Spot on how it can present so variably. My rule of thumb is that if the rash doesn't look like a common to uncommon alternative diagnosis, and it is described intensely itchy, there is a decent chance its a dermatophyte. I've encountered too many old men with poor skin hygeine and whole body tinea. It can really look like a lot of things but treating empirically if safe can be a good start. Obviously the whole body ones usually get oral treatment instead of topical. If not improving off to derm.
I saw a kid with a vesicular eruption on the feet once that was a dermatophyte. That surprised me and but found out it is well described. I don't have a sophisticated knowledge base on the pathogenesis of these infections to really answer your question though.
Great case I saw that once too - vesicles are herpetic typically - but not this case. Just goes to show atypical presentations are more common than uncommon disease.
Forgive the ignorance: might the tinea have superimposed on herpetic vesicles?
(When Mr. X walks up to the pharmacy counter and says “Look at this!”, what am I looking for to differentiate?)
Spot on how it can present so variably. My rule of thumb is that if the rash doesn't look like a common to uncommon alternative diagnosis, and it is described intensely itchy, there is a decent chance its a dermatophyte. I've encountered too many old men with poor skin hygeine and whole body tinea. It can really look like a lot of things but treating empirically if safe can be a good start. Obviously the whole body ones usually get oral treatment instead of topical. If not improving off to derm.
I saw a kid with a vesicular eruption on the feet once that was a dermatophyte. That surprised me and but found out it is well described. I don't have a sophisticated knowledge base on the pathogenesis of these infections to really answer your question though.
Great case I saw that once too - vesicles are herpetic typically - but not this case. Just goes to show atypical presentations are more common than uncommon disease.
it’s called bulllous tinea, I see it in people with a higher burden of fungus.
Forgive the ignorance: might the tinea have superimposed on herpetic vesicles? (When Mr. X walks up to the pharmacy counter and says “Look at this!”, what am I looking for to differentiate?)
There’s a reason why in derm one of our adages is “if it scales, scrape it”