.
Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: results of two randomized, investigator-blinded, multicenter, international, controlled trials. J Am Acad Dermatol.
2008;59(1):41–54.

16. González U,
Seaton T,
Bergus G,

et al.
Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev.
2007;(4):CD004685.

17. Tinea capitis, ringworm of the scalp. In: Pickering LK, Baker CJ, Kimberlin DW, et al. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, Ill.: American Academy of Pediatrics; 2012. http://www.r2library.com/Resource/detail/158110703X/ch0003s0335 (subscription required). Accessed December 12, 2013.

18. Gupta AK,
Adam P,
Dlova N,

et al.
Therapeutic options for the treatment of tinea capitis caused by Trichophyton species: griseofulvin versus the new oral antifungal agents, terbinafine, itraconazole, and fluconazole. Pediatr Dermatol.
2001;18(5):433–438.

19. Gupta AK,
Fleckman P,
Baran R.
Ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis. J Am Acad Dermatol.
2000;43(4 suppl):S70–S80.

20. Gupta AK,
Ryder JE,
Johnson AM.
Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis. Br J Dermatol.
2004;150(3):537–544.

21. Gupta A,
Simpson F.
Device-based therapies for onychomycosis treatment. Skin Therapy Lett.
2012;17(9):4–9.

22. Tey HL,
Tan AS,
Chan YC.
Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis. J Am Acad Dermatol.
2011;64(4):663–670.

23. Foster KW,
Ghannoum MA,
Elewski BE.
Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol.
2004;50(5):748–752.

24. de Berker D.
Childhood nail diseases. Dermatol Clin.
2006;24(3):355–363.

25. de Berker D.
Clinical practice. Fungal nail disease. N Engl J Med.
2009;360(20):2108–2116.

26. Allevato MA.
Diseases mimicking onychomycosis. Clin Dermatol.
2010; 28(2):164–177.

27. American Academy of Dermatology. Five things physicians and patients should question. http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-dermatology/. Accessed June 20, 2014.

28. Summerbell RC,
Kane J,
Krajden S.
Onychomycosis, tinea pedis and tinea manuum caused by non-dermatophytic filamentous fungi. Mycoses.
1989;32(12):609–619.

29. Garcia-Doval I,
Cabo F,
Monteagudo B,

et al.
Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule. Br J Dermatol.
2010;163(4):743–751.

30. Haghani I,
Shokohi T,
Hajheidari Z,

et al.
Comparison of diagnostic methods in the evaluation of onychomycosis. Mycopathologia.
2013; 175(3–4):315–321.

31. Sigurgeirsson B,
Olafsson JH,
Steinsson JB,

et al.
Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study. Arch Dermatol.
2002; 138(3):353–357.

32. Scher RK,
Breneman D,
Rich P,

et al.
Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of distal subungual onychomycosis of the toenail. J Am Acad Dermatol.
1998;38(6 pt 2):S77–S86.

33. Volk B,
Tiu A,
St Anna L.
Clinical Inquiry: which oral antifungal works best for toenail onychomycosis? J Fam Pract.
2013;62(2):100–101.

34. Crawford F,
Young P,
Godfrey C,

et al.
Oral treatments for toenail onychomycosis: a systematic review. Arch Dermatol.
2002;138(6):811–816.

35. Epstein E.
How often does oral treatment of toenail onychomycosis produce a disease-free nail? An analysis of published data. Arch Dermatol.
1998;134(12):1551–1554.

36. Evans EG,
Sigurgeirsson B.
The LION Study Group. Double blind, randomised study of continuous terbinafine compared with intermittent itraconazole in treatment of toenail onychomycosis. BMJ.
1999;318 (7190):1031–1035.

37. Gupta AK,
Cooper EA,
Lynde CW.
The efficacy and safety of terbinafine in children. Dermatol Clin.
2003;21(3):511–520.

38. Gupta AK,
Cooper EA,
Paquet M.
Recurrences of dermatophyte toenail onychomycosis during long-term follow-up after successful treatments with mono- and combined therapy of terbinafine and itraconazole. J Cutan Med Surg.
2013;17(3):201–206.

39. Centers for Medicare & Medicaid Services. Interpretive guidelines for laboratories. Appendix C: survey procedures and interpretive guidelines for laboratories and laboratory services. http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Interpretive_Guidelines_for_Laboratories.html. Accessed January 9, 2014.

40. Effendy I,
Lecha M,
Feuilhade de Chauvin M,

et al.
European Onychomycosis Observatory. Epidemiology and clinical classification of onychomycosis. J Eur Acad Dermatol Venereol.
2005;19(suppl 1):8–12.

41. Lousbergh D,
Buntinx F,
Piérard G.
Diagnosing dermatomycosis in general practice. Fam Pract.
1999;16(6):611–615.

42. Haldane DJ,
Robart E.
A comparison of calcofluor white, potassium hydroxide, and culture for the laboratory diagnosis of superficial fungal infection. Diagn Microbiol Infect Dis.
1990;13(4):337–339.

43. Fathi HI,
al-Samarai AM.
Tinea capitis in Iraq: laboratory results. East Mediterr Health J.
2000;6(1):138–148.

44. Litz CE,
Cavagnolo RZ.
Polymerase chain reaction in the diagnosis of onychomycosis: a large, single-institute study. Br J Dermatol.
2010; 163(3):511–514.

45. Shemer A,
Trau H,
Davidovici B,

et al.
Nail sampling in onychomycosis: comparative study of curettage from three sites of the infected nail. J Dtsch Dermatol Ges.
2007;5(12):1108–1111.

46. Souza PR,
Vettorato G,
Pinto GM,

et al.
Concordance between direct microscopy and fungical culture for the diagnostic of feet’s onychomycosis. An Bras Dermatol.
2012;87(1):157–159.

47. Weinberg JM,
Koestenblatt EK,
Tutrone WD,

et al.
Comparison of diagnostic methods in the evaluation of onychomycosis. J Am Acad Dermatol.
2003;49(2):193–197.

48. Garg J,
Tilak R,
Singh S,

et al.
Evaluation of pan-dermatophyte nested PCR in diagnosis of onychomycosis. J Clin Microbiol.
2007;45(10):3443–3445.

Infections That Cause Hair Loss: Ringworm, Folliculitis, and More

A number of infectious agents and infection-related conditions can contribute to hair loss. Some common ones are described here.

Ringworm

Surprisingly, ringworm has nothing to do with worms, but is a fungal infection that can occur anywhere on the body. If it develops on the scalp, it can cause patches of hair loss and is known to doctors as “tinea capitis.” Ringworm is the same thing as athlete’s foot, and the same kind of fungal infection that can affect the nails too.

On the scalp, ringworm usually begins as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness. The fungus gets into the hair fibers in the affected area and these hairs become brittle and break off easily, leaving a bald patch of skin. Affected areas are often itchy, red, and inflamed, with scaly patches that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring — hence the name, ringworm.

Worldwide, the fungus Microsporum audouinii is a very common cause of ringworm, but increasingly Trichophyton tonsurans can also cause tinea capitis, especially in the US and Latin American countries. Other fungi that may cause tinea capitis include Trichophyton schoenleinii and Trichophyton megninii in Southern Europe and Africa, and Trichophyton violaceum in the Middle East.

The fungus Microsporum gypseum can also sometimes cause tinea capitis. This fungus is common in soil and may be transferred to humans by contact with infected animals. You can also get ringworm from pets that carry the fungus, and cats in particular are common carriers. Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact. You can also catch ringworm through contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces.

Treatment for ringworm varies depending on the particular fungus involved. Some types of ringworm infection will go away spontaneously and no treatment is given. However, most commonly, griseofulvin, an anti-fungal, is used. Griseofulvin is very effective against fungi in hair and skin but it is not so good at treating yeast or bacterial infections. The drug gradually accumulates in the skin and hair. It especially likes to bind with keratin, which is a key component of hair, skin, and nails, and blocks the fungus from infecting the keratin.

More recently, some fungi that cause tinea capitis show some resistance to the drug, which means higher doses and longer courses of treatment. As an alternative to griseofulvin, newer anti-fungal drugs like terbinafine, itraconazole, and fluconazole can be prescribed.

Folliculitis

Folliculitis is a term for inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. In the early stages of a folliculitis, the hair fiber may still be present, but as the folliculitis progresses the hair often falls out. When folliculitis is severe, inflammation is so intense that it can permanently destroy the hair follicles, leaving little bald patches.

There are non-infectious forms of folliculitis, such as those caused by oils and greases applied to the skin that clog up the hair follicles, but folliculitis is usually due to a bacterial infection. Particularly common is an infection of the hair follicles by Staphylococcus aureus. “Hot tub folliculitis” is caused by Pseudomonas aeruginosa which grows in inadequately chlorinated water.

Nonprescription topical antibiotics such as bacitracin, mycitracin, or neomycin can be used to treat minor folliculitis. For more serious infections, oral antibiotics such as erythromycin may be used.

