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