Dermatophytosis differential diagnosis: Difference between revisions
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== Differential Diagnosis == | == Differential Diagnosis == | ||
Dermatophytoses should be differentiated from each other which may all present as a pruritic, annular, papulosquamous rash. It should also be differentiated from other conditions which present with vesicle or pustule formation, scaling, hyperkeratosis or maceration | |||
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Revision as of 19:54, 23 June 2017
Overview
Dermatophytosis should be differentiated from other conditions
Differential Diagnosis
Dermatophytoses should be differentiated from each other which may all present as a pruritic, annular, papulosquamous rash. It should also be differentiated from other conditions which present with vesicle or pustule formation, scaling, hyperkeratosis or maceration
Name of superficial infection | Clinical presentation | Extension to hair follicle | Fungus(i) | Systemic disease | KOH preparations | Morphology in tissue sections |
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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 |
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