Piedra

Piedra (trichomycosis nodularis) happens when the hair fibers are infected by a fungus. The visible indicator of a piedra infection is development of hard nodules on hair fibers. Indeed, “piedra” is Spanish for stone. The nodules are a concretion of hyphae and fruiting bodies of the fungus, known as an ascostroma, from which the fungal spores are released.

There are two basic types of piedra: black piedra and white piedra, referring to the color of the nodules formed on the hair fiber. Black piedra is due to the fungus Piedraia hortae and is mostly found in tropical countries, while white piedra is due to Trichosporon beigelii and is found mostly in Europe and Southern parts of the United States.

Piedra infection may affect hairs of the scalp, body, and genital areas. Usually the infection is relatively benign. In parts of Malaysia, the nodules of black piedra are considered attractive and traditionally women encouraged its growth by sleeping with their hair buried in the soil. However, when the infection is severe the fungus weakens the hair fiber, making it easy to break off. This can result in a patchy, diffuse hair loss.

Treatment generally involves shaving off affected areas. Anti-fungals such as ketoconazole or terbinafine are also used.

Demodex folliculorum

Some people believe Demodex folliculorum contributes to hair loss and that removing it will enable hair regrowth. But the organism does not cause hair loss.

Demodex is a little worm-like creature that likes to live on skin and in hair follicles. It feeds on dead skin and oils, so it particularly likes to live in hair follicles where there are lots of both.

Humans are born free of Demodex, but during childhood, through contact with others, the skin can become infected with it. For the most part, we never know they are there. They are benign, if repulsive, little creatures. The most common problem with Demodex is that they may cause irritation, particularly in the eyelashes. If you have itchy eyelashes, Demodex may be the problem.

However, this is as much as Demodex can do to you. It does not cause hair loss.

Seborrheic Dermatitis

Seborrheic dermatitis is first and foremost a skin condition, but it can involve infection and temporary hair loss if the dermatitis is located on the scalp or other skin areas. The dermatitis causes scaly, sometimes oily, inflamed skin that can be itchy or even painful to touch.

This is an inflammatory condition that is not well understood, although there does seem to be a genetic component and Caucasians, particularly of Celtic descent, are most susceptible. Some newborns develop seborrheic dermatitis when maternal androgens are passed from the mother to the baby across the placenta. Conditions such as Parkinson’s disease, head injury, and stroke can also be associated with seborrheic dermatitis, and stress and chronic fatigue can make it worse. Times of hormone fluctuation, such as during puberty, can activate the onset.

In part, the trigger for seborrheic dermatitis may be androgen steroids. The sebaceous glands attached to the hair follicles begin to produce a very rich form of sebum. The sebum contains fewer free fatty acids and squalene but increased amounts of triglycerides and cholesterol. The excess, rich sebum production triggers the proliferation of skin flora. Yeast Pityrosporon ovale (also called Malassezia furfur) has been shown to increase in numbers with the intensity of seborrheic dermatitis. This excessive yeast proliferation causes more irritation and inflammation.

Although all this inflammation is not specifically directed at the hair follicle, if hair follicles are in the vicinity of the inflammatory cells then they can be affected. Hair follicles find inflamed skin an unhealthy environment in which to grow. Thus seborrheic dermatitis may non-specifically cause diffuse hair loss.

Although seborrheic dermatitis can involve a proliferation of yeast, seborrheic dermatitis is not infectious — you cannot catch seborrheic dermatitis. Where yeast is involved in seborrheic dermatitis it comes from the affected individual’s own skin. We all have yeasts of various types living on our skin — the problem in seborrheic dermatitis is that the yeasts may grow to far greater numbers than normal.

Treatments

There are several treatments for seborrheic dermatitis. The simplest involves medicated anti-dandruff type shampoos to control the skin proliferation and scaling. Several shampoos might be recommended for alternating use on different days and each with its own particular activity.

Shampoos for seborrheic dermatitis may contain sulfur, selenium sulfide, zinc pyrithione, tar, salicylic acid, or oil of cade. These shampoos have been available for many years. More recently azole-based shampoos (such as ketoconazole [brand name: Nizoral]) have been made available over the counter. All can be effective in treating seborrheic dermatitis.

Some dermatologists may also prescribe antibiotics to control the skin flora and in doing so indirectly reduce the inflammation. The inflammation may be directly treated using a corticosteroid cream or lotion to control the body’s immune response. Seborrheic dermatitis can be very persistent once it starts, so staying with treatment is required and preventative treatment is useful even when the symptoms are gone.

Published on March 1, 2010

Tinea Capitis Article

Continuing Education Activity

Tinea capitis, also known as ringworm or herpes tonsurans infection, is a fungal infection of the scalp hair. It is caused primarily by the dermatophyte species Microsporum and Trichophyton. The fungi can penetrate the hair follicle’s outer root sheath and ultimately may invade the hair shaft. Clinically, tinea capitis can be divided into inflammatory and non-inflammatory types. The non-inflammatory type usually will not be complicated by scarring alopecia. The inflammatory type may result in a kerion, a painful nodule with pus, and scarring alopecia. Tinea capitis occurs primarily in children between 3 and 14 years of age, but it might affect any age group. It may also involve the eyelashes and eyebrows. This activity reviews the evaluation and management of tinea capitis and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients.

Objectives:

• Identify the typical presentation of tinea capitis.
• Outline the complications of tinea capitis.
• Review the management of tinea capitis.
• Describe the importance of enhancing care coordination among the interprofessional team to ensure proper evaluation and management of tinea capitis.

Introduction

Tinea capitis is a fungal infection of the scalp hairs. Tinea capitis is also known as ringworm and herpes tonsurans infection.[1] It is caused primarily by the dermatophyte species Microsporum and Trichophyton. The fungi can penetrate the hair follicle outer root sheath and ultimately may invade the hair shaft. Clinically, tinea capitis divides into inflammatory and non-inflammatory types. The non-inflammatory type usually will not be complicated by scarring alopecia. The inflammatory type may result in a kerion (painful nodules with pus) as well as scarring alopecia.[2] Tinea capitis occurs primarily in children between 3 and 14 years of age, but it might affect any age group. It may also involve the eyelashes and eyebrows.

Etiology

Tinea capitis is caused by the dermatophyte species which have the capabilities to infect keratin and keratinized tissue including the hair. Dermatophytes include several genera like Trichophyton, Microsporum, and Epidermophyton. Some common organisms include Trichophyton Sudanese, Trichophyton tonsurans, Trichophyton verrucous, Trichophyton rubrum, and Microsporum canis.[3] Transmission of the infection takes place through direct contact with organisms from:

• Humans (Anthrophillic organisms)
• Animals (Zoophilic organisms)
• Soil (Geophilic organisms)
• Indirectly through fomites: hats, hairbrushes, etc.

Epidemiology

Tinea Capitis is a common dermatological disease. Tinea capitis is seen almost all over the world. It is most common in hot, humid climates such as Africa, Southeast Asia, and Central America. Sexual predilection varies depending on the causative dermatophytes, e.g., Trichophyton infections will affect both sexes equally during the childhood years. Microsporum canis affects boys more than girls. Tinea capitis affects children more than adults.

Pathophysiology

Dermatophytes are a common cause of infection in humans. Once acquired, the fungus grows downwards in the stratum corneum and invades the keratin. The infected hair eventually becomes brittle and then break.

Immunosuppression may lead to impaired hair shaft growth and strength leading to easier colonization. Other associated diseases include:

• Diabetes mellitus
• Prolonged steroid use 
• Cancer
• Immunosuppressant medications
• Anemia

It is worth mentioning that in HIV, the risk is not increasing due to competitive colonization with Malassezia.

Hair will typically get infected in one of three principal ways:

1) Endothrix: where the fungi affect the hair shaft – an example of this type: Trichophyton tonsurans

2) Ectothrix: where the fungi affect the outer sheath root – an example of this type: Microsporum canis

3) Favus: where there is an inflammatory reaction, crusting or scutula, and hair loss – an example of this type: Trichophyton schoenleinii[4]

Histopathology

Tinea capitis shows the following histological findings:

• Subacute and chronic dermatitis either with or without follicular inflammation and destruction. Suppurative folliculitis may be present.
• Hyperkeratosis
• Parakeratosis
• Spongiosis
• A perivascular inflammatory infiltrate

Periodic acid-Schiff stain is a special stain that will help in identifying the fungi. Also, neutrophilic infiltrates might be seen in the papillary dermis.[5]

History and Physical

Tinea capitis usually affects children. Therefore, it is essential to inquire about any colleagues and friends from the school that have the same condition; this might give a clue about the mode of transmission. The infection usually starts as red papules that will increase in size with the time. As the infection spreads, it might involve the whole scalp. The skin of the infected area of the scalp may be normal close to the center of the round patch, but will probably appear irritated, red, or inflamed near the edges. Symptoms of tinea capitis include redness, itching, scale formation, and alopecia.[2] 

The symptomatic presentation of ringworm infection of the scalp is quite different depending upon the causative organism. Commonly, the infection may look like severe dandruff that appears on various places on the scalp. Some infections cause patches of hair loss. The inflammatory type (kerion) is associated with pus discharge and might lead to permanent hair loss.[6] Extension to the eyelashes and eyebrows is not uncommon. Cervical lymphadenopathy is often seen in patients with kerion.

