Dermatophytosis physical examination

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Physical Examination

Appearance of the patient

• Patients are usually well-appearing in dermatophytosis.

Vital signs

• Patient is vitally stable in dermatophytosis

Skin

• Dermatophytosis is characterized by erythematous, papulosquamous, annular, well-circumscribed, superficial rash with central clearing which may be located on the scalp, neck, trunk, extremities and groin.

HEENT

Abnormalities of the head/hair may include:

• Dry scaling, which may be similar to seborrheic dermatitis.
• Black dots, which are areas of broken hair on a scaly surface.
• Smooth areas of hair loss.
• Kerion, charachterized by an inflamed mass, similar to an abscess.
• Yellow crusts and matted hair.

Face in tinea faecei may show:

• Round or annular red patches.
• Indistinct red areas, especially on darkly pigmented skin.
• Little or no scaling.
• Raised edges.

Neck

Neck in tinea corporis may show:

• Red, itchy, scaly, circular skin rash.
• Cervical lymphadenopathy.

Lungs

• Symmetric chest expansion.
• Normal resonance.
• Normal vesicular breath sounds.
• Egophony absent.
• Bronchophony absent.
• Normal vocal and tactile fremitus.

Heart

• Normal chest expansion.
• PMI within 2 cm of the sternum.
• S1 normal.
• S2 normal.
• No rales, rubs or gallop/.

Abdomen

• Non-distended and non-tender abdomen.
• No visceromegaly.

Back

• No point tenderness.
• No costovertebral angle tendreness.

Genitourinary

Genitals may be involved in tinea cruris and examination may show:

• Pustules and vesicles at the active edge of the infected area.
• Maceration.
• Red, scaling lesions with raised borders.
• No urinary frequency, urgency, incontinence, dysuria, discharge, dyspareunia or abnormal mass.

Extremities

Hands in tinea mannum may show:

• Dry and hyperkeratotic palmar surface
• When the fingernails are involved, vesicles and scant scaling.

Feet in tinea pedis may show:

• Fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes.
• Itching or burning.
• Vesiculobullous form of tinea pedis is characterized by the development of vesicles, pustules, and bullae in an inflammatory pattern on the soles