Dermatophytosis physical examination

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.

• Patients are usually well-appearing in dermatophytosis

• Patient is stable in dermatophytosis

• 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]

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 in tinea corporis may show:

• Red, itchy, scaly, circular skin rash
• Cervical lymphadenopathy

• Symmetric chest expansion
• Normal resonance
• Normal vesicular breath sounds
• Egophony absent
• Bronchophony absent
• Normal vocal and tactile fremitus

• Normal chest expansion
• Point of maximum impulse within 2 cm of the sternum
• S1 normal
• S2 normal
• No rales, rubs or gallop

• Non-distended and non-tender abdomen
• No visceromegaly

• No point tenderness
• No costovertebral angle tenderness

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

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

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