There are three distinct clinical presentations which include: 

Black dot tinea capitis, which is the classical presentation: in this type, there is an infection with a fracture of the hair.

Kerion is another presentation that involves inflammation and may progress to scarring alopecia.

Favus is the boggy inflammatory type and typically presents with deep-seated oozing nodules, abscesses, crusting, or scutula.

Id reaction or an idiosyncratic reaction is caused by the immune response to the fungi. The id reaction tends to occur at a distant site and is often triggered by antifungal treatment. The id reaction presents as intense itching of vesicles, usually on the feet. It may also present as erythema nodosum or annular erythema.

Evaluation

One may consider a fungal culture swab, biopsy, or scraping from the scalp in patients with tinea capitis. A fungal culture may confirm the causative fungus. The scraping can be done and placed on a glass slide. A few drops of KOH 20% solution is added, and the slide is examined under a microscope to look for hyphae and spores.

Woods light is a modality to check for fluorescence of the infected areas. With the light of a wood, infected hairs by M. canis, M. audouinii, M. rivalieri, and M. ferrugineum will give a green to a yellow-green color. Infection with T. schoenleinii may show a blue color. It should be noted that tinea capitis caused by T tonsurans usually does not show fluorescence.

Treatment / Management

Tinea capitis can is treatable with systemic antifungal medications. Often the drug of choice is griseofulvin. The treatment is for 4 to 8 weeks. Topical treatment is not recommended, as it is ineffective.

Azole antifungal medications like itraconazole and fluconazole are also alternative treatment options. Specific presentations like kerion need anti-inflammatory treatments like systemic steroids for a short period to help to reduce the inflammatory response and also consequently lower the risk of permanent alopecia. This steroid therapy is in addition to oral antifungal treatment. Allylamines are a great option orally, like terbinafine.

Antifungal shampoos can be part of the treatment plan and often help in preventing spread, but this is not the mainstay of treatment and will usually not cure tinea capitis. Creams may also help in preventing the spread of tinea capitis but typically will not cure this condition. 

Differential Diagnosis

• Dissecting folliculitis (folliculitis decalvans)
• cellulitis
• Bacterial folliculitis
• Secondary syphilis
• Abscess
• Infected eczema
• Pyoderma
• Pustular psoriasis
• Syphilis
• Seborrheic dermatitis
• Systemic lupus erythematosus
• Drug eruption reaction

Toxicity and Side Effect Management

Most oral antifungal treatment may increase liver enzymes, therefore, consider checking liver enzymes before initiating, during, and after therapy.

Prognosis

Tinea capitis has a good prognosis with treatment. However, those who remain untreated are at risk for the development of an abscess, also known as a kerion. The fungi can shed spores for many months leading to spread. A common cause of treatment failure is a lack of medication compliance. Tinea capitis usually has a good prognosis when treated early and appropriately.

Complications

• Hair loss
• Loss of self-esteem and ridicule
• Emotional impairment in children

Deterrence and Patient Education

All household contacts should be screened for tinea capitis. Asymptomatic individuals should be treated; otherwise, the cycle of transmission will continue.

The use of antifungal or selenium shampoo is recommended for 2 to 4 weeks. Teachers should be educated on tinea capitis and place infected children away from other healthy children. The sharing of personal care products should be avoided.

Enhancing Healthcare Team Outcomes

Tinea capitis is a very common infection in children and easily acquired. The best way to prevent and treat tinea capitis is with an interprofessional team. The majority of patients are first seen by the pediatrician, nurse practitioner, or primary care provider. The key is prompt diagnosis and initiating oral therapy. Follow up is essential to ensure cure.

Parents need to be educated about prevention. The easiest method of preventing tinea capitis is avoiding situations where the patient can acquire it from another person or animal. Health care professionals should coordinate as a team across disciplines in identifying the condition, treating, and tracking down the source of contamination. 

Children should be instructed not to share caps, hairbrushes, and combs. Pillows, as well as bed linens, should be washed thoroughly. The fungi responsible for tinea capitis can live for long periods. Hair equipment needs to be cleaned and also disinfected or replaced altogether.

Working as a team and eliminating sources of contamination helps reduce the morbidity of this condition. [Level 5]

(Click Image to Enlarge)

Tinea Capitis

Contributed by DermNetNZ

(Click Image to Enlarge)

Ringworm, Tinea corporis, Fungi, Fungal infection involving the skin, dermatophytic fungal organism, tinea capitis, Skin Disease

Contributed by Dr. Lucille K. Georg, The Centers for Disease Control and Prevention (CDC)

(Click Image to Enlarge)

Dermatophytes, Ringworm, Tinea, Infection, Pathology, Tinea Capitis, Skin Diseases, Fungi, Photomicrograph, Hairshaft affected by endothrix infection caused by dermatophytic fungus

Contributed by Dr. Lucille K. Georg, The Centers for Disease Control and Prevention (CDC)

(Click Image to Enlarge)

Tinea capitis of the scalp showing black-dots picture.

Contributed by Ahmad Al Aboud, MD

Autoimmune Disorders | Hull Dermatology & Aesthetics

AUTOIMMUNE DISORDERS

Vitiligo

Vitiligo is a condition in which your skin loses melanin, the pigment that determines the color of your skin, hair and eyes. Vitiligo occurs when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes to appear on your skin. Vitiligo affects all races, but may be more noticeable in people with darker skin. Vitiligo usually starts as small areas of pigment loss that spread with time. There is no cure for vitiligo. The goal of treatment is to stop or slow the progression of pigment loss and, if you desire, attempt to return some color to your skin.

Urticaria

Chronic hives, also known as urticaria, are batches of raised, red or white itchy welts (wheals) of various sizes that appear and disappear. While most cases of hives go away within a few weeks or less, for some people they are a long-term problem. Chronic hives are defined as hives that last more than six weeks or hives that go away, but recur frequently. In most cases of chronic hives, a cause is never clearly identified. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus. While the underlying cause of chronic hives is usually not identified, treatment can help with symptoms. For many people, antihistamine medications provide the best relief

Morphea

Morphea is a skin condition that causes reddish or purplish patches on your skin. Morphea is a localized form of scleroderma, a condition that can cause a wide variety of problems, from skin discoloration to difficulty with the normal function of joints and muscles and other connective tissues. The condition typically appears on your abdomen, chest or back. Morphea tends to affect only the outermost layers of your skin. Sometimes, morphea can restrict movement in your joints. Treatment depends on the severity of your condition. With morphea, you may naturally be concerned about your appearance. Your doctor may recommend medications and other treatments to help with your appearance and other symptoms of morphea.

Alopecia

Hair loss (alopecia) can affect just your scalp or your entire body. It can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss. Baldness typically refers to excessive hair loss from your scalp. Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications or surgical procedures that are available to treat hair loss. Before pursuing any treatment option, talk with your doctor about the cause of and best possible treatments for your particular type of hair loss
A variety of medical conditions can cause hair loss, including:

• Thyroid problems. The thyroid gland helps regulate hormone levels in your body. If the gland isn’t working properly, hair loss may result.
• Alopecia areata. This disease occurs when the body’s immune system attacks hair follicles — causing smooth, roundish patches of hair loss.
• Scalp infections. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally grows back.
• Other skin disorders. Diseases that can cause scarring, such as lichen planus and some types of lupus, can result in permanent hair loss where the scars occur.

SCALP DISORDERS

Alopecia

Hair loss (alopecia) can affect just your scalp or your entire body. It can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss. Baldness typically refers to excessive hair loss from your scalp. Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications or surgical procedures that are available to treat hair loss. Before pursuing any treatment option, talk with your doctor about the cause of and best possible treatments for your particular type of hair loss.

