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== Differential Diagnosis ==
== Differential Diagnosis ==
Dermatophytoses should be differentiated from each other which may all present as a red, pruritic, annular and scaly rash on different parts of the body. Tinea corporis should also be differentiated from other annular skin eruptions, especially subacute cutaneous lupus erythematosus (SCLE), granuloma annulare, and erythema annulare centrifugum.  
Dermatophytoses should be differentiated from other superficial skin infections which may all present as a red, pruritic, annular and scaly rash on different parts of the body. Tinea corporis should also be differentiated from other annular skin eruptions, especially subacute cutaneous lupus erythematosus (SCLE), granuloma annulare, and erythema annulare centrifugum.  


=== Differential diagnoses of red, pruritic, annular, scaly rash ===
{| class="wikitable"
{| class="wikitable"
! colspan="1" rowspan="1" |Name of superficial infection
! colspan="1" rowspan="1" |Name of superficial infection
Line 62: Line 63:
| colspan="1" rowspan="1" |Fungal elements may be seen through the biopsy, vascular invasion must be determined
| colspan="1" rowspan="1" |Fungal elements may be seen through the biopsy, vascular invasion must be determined
|}
|}
=== Differential diagnoses of annular skin lesions ===
{| class="wikitable"
|Disease
|Clinical presentation
|Treatment
|-
| colspan="1" rowspan="1" |Tinea corporis
| colspan="1" rowspan="1" |Scaly, annular, erythematous plaques or papules on glabrous skin
| colspan="1" rowspan="1" |Topical and systemic antifungals
|-
| colspan="1" rowspan="1" |Pityriasis rosea
| colspan="1" rowspan="1" |Small, fawn-colored, oval patches with fine scale along the borders, following skin cleavage lines
| colspan="1" rowspan="1" |Topical and systemic corticosteroids; UVA, UVB
|-
| colspan="1" rowspan="1" |Granuloma annulare
| colspan="1" rowspan="1" |Indurated, nonscaly, skin-colored annular plaques and papules, usually on the extremities
| colspan="1" rowspan="1" |Topical and intralesional corticosteroids
|-
| colspan="1" rowspan="1" |Sarcoidosis
| colspan="1" rowspan="1" |Indurated, erythematous plaques
| colspan="1" rowspan="1" |Topical, intralesional and systemic corticosteroids; antimalarials; thalidomide
|-
| colspan="1" rowspan="1" |Hansen's disease
| colspan="1" rowspan="1" |Erythematous annular plaques, with or without scale
| colspan="1" rowspan="1" |Dapsone; rifampin (Rifadin)
|-
| colspan="1" rowspan="1" |Urticaria
| colspan="1" rowspan="1" |Evanescent annular, nonscaly, erythematous plaques
| colspan="1" rowspan="1" |Oral antihistamines
|-
| colspan="1" rowspan="1" |Subacute cutaneous lupus erythematosus
| colspan="1" rowspan="1" |Annular or papulosquamous plaques, with or without scale, on sun-exposed areas
| colspan="1" rowspan="1" |Topical, intralesional and systemic corticosteroids; antimalarials
|-
| colspan="1" rowspan="1" |Erythema annulare centrifugum
| colspan="1" rowspan="1" |Annular patches with trailing scale inside erythematous borders
| colspan="1" rowspan="1" |Topical and systemic corticosteroids; oral antihistamines; treatment of the underlying cause
|}
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Revision as of 18:45, 26 June 2017

Overview

Dermatophytosis should be differentiated from other conditions

Differential Diagnosis

Dermatophytoses should be differentiated from other superficial skin infections which may all present as a red, pruritic, annular and scaly rash on different parts of the body. Tinea corporis should also be differentiated from other annular skin eruptions, especially subacute cutaneous lupus erythematosus (SCLE), granuloma annulare, and erythema annulare centrifugum.

Differential diagnoses of red, pruritic, annular, scaly rash

Name of superficial infection Clinical presentation Extension to hair follicle Fungus(i) Systemic disease KOH preparations Morphology in tissue sections
Tinea or ringworm, followed by the location in the body Round lesions with scaly border, accompanied by pruritus and burning Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma Dermatophytes (Epidermophyton spp., Trichophytum spp., Microsporum spp.) Very rare but can invade the dermis and soft tissues, causing mycetomas Hyphae with or without septations Hyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolor Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching Yes, known as Pityrosporum folliculits Malassezia spp. Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts Yeasts and hyphae (“spaghetti and meat balls”) Faintly basophilic hyphae in the stratum corneum
Tinea nigra Brown to black macule, usually in palms, with some scaling No Phaeoannellomyces werneckii Not described Darkly pigmented, septated, and branching hyphae Pigmented hyphae in the stratum corneum
White piedra Creamy-white, small, soft nodules in hair shafts No Trichosporon spp. Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia Septate hyphae perpendicular to hair shaft Not used for diagnosis
Black piedra Hard dark nodules in hair shafts No Piedraia hortae Not described Collections of crescent ascospores surrounded by pigmented hyphae Not used for diagnosis
Superficial candidiasis Intertrigo, chronic paronychia, onychodystrophy, cheilitis Yes Candida spp. Yes, particularly in patients with AIDS and depending on the level of immunosuppression Yeasts, pseudohyphae may be observed Fungal elements may be seen through the biopsy, vascular invasion must be determined

Differential diagnoses of annular skin lesions

Disease Clinical presentation Treatment
Tinea corporis Scaly, annular, erythematous plaques or papules on glabrous skin Topical and systemic antifungals
Pityriasis rosea Small, fawn-colored, oval patches with fine scale along the borders, following skin cleavage lines Topical and systemic corticosteroids; UVA, UVB
Granuloma annulare Indurated, nonscaly, skin-colored annular plaques and papules, usually on the extremities Topical and intralesional corticosteroids
Sarcoidosis Indurated, erythematous plaques Topical, intralesional and systemic corticosteroids; antimalarials; thalidomide
Hansen's disease Erythematous annular plaques, with or without scale Dapsone; rifampin (Rifadin)
Urticaria Evanescent annular, nonscaly, erythematous plaques Oral antihistamines
Subacute cutaneous lupus erythematosus Annular or papulosquamous plaques, with or without scale, on sun-exposed areas Topical, intralesional and systemic corticosteroids; antimalarials
Erythema annulare centrifugum Annular patches with trailing scale inside erythematous borders Topical and systemic corticosteroids; oral antihistamines; treatment of the underlying cause


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