Tinea in Emergency Medicine Workup

Updated: Jul 31, 2018
  • Author: Shari Andrews, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Workup

Laboratory Studies

Direct microscopic examination may be performed. Skin scrapings, nail specimens, or plucked hairs are treated with potassium hydroxide and examined. Hyphae can be visualized in skin and nails. Spores within or around the hair shaft can be detected.

Fungal cultures can be performed for precise identification of the species.

Wood light (UV light) examination may be performed. This examination is used mainly for the diagnosis of tinea capitis. Hairs infected with M audouinii and M canis produce a brilliant yellow-green fluorescence. T schoenleinii causes a dull green fluorescence.

Histology is not needed, but biopsy findings would show spongiosis, parakeratosis (that may alter with orthokeratosis), and a superficial inflammatory infiltrate. Neutrophils may be seen in the stratum corneum, which is a significant diagnostic clue. On occasion, septate branching hyphae are seen in the stratum corneum. Special fungal stains (eg, periodic acid-Schiff, Gomori methenamine silver) may be required.

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Procedures

A biopsy may be needed in recalcitrant or atypical disease.

As mentioned above, dermatophyte infection occasionally leads to formation of a kerion, which is a boggy, large, inflammatory scalp mass caused by a severe inflammatory reaction to the dermatophyte. A kerion may result in scarring hair loss. A kerion may also have pustules and crusting and is commonly mistaken for an abscess. It is important to recognize a kerion because incision and drainage is not indicated. Therefore, other than a biopsy or culture that may be taken by an experienced dermatologist, no procedure is commonly performed by the emergency department physician. [7]

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