Red and sharply demarcated may have other signs of psoriasis such as nail pitting Red-brown no active border coral red fluorescence with a Wood lamp examination Involves scrotum satellite lesions uniformly red without central clearing Tinea cruris (usually occurs in male adolescents and young men spares scrotum and penis) Greasy scale on erythematous base with typical distribution involving nasolabial folds, hairline, eyebrows, postauricular folds, chest annular lesions less common Typically an adolescent with a single lesion on neck, trunk, or proximal extremity pruritus of herald patch is less common progression to generalized rash in one to three weeks More confluent scale less likely to have central clearing Sun-exposed areas multiple annular lesions female-to-male ratio 3:1 3 No scale, vesicles, or pustules nonpruritic smooth commonly on dorsum of hands or feet Target lesions acute onset no scale may have oral lesionsÄusky erythematous usually single, nonscaly lesion most often triggered by sulfa, acetaminophen, ibuprofen, or antibiotic use Personal or family history of atopy less likely to have active border with central clearing lesions may be lichenified Gray or silver scale nail pitting 70% of affected children have family history of psoriasis 2 Tinea corporis (annular lesions with well-defined, scaly, often reddish margins commonly pruritic) Failure to treat kerion promptly can lead to scarring and permanent hair loss. However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen. Oral terbinafine is first-line therapy for tinea capitis and onychomycosis because of its tolerability, high cure rate, and low cost. Tinea corporis, tinea cruris, and tinea pedis generally respond to inexpensive topical agents such as terbinafine cream or butenafine cream, but oral antifungal agents may be indicated for extensive disease, failed topical treatment, immunocompromised patients, or severe moccasin-type tinea pedis. Physicians should confirm suspected onychomycosis and tinea capitis with a potassium hydroxide preparation or culture. For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toe-nails from repeated low-level trauma. The clinical diagnosis can be unreliable because tinea infections have many mimics, which can manifest identical lesions. The most common infections in prepubertal children are tinea corporis and tinea capitis, whereas adolescents and adults are more likely to develop tinea cruris, tinea pedis, and tinea unguium (onychomycosis). Tinea infections are caused by dermatophytes and are classified by the involved site.
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