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin disorder that mainly affects your scalp, causing scaly, itchy, red skin and stubborn dandruff. In infants, seborrheic dermatitis of the scalp is known as cradle cap. Seborrheic dermatitis can also affect your face, upper chest, back and other areas of your body that have many oil (sebaceous) glands. Seborrheic dermatitis doesn’t affect your overall health, but it can be uncomfortable and cause embarrassment when it develops on visible parts of your body. It isn’t contagious, and it’s not a sign of poor personal hygiene. Seborrheic dermatitis tends to recur, but you may be able to manage flare-ups by recognizing its signs and symptoms and by using a combination of self-care steps and over-the-counter (nonprescription) medications

Head Lice

Head lice are a very common problem, affecting millions of people each year — especially preschool and elementary school-aged children and their close contacts. Head lice are tiny, wingless, parasitic insects that live and feed on blood from your scalp. Getting head lice isn’t a sign of bad personal hygiene or an unclean living environment. This itchy infestation, also called pediculosis capitis, most commonly spreads through close personal contact and by sharing personal belongings. Both over-the-counter and prescription medications are available to treat head lice. Following the directions properly and taking necessary steps at home are important to prevent head lice from recurring

Folliculitis

Folliculitis occurs when hair follicles become infected, often with Staphylococcus aureus or other bacteria. Certain variations of folliculitis are also known as hot tub folliculitis and barber’s itch. Severe infections can cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing. The infection usually appears as small, white-headed pimples around one or more hair follicles — the tiny pockets from which each hair grows. Most cases of folliculitis are superficial, and they may itch, but on occasion they’re painful too. Superficial folliculitis often clears by itself in a few days, but deep or recurring folliculitis may need medical treatment

SKIN INFECTIONS

Cellulitis

Cellulitis is a common bacterial skin infection that is caused by either Staphylococcus or Streptococcus bacteria. Both of these bacteria occur naturally on the skin. A break or cut in the skin causes the bacteria to enter the body, which leads to an active infection. Cellulitis most often occurs from:

• cracking or peeling skin between the toes,
• insect bites or stings, and
• a skin cut, break or trauma.

Cellulitis appears as a swollen red area of skin that is tender and hot to the touch. Symptoms include chills, fever, muscle ache, fatigue, pain or tenderness in an area with a skin rash or sore. The redness increases in size as the infection spreads. It typically comes on suddenly and spreads quickly. Cellulitis can arise anywhere on the body, but usually appears on the face or legs. Be sure to contact your dermatologist as soon as you observe these symptoms to start an effective treatment.

To prevent cellulitis, be sure to clean any cut or break in the skin promptly with soap and water and cover the wound with a bandage until it scabs over. Watch for redness, tenderness, drainage or pain as these are signs of infection.

Tinea

Ringworm is a common fungal infection, especially among children, that appears on different parts of the body. It is characterized by ring-shaped, scaly and itchy patches of the skin. The patches may blister or ooze fluid. Ringworm is contagious and can be passed from person to person or through contact with contaminated personal care products, clothing or linens. Pets, particularly cats, can also pass on the infection.

The fungi are attracted to warm, moist environments, which is why the most common forms of ringworm include:

• Tinea Barbae, which occurs on bearded areas of the face and neck.
• Tinea Capitus, which occurs on the scalp.
• Tinea Cruris, also known as Jock Itch, occurs in the groin area.
• Tinea Pedis, also known as Athlete’s Foot, occurs between the toes.

Ringworm generally responds well to home remedies and will disappear in about four weeks. In addition to keeping the area clean and dry, you can apply over-the-counter antifungal powders, lotions or creams. In more severe cases, your dermatologist may recommend prescription antifungal medications and antibiotics.

Herpes Simplex Virus

A group of viral infections that cause sores on the mouth (oral herpes) or genitals (genital herpes).. There are two types of Herpes Simplex Virus:

Herpes Simplex Virus Type 1 is the most common form of herpes that affects most people at least once during childhood. It is passed from person-to-person through contact with saliva. It is responsible for the formation of cold sores (fever blisters) and canker sores around the mouth and lips. It may also cause an enlargement of lymph nodes in the neck. Generally, this type of herpes does not need any treatment however, oral medications to treat are available. It will disappear on its own in seven to ten days.

Herpes Simplex Virus Type 2 is sexually transmitted either to the genital area or mouth. About one in five adults in the U.S. has this form of the herpes virus, although many people don’t know they have it. The infection is characterized by sores that look like small pimples or blisters, which break open quickly and ooze fluid. This is followed by a period of crusting over and scabbing until the lesions finally heal, which can take up to four weeks. The infection spreads to areas of skin that come into contact with secretions from the blisters. The lesions most frequently appear on the vagina, vulva, penis, scrotum testicles, thighs or buttocks. They may be accompanied by a fever, swollen glands, headache or painful urination. Many people with genital herpes experience sensations of itching, tingling, burning or pain in areas where lesions will develop.

Genital herpes is diagnosed through a viral culture test of the blister fluid from a lesion and blood tests. There is no known cure. Treatment is designed to reduce pain and hasten healing and includes antiviral medications. For people with more severe, prolonged or frequent outbreaks, your dermatologist may prescribe a stronger antiviral drug.

On average, adults with genital herpes have about four or five outbreaks a year. The first outbreak is usually the most severe and more outbreaks occur the first year than any subsequent year. Generally, symptoms begin to appear about two weeks after transmission. The virus takes root in nerve cells, lying dormant until it re-emerges with another outbreak. Outbreaks are known to be triggered by stress, illness or excessive sunlight. It is important for people with genital herpes to avoid sexual contact during an active outbreak to reduce the risk of passing the infection on to a sex partner. However, herpes simplex virus type 2 can be transmitted a few days before the appearance of any lesions. That is why people with this infection are encouraged to practice safe sex and use condoms at all times

Erysipelas

A particular type of skin infection (cellulitis) that is characterized by blisters; skin that is red, swollen, warm and/or painful to the touch; or by lesions with raised borders that most frequently appear on the face or legs. It also appears as sores on the cheeks and bridge of the nose. It is usually caused by the Streptococcus bacteria and occurs in both adults and children.

Erysipelas requires medical treatment, so you should contact your dermatologist as soon as you suspect you may have this infection. Antibiotics (usually penicillin) are generally prescribed. In severe cases, the patient may need to have antibiotics delivered intravenously

Staphylococcus Infection

Staph infections are caused by staphylococcus bacteria, a type of germ commonly found on the skin or in the nose of even healthy individuals. Most of the time, these bacteria cause no problems or result in relatively minor skin infections. But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart.

In the past, a lethal staph infection might have occurred in a person who was hospitalized or had a chronic illness or weakened immune system. Now, a growing number of otherwise healthy people are developing life-threatening staph infections. And many staph infections no longer respond to common antibiotics.

Impetigo

Impetigo is a highly contagious skin infection that mainly affects infants and children. Impetigo usually appears as red sores on the face, especially around a child’s nose and mouth. Although it commonly occurs when bacteria enter the skin through cuts or insect bites, it can also develop in skin that’s perfectly healthy. Impetigo is seldom serious, and usually clears on its own in two to three weeks. But because impetigo can sometimes lead to complications, your child’s doctor may choose to treat impetigo with an antibiotic ointment or oral antibiotics. Your child can usually return to school or a child care setting as soon as he or she isn’t contagious — often within 24 hours of starting antibiotic therapy

Herpes Zoster (Shingles

Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you’ve had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn’t a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.

Varicella (Chickenpox)

Chickenpox (varicella) was once considered a rite of passage for most children. Before routine chickenpox vaccination, virtually everyone had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically. However, when chickenpox does occur, it’s highly contagious among people who aren’t immune. Most people think of chickenpox as a mild disease — and, for most, it is. Unfortunately, there’s no way to know who will develop a severe case. The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Folliculitis

Folliculitis occurs when hair follicles become infected, often with Staphylococcus aureus or other bacteria. Certain variations of folliculitis are also known as hot tub folliculitis and barber’s itch. Severe infections can cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing. The infection usually appears as small, white-headed pimples around one or more hair follicles — the tiny pockets from which each hair grows. Most cases of folliculitis are superficial, and they may itch, but on occasion they’re painful too. Superficial folliculitis often clears by itself in a few days, but deep or recurring folliculitis may need medical treatment.

Hidradentitis Suppurativa

Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several recurrences. Considered a severe form of acne (acne inversa), hidradenitis suppurativa occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected — the groin and armpits, for example — are also the main locations of apocrine sweat glands. Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing

Arthropod Bites

Spider bites are uncommon. Often, people mistake a skin infection or a bite by another insect as a spider bite. Only a few spiders have fangs strong enough to pierce your skin and enough venom to cause a reaction. In the U.S., these include the black widow spider and the brown recluse spider. Even these types of spiders tend to bite only when threatened. Spider bites are rarely lethal. Treating the site of the spider bite is generally all that’s necessary. In a few cases, symptoms may be severe and widespread enough to require antivenom treatment and hospitalization

Pityriasis Rosea

Pityriasis rosea is a skin rash that usually begins as one large circular or oval spot on your chest, abdomen or back. Called a herald patch, this initial spot can be up to 4 inches (10 centimeters) across. The herald patch is typically followed by a distinctive pattern of similar but smaller lesions that sweep out from the middle of your body in a shape that resembles drooping pine-tree branches. Pityriasis rosea can affect any age group, but it most commonly occurs between the ages of 10 and 35. It usually goes away on its own within six weeks. Pityriasis rosea can cause itching, and treatment usually focuses on relieving symptoms.

Can Hydrogen Peroxide & Rubbing Alcohol Treat Ringworm?

