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Abstract: This article is about a 20-year-old male patient who complained of a coin-sized erythematous rash on his back with mild itching that was not taken seriously 1 week ago, but later the rash gradually increased in size and spread to the surrounding skin, and was already palm-sized with itching before the consultation. The patient was diagnosed with tinea corporis, a common fungal skin infection, after a positive fungal microscopy was performed. The patient was given antifungal treatment with topical medication, and the rash gradually subsided without recurrence.
[Basic information] Male, 20 years old
Disease Type】Tinea corporis
Hospital】Tianjin Haihe Hospital
Consultation time】July 2019
Treatment plan] Topical medication (miconazole nitrate cream)
Treatment Period】2 weeks of medication, 1 month of outpatient review
【Treatment effect】The rash all disappeared, no recurrence
I. Initial consultation
The patient came to the clinic complaining of a coin-sized erythematous rash on her back one week ago, with mild itching, which was not taken seriously. The rash gradually increased in size and spread to the surrounding skin, and was already palm-sized with pruritus before the visit. On examination, a polycyclic maculopapular rash of about 6×10 cm in size was seen on the patient’s back, with clear borders, slightly elevated rash edges, light red, covered with a small amount of flaking, and a flat, nearly skin-colored middle area; several satellite rashes were scattered around the main rash, with the same morphology as the main rash. The patient’s medical history was followed up, and no other abnormalities were found when the patient’s hands and feet were examined. The rash was diagnosed as tinea corporis after a positive fungal microscopy.
II. Treatment history
Tinea corporis is a superficial dermal fungal infection, and treatment is mainly antifungal. The patient had no history of other fungal infections, so this treatment only required topical treatment of the back rash. Topical miconazole nitrate cream was used as an antifungal treatment. After 1 week, the fungal culture returned that the species was Trichophyton rubrum, which is a common cause of ringworm and is likely to cause a generalized rash with itchiness. It is best to apply topical medication in one direction from the outer edge of the rash to the middle to prevent the colonies from spreading outward. Pay attention to avoid scratching to prevent accelerating the expansion of the rash or the appearance of new rashes in other areas.
Third, the effect of treatment
After 1 week of antifungal treatment, the patient’s rash has significantly decreased, no obvious flaking, itching relief, no new rash. After 1 week of further treatment, the rash had all subsided without discomfort, and after 1 month of review, the rash did not recur and there was no new rash. Patients are advised to maintain good hygiene habits and never share personal clothing and hygiene products with others to prevent the risk of mutual infection.
Fourth, precautions
I am happy that the patient recovered after medication. During the treatment period, you should wear loose and breathable clothes, wash and change them regularly, store personal clothes, bath tubs and towels separately, avoid mixing them with others, and clean and disinfect them regularly. If the climate is hot and the patient is active and sweaty, ask him to maintain personal hygiene, wash his body regularly and change his clothes in time. You should eat a light and balanced diet, avoid spicy and stimulating foods, get enough rest, and relax mentally. Some oral antifungal medications have the potential to damage the liver and should not be used on their own, as prescribed by the doctor. After recovery from treatment, patients should avoid sharing toiletries and intimate clothing with other patients who have fungal infections (including ringworm, tinea corporis, ringworm, nail fungus, ringworm, ringworm of the head, ringworm of the femur, etc.), especially in certain public health places and group living places, and should clean and disinfect the items and environment.
V. Personal insight
The fungus in the shallow part usually feeds on the skin keratin, and when the keratin in the center of the rash is almost consumed, the colony spreads outward, so ringworm spreads from the center to the surrounding area in a circular or multi-ring shape, as if “drawing a map” on the skin. If the rash covers a large area or if the infection is of a specific strain, oral antifungal medication should be used, and the dosage and treatment period should be strictly followed. Some drugs that may affect the body’s resistance, such as glucocorticoids and immunosuppressants, should be avoided for abuse to avoid secondary infection due to weak body resistance. If the patient has a pre-existing wasting disease, such as diabetes, the symptoms may be more severe, the treatment effect may be less effective, and the treatment plan should be more thorough.