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Abstract: The patient in this case is a 36-year-old male who developed red papules with pruritus around his buttocks 6 months ago due to high indoor temperature and prolonged absence of bathing, which was not seen in time due to work, resulting in gradual worsening of symptoms. After consultation, the diagnosis of ringworm was made clearly through physical examination and fungal microscopy. After treatment, the skin surface lesions subsided and the itching disappeared, and the treatment was effective.
Basic information】Male, 36 years old
Disease Type】Tinea capitis
【Visiting Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2019
Treatment plan】Medication (Itraconazole capsules, Econazole nitrate cream)
Treatment period】30 days of home medication
【Treatment effect】The skin surface lesions subsided, the itching disappeared, and the treatment effect was good
I. Initial consultation
One day in May 2019, I went to the clinic as usual to prepare for my visit, and a male patient was already waiting outside the door. After entering the clinic, the patient began to describe his condition: 6 months ago, a red papule with pruritus appeared around the buttocks due to high indoor temperature and long absence of bathing. At that time, he did not consult the doctor in time because of work and was too shy to consult the doctor because of the private area, so he kept delaying his condition. As a result, the red papule gradually expanded to the surrounding area, forming a large area of skin damage along with intense itching. On examination, the patient was found to have large red and dark red patches on the buttocks, vulva and thighs, up to the waist and down to the popliteal fossa, with a relatively large area of skin lesions, but some red-brown flakes could be seen adhering to the large area of skin lesions at the edges, and obvious scratch marks could be seen. Based on the skin lesions alone, ringworm was considered. After initial communication with the patient, a fungal microscopy was performed to clarify the diagnosis, and the fungal microscopy results: a large number of spores and hyphae, and the examination results were consistent with the diagnosis of ringworm.
(Found on physical examination)
II. Treatment history
The patient’s skin damage was 6 months old, relatively large in area, and seriously affecting the quality of life. After communicating with the patient to finalize the treatment plan, we chose oral medication with topical medication, oral itraconazole capsules and topical econazole nitrate cream. Itraconazole capsules ingested into the body can inhibit the metabolic reproduction of superficial bacteria from the inside out, and can relieve the symptoms of irritability and itching due to fungal metabolism. Itraconazole nitrate cream is applied to the skin surface to gradually clear the fungus from the outside in order to achieve a therapeutic effect. After understanding the medication process, the patient followed the doctor’s instruction to get the medication from the pharmacy and then said that he would take the medication regularly at home and asked the patient to come back to our hospital in 30 days.
III. Treatment effect
After 30 days of medication, the patient reported that the itching on the skin surface was mildly relieved and did not affect normal sleep. The red and brown flakes on the skin surface gradually softened and fell off, and the patches on the skin surface gradually flattened. After 30 days of continuous drug application, the degree of pruritus on the skin surface completely disappeared, and although the large area of skin damage was significantly relieved, the local residual light brown pigmentation and the skin surface had returned to a smooth state with good treatment effect. The patient was instructed to go home and observe for a period of time, and if he wanted to eliminate the pigmentation as soon as possible, he could go to the outpatient clinic for light pigmentation treatment.
IV. Notes
The patient is recovering well, and I am very happy for him. Tinea corporis is a contagious disease, and if you do not repeatedly disinfect your underwear, there is a possibility that the disease may recur due to contact with contaminated items. For this reason, patients should take care to change their underwear in a timely manner during treatment, during the consolidation period of treatment, and even after cure, and disinfect them repeatedly and take a bath regularly. In terms of diet, keep in mind to eat less spicy and irritating foods to avoid these factors from causing recurrent attacks of ringworm again. During the application of medication, follow the doctor’s instructions to use the full course of treatment, if you stop the medication too early there is a risk of not achieving the desired therapeutic effect, and if there is an increase in the local rash or an increase in itching, you should immediately seek medical follow-up.
V. Personal insight
Tinea corporis itself is caused by fungal infection of the body, so a fungal test can clarify the diagnosis. In this case, the patient did not take a bath for a long time, so it is important to take a bath regularly to prevent this disease, regardless of winter or summer. Once symptoms such as localized red rash and itching appear, it is important to seek medical attention and treat the symptoms promptly. Clinically, oral + topical medications are often given and should be given in full doses during the medication period and should not be stopped on your own. During treatment, care needs to be taken not to scratch the lesions repeatedly, as if repeated scratching can cause fungal infestation of the hands, which can lead to ringworm. In addition, although ringworm is not a sexually transmitted disease, it may be transmitted to a sexual partner due to skin contact during sexual intercourse, so it is recommended not to have sexual relations until it is completely cured.