The medical term for ringworm on the body is tinea corporis. It is a fungal infection that causes a red, itchy rash outlined by a scaly border in the shape of a ring, creating a “ring” of scales.

The shape of this rash is called annular or polycyclic as the rash can look like one circular plaque of rash or interconnecting circles of rash.

The ringworm rash can occur on any area of the body. This infection is mostly superficial, which means that the fungus thrives only on the first layer of the skin (stratum corneum). (1)

Causes of Ringworm

“Ringworm” is a misnomer as it is not caused by worms but by a specific species of fungus called dermatophytes, which live on the skin, hair, and nails.

Dermatophytes can also cause:

• Tinea pedis (athlete’s foot)
• Tinea cruris (jock itch)
• Tinea manuum (involves the hands)
• Tinea capitis (involves the skin of the scalp, eyelashes, and eyebrows)
• Tinea faciei (involves the face)
• Tinea barbae (involves the hair)
• Onychomycosis (involves the fingernails or toenails)

Symptoms of Ringworm

Itch (pruritus) is very common with fungal infections, but it is not always present. For instance, some people with neuropathy and/or diabetes may feel the classic itch associated with the rash of tinea pedis (athlete’s foot).

Pain can also be associated with the fungal infection, especially if there is:

• Associated maceration between the toes
• A secondary bacterial infection, wherein the bacteria infect open sores caused by an initial fungal infection

Both of these conditions can lead to a serious skin infection called cellulitis.

Mode of Transmission for Ringworm Fungus

Ringworm is highly contagious. The dermatophytes that cause ringworm can be transmitted by infected animals (zoophilic) to humans or by contact with an infected human (anthropophilic).

The infection can also transfer from one part of the body to another, known as autoinoculation.

For instance, people with athlete’s foot (tinea pedis) can spread the fungus from their feet to their groin (jock itch) through their contaminated hands. The fungus can also be picked up from an infected surface/soil (geophilic).

Given that the fungus thrives in warm, humid, congested conditions, community pools, gyms, and changing rooms are some of the most common contamination sites.

Medical Treatment for Ringworm

Tinea corporis (ringworm of the body) can be treated with antifungals. Antifungals are classified into two categories:

Fungistatic medications halt the growth of the fungus but do not directly kill it, whereas fungicidal treatments destroy the dermatophytes directly.

Treatment options come in topical cream formulations or oral pills. (2)

Tips to Prevent Fungal Infections Like Ringworm

My main tips are as follows:

1. Don’t walk barefoot on public floors

Be mindful of your surroundings and avoid walking barefoot in public areas including gyms, locker rooms, public showers, and hotel rooms. Pack your own flip-flops/slippers when you travel.

2. Change your footwear and socks daily

Avoid reusing socks and cycle through various pairs of shoes. Wear a fresh pair of socks every day. Also, alternate your footwear/shoes daily and especially avoid wet shoes.

Try to use flip-flops/open-toed shoes in warmer weather to prevent increased moisture from collecting in your footwear and the growth of dermatophytes.

3. Keep your feet moisture-free

After a shower, make sure to dry your feet adequately, especially before putting on your socks.

4. During and after treatment of fungus

If you are recovering from an athlete’s foot infection, use an over-the-counter antifungal spray such as a tolnaftate spray for all of your footwear to prevent reinfection.

Also, wear socks before putting on your pants to avoid moving the fungus from your feet to your groin (jock itch), especially if you suffer from chronic athlete’s foot or get recurrent athlete’s foot.

Healing Period for Ringworm Infection

Early treatment is the best way to ensure a quick recovery from ringworm. Otherwise, it can persist for a long time.

It typically takes 2–4 weeks to treat a superficial ringworm rash with topical creams, which may or may not be accompanied by oral antifungal treatment.

The aim is to contain the dermatophytes while they are still on the surface of the skin to keep them from infiltrating into the hair follicles.

An infection that spreads to the dermis or the second layer of the skin through the hair follicles is called Majocchi’s granuloma. This condition is much harder to treat and can take more than a month to resolve with high-dose oral antifungal medication.

Can Ringworm Go Away Without Any Treatment?

I do not see these cases since everyone who comes to the dermatologist for this issue has a persistent rash for weeks to months.

Technically, your immune system can clear minor bacterial infections and viral infections (common warts) without treatment. The same can be said for fungal infections.

However, people with compromised immune systems can have more frequent fungal infections or very resistant cases that do not respond to topical medications. These immunocompromised groups include those with diabetes mellitus, HIV/AIDS, and advanced age. (3)

Avoid Home Remedies for Treating Ringworm

Rubbing alcohol, tea tree oil, apple cider vinegar, and hydrogen peroxide have antimicrobial and antifungal properties that justifies their use in various home remedies to fight skin infections. These mild disinfectants can kill fungal hyphae, but I typically do not recommend its use on a rash.

Rubbing alcohol, apple cider vinegar (undiluted), and hydrogen peroxide can slow wound healing if there are wounds/open sores associated with the fungal infection.

They can cause discomfort, chemical burn, and dry skin, which can lead to a flare-up or worsening of eczema and dry skin.

For ringworm/tinea, see your dermatologist if the over-the-counter antifungal creams are not effective.

For fungus infecting the toenail (onychomycosis), I recommend over-the-counter options as the prescription options are not very effective and can be very pricey.

For onychomycosis, I typically recommend soaking the nails in white vinegar diluted in water, followed by an application of hand sanitizer with greater than 60% alcohol content or tea tree oil.

Role of Healthy Lifestyle and Diet in Ringworm Prevention

There are no dietary factors involved with fungal infections. However, if one has diabetes mellitus (high blood glucose) or a compromised immune system, tinea infections can become a recurrent problem.

Thus, exercise (increases insulin sensitivity and allows insulin to work more efficiently) and a healthy diet are recommended to prevent the development of type 2 diabetes.

In general, unhealthy eating, weight gain, smoking, drinking alcohol, and emotional stress can worsen any skin condition.

Risk of Scarring in Ringworm Infection

Tinea can leave a darkened/discolored flat patch of post-inflammatory hyperpigmentation, but this fades with time.

Ringworm does not typically cause a scar unless it involves a severe blistering fungal infection called bullous tinea. This type of infection typically involves the feet and lower shins.

Prevalence of Ringworm During Summers

Fungal species thrive in moist and warm environments. During summer, besides the obvious heat, there is increased perspiration of the occluded surfaces of the body, such as the groin and feet. (4)

Men will be affected in the folds of the groin, especially in the area where the scrotum approximates with the adjacent inner thigh.

Overweight or obese individuals tend to have more fungal infections as they have prominent skin folds all over their bodies, which collect sweat and heat, thus providing an ideal environment for dermatophytes or yeast to grow.

Major Differences Between Psoriasis and Ringworm

Here are some of the major differences between psoriasis and ringworm:

• Psoriasis is an inflammatory condition that involves the skin, joints, and even the cardiovascular system, whereas ringworm is a fungal infection.
• Psoriasis can cause a red rash with white scales, which are much thicker than the fine scales seen in ringworm or tinea. (5)
• Unlike ringworm, psoriasis is not contagious and does not involve any microbes (bacteria, fungus, virus, or parasite), although it can occur after a streptococcal pharyngitis (strep throat) infection.
• Psoriasis will improve with topical corticosteroids. On the other hand, tinea will have a change in appearance with topical steroids (tinea incognito) or worsen and become a deeper infection in the skin (Majocchi’s granuloma).

When to See a Doctor

If you are treating a rash with over-the-counter antifungal medications and your rash is persistent, schedule an appointment with your skin specialist.

At the appointment, bring what medications you have tried and be ready to answer questions on your medical history (history of immunosuppression, diabetes).

Your dermatologist may scrape your rash and look at the cells under the microscope to visualize fungal elements.

If your rash worsened with a topical steroid or cortisone, you might have a fungal or yeast infection that needs to be evaluated by a skin specialist at the earliest as this may need oral medication.

Final Word

Ringworm is a fairly common fungal skin infection that does not pose a serious threat to your health. However, it can give rise to a lot of skin irritation and can be highly contagious, necessitating proper treatment and care.

People with strong immunity usually overcome this condition rather quickly without much treatment, but those with compromised immunity are not only at a greater risk of contracting the infection but are also less responsive to traditional treatment. These high-risk groups must exercise extra care.

As with any other ailment, “prevention is better than cure” applies to ringworm as well.

You can steer clear of this infection by following basic personal hygiene along with the above-listed precautionary measures. If you do contract the fungal infection, consult a doctor about the appropriate medication.

