Dermatophytosis physical examination
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Overview
Patients are usually well-appearing in dermatophytosis. The skin is characterized by erythematous, papulosquamous, annular, well-circumscribed, superficial rash with central clearing which may be located on the scalp, neck, trunk, extremities and groin. Abnormalities of the head/hair may include, dry scaling, which may be similar to seborrheic dermatitis; black dots, which are areas of broken hair on a scaly surface; smooth areas of hair loss. Neck in tinea corporis may show, red, itchy, scaly, circular skin rash and cervical lymphadenopathy. Genitals may be involved in tinea cruris and examination may show pustules and vesicles at the active edge of the infected area along with maceration. Hands in tinea mannum may show dry and hyperkeratotic palmar surface. Feet in tinea pedis may show fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes.
Physical Examination
Appearance of the patient
- Patients are usually well-appearing in dermatophytosis
Vital signs
- Patient is stable in dermatophytosis
Skin
- Dermatophytosis is characterized by erythematous, papulosquamous, annular, well-circumscribed, superficial rash with central clearing which may be located on the scalp, neck, trunk, extremities or groin[1]
HEENT
Abnormalities of the head/hair may include:[2]
- Dry scaling, which may be similar to seborrheic dermatitis
- Black dots, which are areas of broken hair on a scaly surface
- Smooth areas of hair loss
- Kerion, characterized by an inflamed mass, similar to an abscess
- Yellow crusts and matted hair
Face in tinea faecei may show:
- Round or annular red patches
- Indistinct red areas, especially on darkly pigmented skin
- Little or no scaling
- Raised edges
Neck
Neck in tinea corporis may show:
- Red, itchy, scaly, circular skin rash
- Cervical lymphadenopathy
Lungs
- Symmetric chest expansion
- Normal resonance
- Normal vesicular breath sounds
- Egophony absent
- Bronchophony absent
- Normal vocal and tactile fremitus
Heart
- Normal chest expansion
- Point of maximum impulse within 2 cm of the sternum
- S1 normal
- S2 normal
- No rales, rubs or gallop
Abdomen
- Non-distended and non-tender abdomen
- No visceromegaly
Back
- No point tenderness
- No costovertebral angle tenderness
Genitourinary
Genitals may be involved in tinea cruris and examination may show:[3][4]
- Pustules and vesicles at the active edge of the infected area
- Maceration
- Red, scaling lesions with raised borders
- No urinary frequency, urgency, incontinence, dysuria, discharge, dyspareunia or abnormal mass
Extremities
Hands in tinea mannum may show:[5][6]
- Dry and hyperkeratotic palmar surface
- When the fingernails are involved, vesicles and scant scaling
Feet in tinea pedis may show:[7]
- Fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes
- Itching or burning
- Vesiculobullous form of tinea pedis is characterized by the development of vesicles, pustules, and bullae in an inflammatory pattern on the soles
References
- ↑ Ely JW, Rosenfeld S, Seabury Stone M (2014). "Diagnosis and management of tinea infections". Am Fam Physician. 90 (10): 702–10. PMID 25403034.
- ↑ Gupta AK, Summerbell RC (2000). "Tinea capitis". Med. Mycol. 38 (4): 255–87. PMID 10975696.
- ↑ Choudhary S, Bisati S, Singh A, Koley S (2013). "Efficacy and Safety of Terbinafine Hydrochloride 1% Cream vs. Sertaconazole Nitrate 2% Cream in Tinea Corporis and Tinea Cruris: A Comparative Therapeutic Trial". Indian J Dermatol. 58 (6): 457–60. doi:10.4103/0019-5154.119958. PMC 3827518. PMID 24249898.
- ↑ Achterman RR, White TC (2012). "A foot in the door for dermatophyte research". PLoS Pathog. 8 (3): e1002564. doi:10.1371/journal.ppat.1002564. PMC 3315479. PMID 22479177.
- ↑ Noble SL, Forbes RC, Stamm PL (1998). "Diagnosis and management of common tinea infections". Am Fam Physician. 58 (1): 163–74, 177–8. PMID 9672436.
- ↑ Sahuquillo Torralba A, Navarro Mira MÁ, Botella Estrada R (2017). "Inflammatory tinea manuum: The importance of pustules". Med Clin (Barc). 149 (3): e15. doi:10.1016/j.medcli.2016.10.020. PMID 27916265.
- ↑ Canavan TN, Elewski BE (2015). "Identifying Signs of Tinea Pedis: A Key to Understanding Clinical Variables". J Drugs Dermatol. 14 (10 Suppl): s42–7. PMID 26461834.