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By Brian J. Stairs, DO, and Stephen M. Schleicher, MD
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CASE:
The parents of a one-year-old boy who has a rash on his back seek medical consultation. The eruption was first noted approximately four weeks ago, at which time a pediatrician recommended application of an over-the-counter 1% hydrocortisone cream twice a day. Subsequently, both of two affected areas began to enlarge. Examination reveals annular, erythematous patches with raised borders and central clearing. Family history is negative for eczema. Two kittens live in the house.
WHAT IS YOUR DIAGNOSIS?
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Tinea corporis is characterized by well-demarcated, erythematous, scaling patches and plaques. Because a cell-mediated immune response results in central clearing, hyphae are best identified from the border. Many cases arise from direct contact with an infected dog or cat. The condition is often misdiagnosed as eczema and treated with topical steroids, which results in gradual extension of the lesions. Tinea corporis responds readily to treatment with an antifungal cream, although more extensive cases may benefit from an additional course of oral therapy. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Stairs is an associate with Westmoreland Dermatology in Greensburg, Pennsylvania.
Emerg Med 39(01):47-8, 2007
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