References

1. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian dermatology online journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804599/. Published 2016.
2. El-Gohary M, van Zuuren EJ, Fedorowicz Z, et al. Topical antifungal treatments for tinea cruris and tinea corporis. The Cochrane database of systematic reviews. https://www.ncbi.nlm.nih.gov/pubmed/25090020. Published August 4, 2014.
3. Kaul S, Yadav S, Dogra S. Treatment of Dermatophytosis in Elderly, Children, and Pregnant Women. Indian dermatology online journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621188/. Published 2017.
4. Bhatia VK, Sharma PC. Epidemiological studies on Dermatophytosis in human patients in Himachal Pradesh, India. SpringerPlus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320242/. Published March 9, 2014.
5. Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harbor perspectives in medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4109580/. Published August 1, 2014.

AFTERCARE & POLICY | mysite

We will NOT be able to perform microblading on your eyebrows if any of the following conditions exist:

• Pregnant

• Breastfeeding

• Non-Compliant Diabetes. You must heal well and adhere to your doctor recommended diet and medication.

• If any skin diseases, symptoms, or irritation appears on the eyebrow- such as eczema, psoriasis, dermatitis, scabies, ringworm, acne, allergic reaction, boils, wounds, severe scaling keratosis, damaged capillaries.

• Directly after botox treatment

• If you are using accutane, isotretinoin or other strong retinoids (after 6 months it is allowed)

• If you are suffering from a sunburn or frostbitten

• 48-72 hours after waxing must have passed.

• After a strong chemical peel, dermabrasion, immunotherapy, or any other intense skin resurfacing treatment. This will cause the skin to be irritated and must be stopped 2-3 weeks before the treatment

• Raised moles and other skin derivatives on the brow area. Moles do not take pigment so the mole will still remain and we will work around the area.

• If you are allergic to lidocaine, please notify your technician because it is the numbing agent we use. Lidocaine is commonly used as your numbing agent while at the dentist.

• Notify your technician if you have ever had any type of treatment done to your brow area. If you had previous permanent make-up done, it has to be very faded to the point of almost no detection in order to achieve optimal results. If there is still green, blue, or red tones to your previously botched permanent make-up procedures from the past, it will most likely need to be removed by laser from a trained professional before attempting microblading. Please send a picture to your technician to help determine severity.

• Due to the patented techniques and to keep a sterile environment, no other person or animal is allowed in the room during the procedure.

• An appointment will only be made once a retainer of $100 is made. That $100 will go towards your service. This is to respect our time and to ensure against “no-shows”.

Failure to inform us of any of the above conditions prior to your appointment, will result in forfeiting your retainer. We want to ensure the best results and satisfaction.

Before Your Arrival:

• To avoid excessive bleeding, please avoid blood thinners:

​Do not consume alcoholic beverages the 24 hrs. before

No caffeine the day of procedure

Please refrain from consuming pain relievers/killers unless directed by your physician.

Please stop any fish oil or biotin one week prior to arriving.

• If you normally draw your eyebrows, please fill them in prior to the appointment and wear your makeup the way you normally would 

• It is recommended that you shower before your procedure.

​

Aftercare:

I love a good acronym so here’s one to help you out, just think of:  A – W – M which stands for Absolutely Wonderful Make-up or better yet:  Absorb, Wash, and Moisturize!

The day of the treatment: Absorb

After the procedure, gently blot the area with clean tissue to absorb excess lymph fluid. Do this every 5 minutes for the full day until the oozing has stopped.  Removing this fluid prevents hardening of the lymphatic fluids.

Days 1-7: Wash

Wash daily to remove bacteria, build up of product and oils, and dead skin. (Don’t worry, THIS DOES NOT REMOVE THE PIGMENT!)

Gently wash your eyebrows each morning and night with water and an antibacterial soap like Dial Soap, Cetaphil, or Neutrogena. With a very light touch, use your fingertips to gently cleanse the eyebrows. Rub the area in a smooth motion for 10 seconds and rinse with water ensuring that all soap is rinsed away. To dry, gently pat with a clean tissue. DO NOT use any cleansing products containing acids (glycolic, lactic, or AHA), or exfoliants.  

Days 1-7 Moisturize

Apply a rice grain amount of aftercare ointment with a cotton swab and spread it across the treated area. Be sure not to over-apply, as this will suffocate your skin and delay healing. The ointment should be barely noticeable on the skin. NEVER put the ointment on a wet or damp tattoo.

​

AWM should have you covered, but here are some extra tips to help with a smooth and easy recovery:

Important Reminders

• Use a fresh pillowcase while you sleep.

• Let any scabbing or dry skin naturally exfoliate away. Picking can cause scarring or loss of color.

• No facials, botox, chemical treatments or microdermabrasion for 4 weeks.

• Avoid hot, sweaty exercise for one week.

• Avoid direct sun exposure or tanning for 4 weeks after the procedure.  Wear a hat when outdoors.

• Avoid long, hot showers for the first 10 days.

• Avoid sleeping on your face for the first 10 days.

• Avoid face-down swimming, lakes, and hot tubs for the first 10 days,

• Avoid topical makeup and sunscreen on the area.

• DO NOT rub, pick, or scratch the treated area.

• ​

Remember, with the proper prep and aftercare routine, you will have much better results with your microblading procedure. Don’t forget your new favourite acronym: AWM – Absorb, Wash, Moisturize!

Important note about showering:

Limit your showers to 5 minutes so that you do not create too much steam. Keep your face/procedure area out of the water while you wash your body, then, at the end of your shower, wash your hair. Your face should only be getting wet only at the end of the shower.  Avoid excessive rinsing and hot water on the treated area.

WARNING: In extreme cases- long exposure to chlorine, exfoliation creams, and exposure to the sun will cause colors to fade.

Failure to follow post-procedure instructions may cause loss of pigment, discoloration or infection. We do not offer refunds on service already performed.

​

Itchy Scalp – Narberth, PA Dermatologist

Scratching your head as you read this?

You may be embarrassed – but you’re certainly not alone.

Thousands of Americans suffer from itchy scalp. Many find relief in over-the-counter medicated shampoos. For those who don’t, a good dermatologist can pinpoint and attack the culprit behind the itch.

Common Causes of an Itchy Scalp

Seborrheic Dermatitis

Seborrheic dermatitis accounts for most cases of itchy scalp that dermatologists will see day to day. Symptoms can include greasy scales on the scalp, eyebrows, eye lids, and nose. Excessive scratching can lead to bleeding and infection. The causes of dandruff are many, from cold weather, to infrequent shampooing or using certain hair products, even stress and lack of sleep can cause dandruff.

Prescription steroid lotions, applied topically to the scalp and other affected areas can clear up the dandruff more quickly and efficiently than anything that could be purchased over-the-counter. With this, the problem often will resolve after just a few days of treatment.

Ringworm

Other, less common culprits behind scalp itch need more aggressive attention. Because it also causes scaling, a fungus (commonly called “ringworm”) is sometimes confused with seborrheic dermatitis, though the former can also cause patchy hair loss in the affected area. A dermatologist can confirm the diagnosis.

Ringworm of the scalp (tinea capitis) is a fungal infection of the scalp and hair shafts. The signs and symptoms of ringworm of the scalp may vary, but it usually appears as itchy, scaly, bald patches on the head. Treatment for ringworm of the scalp includes medications taken by mouth to kill the fungi, as well as medicated shampoos that may lessen the spread of infection.

Lice

And then there’s the dreaded L word: Much more prevalent in children, lice spread easily through classrooms, sometimes migrating onto adult heads. The key to banishing the bugs is getting rid of their tiny eggs, called “nits”, which remain glued to the hair until a fine-tooth comb removes them.

Many topical over-the-counter and prescription treatments kill lice, but not their eggs. When we diagnose patients with lice, we discuss several treatment options.

What is shingles and what to do to never meet with it

Before you read the article and decide to diagnose yourself, we remind you: suspicious rashes should be shown to doctors. Changes in the skin can be symptoms of much more serious diseases than lichen. Therefore, an unknown rash and spots do not need to be treated and smeared (especially with green stuff) until the doctor sees them.

1. Lichen planus

What is it

Chronic disease, because of it round spots and plaques appear on the skin, which gradually merge.They shine a little, as if smeared with wax. Most often, spots form on the wrists, ankles and mucous membranes: in the mouth and on the genitals.

Where does

come from. Nobody knows for sure. Most likely, malfunctions of the immune system and genetics are to blame. The risks are greater in people with chronic medical conditions (such as diabetes).

What is dangerous

The disease is often exacerbated, ulcers may appear at the site of the spots.

How to deal with it

Show the doctor and apply the ointments and tablets that he prescribes.Sleep more, walk a lot and eat right. Try to cure exacerbations of other chronic diseases and go to the good old resort.

How not to get sick

Leave in life as few harmful factors as possible:

• Do not work with chemicals and anything that can irritate the skin.
• Avoid contact with possible allergens.
• Lead a healthy lifestyle so that there are no problems with immunity.

2. Ringworm

What is it

Microsporia, trichophytosis and other terrible names.These are infections caused by fungi that live on the skin and hair. Ringworm looks like red or light spots on which the skin is peeling. The hair on the affected areas is broken off at a distance of 1–5 mm from the root. If the fungus attacks the nails, then they become bumpy, flake off.

