Emergency Department Care

Certain forms of tinea can easily be identified and treated with antifungals in the emergency department. However, the diagnosis should probably be confirmed with a potassium hydroxide smear and/or cultures.

A common practice that is highly discouraged is the prescribing of combined steroid/antifungal creams.

It is important that the evaluating physician be aware of the possible presence of superinfection. This is known as the dermatophytosis complex. In the dermatophytosis complex presentation, inflammation, maceration, and odor may be present with bacterial involvement.

It is imperative to also recognize comorbidities that may increase the healing time or depress host immune response. These comorbidities may include age, diabetes, or immunodeficient status (eg, HIV infection or chronic immunosuppressive use). Defining the relationship between comorbidities and dermatophytosis is complex, since complications of these conditions in themselves, including peripheral vascular disease, could also contribute to persistent infection.

Consultations

A dermatologist may be consulted. Outpatient phototherapy protocols have been developed for chronic situations in which oral medications are not tolerated.

Prevention

Deterrence and prevention of tinea infection includes the following:

Practice proper hygiene.
Avoid contact with suspicious lesions.

Medication

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Media Gallery

Wax model of kerionlike tinea barbae. Courtesy of the Museum of the Department of Dermatology, University of Medicine, Wroclaw, Poland.
Tinea capitis; gray patch ringworm. Gray patch refers to the scaling with lack of inflammation, as noted in this patient. Hairs in the involved areas assume a characteristic dull, grayish, discolored appearance and are broken and shorter.
Typical lesions of kerion celsi on the vertex scalp of a young Chinese boy. Note numerous bright yellow purulent areas on skin surface, surrounded by adjacent edematous, erythematous, alopecic areas. Culture from the lesion grew Trichophyton mentagrophytes. Courtesy of Skin Diseases in Chinese by Yau-Chin Lu, MD. Permission granted by Medicine Today Publishing Co, Taipei, Taiwan, 1981.
Annular plaque (tinea corporis).
Tinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle.

of 5

Table. Ecology of Common Human Dermatophyte Species. Table reprinted with permission from David Ellis, Bsc (Hons), MSc, PhD, FASM, FRCPA (Hon), Affiliate Associate Professor, The University of Adelaide (http://www.mycology.adelaide.edu.au/mycoses/cutaneous/dermatophytosis).

Table. Ecology of Common Human Dermatophyte Species. Table reprinted with permission from David Ellis, Bsc (Hons), MSc, PhD, FASM, FRCPA (Hon), Affiliate Associate Professor, The University of Adelaide (http://www.mycology.adelaide.edu.au/mycoses/cutaneous/dermatophytosis).

Species	Natural habitat	Incidence
E floccosum	Humans	Common
T rubrum	Humans	Very common
T interdigitale	Humans	Very common
T tonsurans	Humans	Common
Trichophyton violaceum	Humans	Less common
Trichophyton concentricum	Humans	Rare
Trichophyton schoenleinii	Humans	Rare
Trichophyton soudanense	Humans	Rare
Microsporum audouinii	Humans	Less common
Microsporum ferrugineum	Humans	Less common
T mentagrophytes	Mice, rodents	Common
Trichophyton equinum	Horses	Rare
Trichophyton erinacei	Hedgehogs	Rare
Trichophyton verrucosum	Cattle	Rare
M canis	Cats	Common
Microsporum gypseum	Soil	Common
Microsporum nanum	Soil/pigs	Rare
Microsporum cookei	Soil	Rare

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Author

Mityanand Ramnarine, MD, FACEP Chair, Department of Emergency Medicine, Robert Wood Johnson University Hospital Rahway

Mityanand Ramnarine, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Canadian Association of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Residency Directors in Emergency Medicine, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

Shari Andrews, MD Attending Faculty, Department of Emergency Medicine, North Shore-Long Island Jewish Medical Center, Hofstra University School of Medicine

Shari Andrews, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Acknowledgements

Andrew C Miller, MD Fellow, Critical Care Medicine Department, National Institutes of Health; Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center

Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians and Society of Critical Care Medicine (USA)

Disclosure: Nothing to disclose.

Rashid M Rashid, MD, PhD Medical Director, Department of Hair Transplants and Dermatology, Mosaic Clinic and Morzak Research Initiative

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, MMB, FACEP Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.