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Abstract: A 53-year-old male patient had skin papules with intense itching due to hot weather. Within the past 1 month, the red papules spread to the surrounding area after repeated scratching and irritation due to untimely treatment and shyness to seek medical attention for the particular area, resulting in larger plaque-like changes. He was treated with a combination of oral medication and topical medication, and the local skin damage gradually subsided and the itching was relieved.
Basic information】Male, 53 years old
Disease Type】Tinea capitis
Hospital】Harbin Traditional Chinese Medicine Hospital
Date of consultation】May 2021
Treatment plan】Medication (Itraconazole capsules + miconazole nitrate cream)
【Treatment Period】Home treatment for 22 days, follow-up by phone on the 15th, outpatient review on the 22nd
Effectiveness】Surface damage gradually subsided and itching was relieved.
I. Initial consultation
A 53-year-old middle-aged male came into the clinic. The patient frowned and said that he had been on a business trip to Guangdong, and due to the hot weather, his skin developed papules and intense itching. Over time, within 1 month, the red papules gradually expanded to the periphery, forming red patches with raised edges, depressed middle and clear borders, and white and red flakes could be seen on top. Scratch marks from scratching can be seen with the naked eye above the patch-like changes. The probability of considering ringworm based on clinical manifestations alone is high, and the patient is advised to have a fungal microscopy to clarify the diagnosis. The patient agreed to have the test after understanding the condition, and the fungal microscopy showed a large number of mycelium, and the test results were consistent with the diagnosis of ringworm.
II. Treatment history
The patient had had tinea cruris for more than 1 month, and the symptoms were relatively heavy, large in area, and itchy, which had seriously affected normal life and work. Itraconazole capsules are oral antifungal drugs that can effectively inhibit the metabolism and reproduction of fungi in superficial areas, while miconazole nitrate cream is an imidazole-based topical cream that can slow down the reproduction of fungal flakes through the skin surface in order to achieve a therapeutic effect. Oral medication plus topical medication combined treatment. After the patient understood the medication method, he said he would go home for home treatment and was asked to follow up on time.
III. Treatment effect
After 15 days of medication, a telephone call was made with the patient. The patient said that the itchiness was significantly relieved on the day of medication, and he was able to avoid scratching at night through subjective control. After 3 days of medication, the red and white flakes on the skin surface gradually became lighter, and the itching was significantly relieved, and the patient was able to sleep peacefully. After about 7 days of medication, the skin damage with raised edges gradually flattened and the rough surface skin gradually returned to a smooth state. As of the date of the telephone call, 15 days of medication had elapsed, and the color of the skin damage at the root of the thigh gradually became lighter, the itching symptoms basically disappeared, and there was dark brown pigmentation on the surface of the skin. The patient was instructed to continue the medication and return to the outpatient clinic for follow-up fungal microscopy on about 7 days, and the results were normal.
IV. Precautions
The patient’s skin recovered well and was happy for it. Since ringworm grows on the root of the thighs, it is recommended to wear loose, comfortable and breathable cotton underwear, and to pay attention to disinfection and cleaning of underwear worn close to the body to avoid contact with fungus-carrying substances that can cause recurrent attacks of the disease; avoid repeated scratching that can cause aggravation of symptoms. Until the disease is completely cured, it is important to eat less spicy and irritating food, drink less alcohol, and sweat less to avoid irritation that can lead to recurring attacks of ringworm. It is recommended not to have intercourse with your partner until the disease is completely cured. Although the disease is not included in the category of STDs, it can be transmitted to your partner through skin contact.
V. Personal insight
Tinea corporis is a contact infectious disease that occurs at the root of the thighs due to fungal attack; although it can be transmitted through skin contact, it is not a sexually transmitted disease, so don’t be ashamed to consult a doctor and delay the disease like the patient in this case, but once you have similar symptoms, consult a doctor early and take good care of it. It is important to pay attention to cleanliness in your daily life and to take a shower in time after sweating to avoid irritation and prevent this disease. Most ringworm occurs unilaterally and is more common in men. Individuals with more severe symptoms can develop it bilaterally; the treatment period for ringworm is relatively long, and if you choose to take oral medications for treatment, you should review your liver function regularly to avoid liver toxicity.