Where does it come from

Ringworm fungi live on animals, in the city they are most often found on cats. To pick up an infection, it is enough to pet the cat and not wash your hands or sit in the sandbox, which is loved by stray animals.It is difficult to get infected from a person, but it is real, especially in places where it is warm and humid: swimming pools, changing rooms and showers in gyms. Most often, children get sick, because they are the ones who are busy with the sand and are drawn to orphan animals.

What is dangerous

Constant itching, flaking of the skin, hair loss, unpleasant appearance. If the disease is started, suppuration may appear.

How to deal with it

Show all suspicious spots to a dermatologist, use pharmacy antibiotics-fungicides (those that destroy fungi).Wash all clothes and bed linen, preferably in very hot water (wash at 90 ° C), then iron.

How not to get sick

• Don’t touch the wonderful stray cats and dogs if you can’t wash your hands right away. Even if outwardly the animal is healthy, you can get infected from it.
• If you pick up a pet on the street, be sure to show it to the veterinarian and check the coat under ultraviolet light.
• Do not use other people’s combs, towels or any other hygiene items.
• Do not go barefoot in swimming pools and changing rooms, wash the slippers in which you visit these places thoroughly.

3. Lichen pink

What is it

Skin disease in which first a round pink spot appears on the body, in the center of which the skin is peeling. After a while, smaller spots are poured on the back, shoulders, sides, the same pink and flaky. The spots itch.

Where does

come from

Nobody knows for sure, they assume that the virus is to blame for everything.Most often, lichen pink appears after an illness, when the immune system is weakened, and disappears on its own in a month and a half.

What is dangerous

May be repeated or last up to six months.

How to deal with it

Wear clothing that does not irritate the skin if stains appear. Do not sunbathe, use mild detergents, wash less stains and do not rub them. In some cases, when the rash itches a lot, your doctor will prescribe antiallergic ointment.

How not to get sick

• Do not tolerate ARVI on your feet, get treatment on time.
• Try to eliminate allergens.

4. Pityriasis versicolor (pityriasis) versicolor

What is it

Fungal disease of the skin. With it, small spots with clear boundaries appear. At first, the spots are pink, and then change color to brown. Sometimes they are lighter than the underlying skin tone.

Where does it come from

The pathogen is found on human skin and usually does not manifest itself, but if it gets into favorable conditions, it begins to multiply.Favorable conditions are sweating, immune disorders in the wearer, diseases of the hormonal system, stress.

What is dangerous

Changes the color of the skin, itches.

How to deal with it

Repeat the same as in the case of ringworm, apply antifungal shampoos.

How not to get sick

• Wear natural fabrics to keep your skin from sagging if you sweat a lot.
• Wash more often, but use mild products.
• Learn to manage stress.
• Treat chronic diseases.

5. Shingles

What is it

A disease caused by a virus of the herpes family. The same one that causes chickenpox. First, the temperature rises, the person begins to feel pain along the nerve (often intercostal nerves). After a few days, bubbles and spots appear at the site of the pain, which gradually disappear.

Where does it come from

After the transferred chickenpox, the virus hides in the nerve cells, and due to different conditions it manifests itself.Herpes viruses wake up when a person is sick, when the immune system is weakened by other infections.

What is dangerous

The virus affects the nervous system, there is a risk of complications: the eyes may be damaged, and the failure of the nerves can lead to paresis. Sometimes after the rash has disappeared, pain remains.

How to deal with it

The virus cannot be eradicated from the body, most often the exacerbation goes away on its own. Sometimes doctors prescribe acyclovir, a herpes remedy. The dosage is chosen only by the doctor.

How not to get sick

• If you have not had chickenpox yet, get vaccinated.
• Check your HIV status, it’s generally helpful.
• Think about your health and do not drive yourself to exhaustion, burnout and other troubles to prevent the virus from waking up.

Microsporia and trichophytosis or ringworm

Monday,
thirty
May
2016

On the basis of the order of the Health Department of the Khanty-Mansi Autonomous Okrug-Ugra, anti-epidemic and preventive measures for microsporia and trichophytosis are being carried out at the Nefteyugansk Regional Hospital.

Within the framework of the events, the dermatovenerologist Mikhailova M.V. conducts explanatory conversations with patients, talking about the signs and symptoms of diseases. In addition, on an ongoing basis in the BU “Nefteyugansk Regional Hospital”, there is a specialized promotion of the prevention of dermatophytosis, through the means of disseminating information material.

It should be noted that when the diagnosis is confirmed, the dermatovenerologist immediately goes to check the patient’s immediate environment in order to identify infections.

The first signs of ringworm may be small red patches that form around the hairs on the scalp (rarely on the eyelashes or eyebrows). After a few days, these spots fade and become scaly, and the hair becomes faded and begins to break at a height of a few millimeters from the surface of the skin. Bald spots are formed. The scalp becomes brush-like with short, stiff fibers. Sometimes, bald spots appear to be covered with black dots.This is the first stage in the development of ringworm. Later, the lichen lesions enlarge and become round or oval. At the same time, they are covered with gray, very dense scales. The size of the foci of ringworm can reach up to 10 cm in diameter or more. Nearby foci may merge. Sometimes ringworm may not cause hair loss and may only look like “severe dandruff” that suddenly appears in a healthy baby all over the scalp.

If you notice the symptoms described above in yourself or your child, immediately consult a dermatologist or infectious disease doctor.

If the doctor confirms that you are sick with ringworm, he will be able to prescribe the correct treatment for you, without which the disease can develop for a very long time, can cause a number of extremely unpleasant complications and can spread to other people. It is also possible that after examination, the doctor will determine that in your case the disease is not ringworm and requires a completely different treatment. In some cases, symptoms similar to ringworm develop in diseases such as alopecia areata, atopic dermatitis, lichen planus, psoriasis, etc.etc.

To clarify the diagnosis, it is usually enough for a dermatologist to examine the lesions of “lichen” on the skin of a sick child or adult. The doctor can also examine the lichen using a Wood’s lamp (it emits ultraviolet light). To finally confirm the diagnosis, the doctor may conduct a microbiological analysis of the hair and culture of fungi.

Natural sources of Microsporia can be cats (often stray), pigs and other animals. The causative agents of the disease live in the fur (bristles) of animals.Often, infected animals show no signs of ringworm. This phenomenon is called colonization.

You can get Trichophytosis from other people. As we have already shown in our special articles on this topic, fungi from the genus Trichophyton cause not only ringworm, but also the well-known fungus on nails, hands, feet, etc. For this reason, an adult or child can get ringworm from another person who has fungus on their feet, between toes, palms, or nails.
Ringworm fungal spores can survive for a long time on combs, brushes, sofas, bedding, car seats, stuffed animals, and other items.

To minimize the risk of your infection:

• Make sure your child uses separate sheets and towels during the entire period of illness.
• Wash your hands thoroughly with soap and water whenever you touch any ringworm lesions on your baby’s skin or belongings.
• If you must apply ointment to ringworm lesions on your child’s head, wear disposable rubber gloves.
• Be sure to see a doctor to check if you are a carrier of ringworm fungus spores. This is possible even if you do not have any symptoms of the disease

If tests show that a family member has spores in the hair or skin of the fungus (especially microsporia) that causes ringworm (in medicine this is called carrier), the doctor will have to prescribe prophylactic antifungal treatment for all family members.This treatment is as follows: you need to wash your hair with an antifungal shampoo, twice a week, for 4 weeks (shampoo should be applied to the head for 10-15 minutes and then rinsed off).

Causes of alopecia areata | Clinic Family Doctor

Alopecia areata is a disease in which the immune system mistakenly attacks not viruses and bacteria, but hair follicles (skin formations from which hair grows).This can lead to hair loss from the scalp and other areas of the body. Hair loss usually results in rounded patches. The number of such sites usually does not exceed 3-4. In some people, hair loss may be more pronounced, and as the disease progresses, there may be a complete loss of hair on the scalp and even on the face and body.

What causes alopecia areata?

In alopecia areata, the immune system attacks the rapidly growing cells of the hair follicles.The affected hair follicle shrinks and hair growth stops abruptly. At the same time, the stem cells of the hair follicle are not affected and retain the ability to form hair, thus, the possibility for hair restoration is preserved.
Scientists do not know the exact causes of aggression against hair follicles, but a combination of genetic factors and environmental influences is assumed.

Who is most susceptible to this disease?

Alopecia areata affects about 2% of people of any gender, age, and race.If your family has had cases of alopecia areata, especially before the age of 30, then there is a risk of developing the disease. Overall, 1 in 5 people with alopecia areata in the family had a case of this disease.

Is hair loss a symptom of a serious illness?

