Dermatophyte Infections: The Daily PANCE Blueprint

A 28-year-old female presents with an annular, erythematous rash with central clearing on her forearm that has gradually enlarged over 2 weeks. The lesion is pruritic and has a raised, scaly border. She has no systemic symptoms. A potassium hydroxide (KOH) preparation of skin scrapings shows septate hyphae. Which of the following is the most appropriate initial management?

A. Oral terbinafine
B. Oral griseofulvin
C. Topical clotrimazole
D. Topical corticosteroids
E. Observation only

Answer and topic summary

The answer is C. Topical clotrimazole

Dermatophyte (tinea) infections are the most common fungal infection of skin/hair/nails. Causes include Trichophyton (most common), Microsporum, and Epidermophyton genera. The best diagnostic test is a KOH preparation. Treatment is anti-fungals, usually topical (e.g., clotrimazole). It’s important to note, though, that both tinea capitis and onychomycosis require oral fungal medications (e,.g., first-line griseofulvin and terbinafine, respectively).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Dermatologic Infectious diseases ⇒ Fungal Infections => Dermatophyte Infections

Also covered as part of the Family Medicine EOR topic lists