Tinea (Superficial Fungi, Dermatophytosis, Ringworm)

Abstract

Entire references have been written on the subjectof tinea. Because the goal of this book is to improve the reader’s clinical skills, discussion will be limited as much as possible to common presentations at specific anatomic sites. Actual mycology will be kept to a minimum. These common superficial mycoses are caused by a number of related organisms and there is considerable variation in presentation depending on the interaction between the causative organisms, and the host. Only dermatologists have the mycology training and clinical experience to deal with difficult cases and should be consulted if the diagnosis is in question. Inappropriate treatment with systemic antifungal medication is expensive, and inappropriate topical therapy can worsen the condition or make a consultant’s task nearly impossible. There are three important statements with which the authors would like to preface this section:

• 1. Mycolog® and its generic counterparts (triamcinolone/mycostatin combinations) do not treat tinea infections.

• 2. Topical steroids used alone may initially improve symptoms by suppressing inflammation, but will worsen the infection in the long run.

• 3. The combination of betamethasone diproprionate (a potent fluorinated corticoid) and clotrimazole (Lotrisone®) is, in the authors’ opinion, inappropriate for use in intertriginous regions and, in the authors’ experience, often exacerbates dermatophyte infections wherever it is used.