Alopecia areata is a non-life-threatening disease. The disease is painless and non-contagious. The general state of health does not suffer from this disease, but the disease, of course, affects the emotional state.A common form of alopecia areata, in which hair falls out on eyelashes, eyebrows, etc. makes a person susceptible to irritating environmental factors, such as dust, bacteria, large foreign particles.
Alopecia areata often occurs in people in whose family there are patients with autoimmune diseases, for example, type 1 diabetes mellitus, rheumatoid arthritis, thyroid diseases, systemic lupus erythematosus, pernicious anemia, Addison’s disease, etc. Patients with alopecia areata, as a rule, do not get sick from others autoimmune diseases, but have a high risk of thyroid disease, atopic dermatitis, hay fever and asthma.
A visit to the doctor in case of hair loss is necessary in order to exclude infectious and more severe diseases of similar symptoms, such as ringworm, lupus erythematosus.

Is it possible to regain hair growth?

There is a chance that hair will heal with or without treatment, but it can start falling out again. No one can predict when this will happen. The course of the disease varies from person to person.The use of drugs helps to stop hair loss in the initial stage and accelerate the restoration of hair growth in the future. For the treatment of alopecia areata, there are about 8 treatment approaches used, both singly and in combination. An important role in the treatment is played by the identification of provoking factors and / or diseases of the internal organs leading to the onset of alopecia areata.
The information in this publication should not be used as a substitute for medical attention and medical advice.

author of the publication: Mikhail Sergeevich Betekhtin, Ph.D., dermatovenerologist, oncologist, cosmetologist.

Prevention of microsporia | Gomel Regional CGE and OZ

Microsporia (or ringworm ) is a fungal disease clinically characterized by superficial inflammation of the skin and breakage of hair and nail damage, carried by both animals (mainly cats and dogs) and humans.Microsporia is the most common fungal infection. Usually appears from mid-August to October, after the summer breeding of domestic animals.

Sick animals are the source of the causative agent. A particular danger in the spread of the pathogen to children is represented by stray cats and dogs. While playing with animals, children take them in their arms, press them to their face, neck, put them in their bed, and wash them in a shared bath.

In a sick cat or dog, round or oval spots appear most often on the forehead, ears, temples, near the eyebrows on the forelegs, the coat looks clipped or matted, and the skin is covered with grayish scales.In adults, the flowing forms of ringworm can be latent, and then the disease in the animal can be detected only with the help of special studies in the veterinary hospital.

A person becomes infected when skin, hair, wool scales contaminated with the pathogen come into contact with his skin. Possible transmission of the pathogen through hats, bedding, hairdressing tools, household items.

In order not to get infected with ringworm, the following rules must be observed:

– do not use other people’s hats, combs, washcloths, towels and other personal items;

– Children should not be allowed to communicate with stray animals.Kittens or puppies taken into the house should be shown to the veterinarian, children should not be allowed to take animals to bed;

– pets should be washed with soap as needed, to prevent fleas from appearing in them and be sure to show them to a veterinarian once a year;

– after contact with a sick animal, it is necessary to wash your hands with soap, grease scratches and abrasions with 5% iodine, change clothes, boil removed things or iron them with a hot iron;

– if the patient uses a shared bathroom, then after bathing, the bath must be washed with hot water, disinfected with a 5% solution of a chlorine-containing agent.

Epidemiologist
of the anti-epidemic department
Svetlana Vasilievna Bondarenko

90,000 Lichen in cats: signs, symptoms, treatment

Ringworm in cats and its types

Ringworm or ringworm in cats is an infectious disease caused by molds or dermatophytes. In cats, the skin is most often damaged, but also wool and claws, the disease can be transmitted to humans, ring-shaped spots often appear on the skin, which explains the name (from the English.ring – ring). In most cases, lichen in cats disappears itself after a while, but pets need to be treated, especially since the animal can infect the owner as well. So every cat owner should be aware of the first signs, prevention and treatment of this disease. As they say, forewarned means forearmed.

The causative agents of lichen are fungi of the species Microsporum gypseum, Microsporum canis, Trichophyton. The first two lead to a type of disease called microsporia, and Trichophyton causes trichophytosis.In both cases, the animals show identical clinical signs.

Fungi can be found both on an infected cat and on its territory. Disputes remain viable for about 2 years. The fungus develops more actively if it enters a humid and warm environment. Disputes can remain on any household items that the sick animal has come into contact with – furniture, bedding, brushes, as well as on fallen hair. Sometimes the fungus may not manifest itself for a long time and only months later it will be possible to see the symptoms of infection.

It is believed that cats with previous injuries or skin diseases, sick and weak animals are predisposed to this disease.

How is versicolor spread in cats?

Transmitted by contact with spores – they can be found on household items and on an infected animal. Fortunately, if the animal is healthy, it has a natural immunity to shingles and no symptoms of infection will appear. Basically, kittens under one year old are infected, which still have a weak immune system, weakened or sick cats.There is an increased risk for animals that are free to walk outdoors, are stressed or have poor nutrition, or if cats are infected with parasites or infections. Genetic factors also play an important role: for example, Persian cats, which were bred through long-term selection, have a weaker resistance to lichen.

Symptoms of lichen in cats

Depending on the duration and location of the disease, characteristic manifestations of lichen can be seen on the skin of cats. The most common symptom is small, rounded specks with no fur.In the center of the lesion, scales, vesicles, or small abscesses can form on something.

Gradually the spot increases in size, itching may or may not be present. Most of the affected skin is on the ears, head, or tail. Sometimes there is a more elongated form of spots, which resembles the symptoms of autoimmune diseases. In rare cases, lichen in cats can spread throughout the body, the skin of the animal becomes greasy or heavily flaky, hair falls out.The first signs of the disease sometimes include the appearance of hairballs, increased shedding, the cat intensively scratches its ears. If the disease is localized on the claws, they begin to grow abnormally and deform.

How is ringworm diagnosed?

Often, external signs are not enough to diagnose and determine how to treat lichen in cats. One of the most popular diagnostic methods is the “black light” lamp or Wood’s lamp. Some types of lichen spores begin to flicker with fluorescent light after the cat’s fur is exposed to the light.But the problem is that many pathogens never glow, and other microorganisms that have absolutely nothing to do with lichen can fluoresce. It is also worth considering the fact that cats can be carriers of the fungus, but not be infected. The accuracy of this method is rather low – up to 60%.

Therefore, many veterinarians prefer to take a fungal culture sample using crusts and scales collected from the skin and hair of the animal. The sample is placed in a special environment, which helps to identify the pathogen.Any specialist can perform this procedure. It is also worth checking pets in a timely manner for other diseases, since most often healthy cats successfully resist the fungi that cause lichen.

How to treat lichen in cats?

After the disease is identified, short-haired individuals with small lesions are treated with antifungal ointments. Most often it is thiabendazole or miconazole, and the animal also needs to be provided with good nutrition, checked for other diseases, and limit its contact with other cats or people.If lichen is severe, ointments are combined with oral medications. It is not uncommon for long-haired cats to have their hair trimmed in order to apply the drug to the skin. It is very important to avoid irritation and unnecessary contact with the pet’s skin when cutting, so that the disease does not spread throughout the body.

It is also worth remembering that scissors and wool that have been in contact with an animal contain spores of the causative agent of the disease, so they must be sterilized before further use.You can bathe the animal with sulphurous lime baths – of course, the smell is not pleasant, and the wool can acquire a yellowish tint, but it is a very effective remedy. You can also buy shampoos, lotions, which contain enilconazole and miconazole.

If the cat has large areas of skin or claws, and the animal is a long-haired breed, the veterinarian may prescribe oral medications, but only if the ointments and baths did not give the desired result. Terbinafine, itraconazole, griseofulvin and other analogues are used, but there may be a risk of complications, so it is advisable to do without them and not start the disease.

Disinfection and prevention of ringworm in cats

As you already understood, ringworm in cats can be transmitted to humans. At risk are people with lowered immunity, undergoing chemotherapy or suffering from chronic diseases. And healthy owners will not hurt to look after their pet with gloves and wash their hands after contact with an animal.

Since spores remain viable for a long time, it is very important to carry out timely cleaning of the room, pay special attention to the cat’s living space.All pieces of furniture, carpets must be thoroughly vacuumed and steamed, radiators, floors, window sills must be washed with a disinfectant. Rusted or wood surfaces are often re-painted. Well kills microorganisms chlorine, which is diluted with water in a ratio of 1 to 10. The cat’s bed, bowls and brushes are also disinfected.

In fact, lichen in cats , like other diseases, is much easier to prevent than to cure. If a pet already lives in your house, and you want to buy a new one, do not be lazy and promptly examine it with a veterinarian, do not allow the cat to come into contact with other participants at exhibitions.If the table is not sanitized after another cat, do not place your pet on it. If possible, keep your pet off the street, provide it with a full diet, and visit your veterinarian regularly for routine checkups.

Lichen is … What is Lichen?

Lichen | Dermatology – skin health / specialist care dermatologist treatment / skin diseases

.