Do not give topical steroids for a tinea infection, it will worsen the infection
Do not give topical steroids for a tinea infection, it will worsen the infection: Excerpt from Avoiding Common Pediatric Errors
Author:
William Giasi, Jr., MD
What to Do - Make a Decision
The dermatophytes, or ringworm fungi, include a group of fungi that have
the ability to infect and survive only on dead keratin, the top layer, of skin,
hair, and nails. The dermatophytes are ubiquitous in the environment and
tinea infections are among the most common dermatologic disorders in the
world. Dermatophytes are classified into three genera: Microsporum, Trichophyton, and Epidermophyton. The prevalent species of dermatophytes
change with time and geographic location. The organisms may invade both
the stratum corneum and the terminal hair shaft. Transfer of the organism
may occur through the shedding of scales, autoinoculation, or transfer of
spores. Microsporum canis is a frequent cause of tinea infections in children
and is transferred from affected cats, dogs, horses, or cattle. Clinically, infections caused by dermatophytes are classified by the affected body region.
The history and physical exam will often establish the diagnosis of a
dermatophyte infection. The use of laboratory resources, such as direct
visualization of branching hyphae under a microscope, culture, or Wood's
light examination, increases diagnostic accuracy.
In many cases of tinea infections, topical antifungal treatment is efficacious. Oral antifungal therapy is needed to efficaciously treat tinea capitis
and tinea barbae when large portions of the body are involved or if the
patient is immunocompromised. Combination antifungal and corticosteroid
preparations are widely used by physicians for the treatment of superficial
tinea infections. These preparations include an antifungal agent in combination with a mid-to high-potency steroid. The proposed mechanism of these
agents is to treat the symptoms in addition to the dermatophyte infection.
Physiciansareoftenunawareofthepotencyofthesteroidcomponentofthese
preparations and, thus, their potential for local and systemic complications.
Furthermore, the use of topical steroids for tinea infections may prolong the
course of treatment.
Topical corticosteroid therapy suppresses inflammation and gives the
patient and physician the false impression that the lesion is improving,
whereas the fungal infection continues to flourish in the face of an altered
immunologic defense. Following cessation of steroid treatment, the rash will
return and may be transformed into an unrecognizable skin eruption, referred to as tinea incognito. The lesion may be characterized by the absence
of scaling or a well defined border, diffuse erythema, scattered papules or
pustules, and brown hyperpigmentation. Hyphae are easily demonstrated
and can be seen a few days after discontinuing the use of a topical steroid.
Suggested Readings
Alston SJ, Cohen BA, Braun M. Persistent and recurrent tinea corporis in children treated with
combination antifungal/corticosteroid agents. Pediatrics. 2003;111:201–203.
Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections
of the skin: tinea capitis and tinea barbae. Guidelines/Outcomes Committee. American
Academy of Dermatology. J Am Acad Dermatol. 116;34(2 Pt 1):290–294.
Stein DH. Tineas–superficial dermatophyte infections. Pediatr Rev.1998;19(11):368–372.
Weinstein A, Berman B. Topical treatment of common superficial tinea infections. Am Fam
Physician. 2002;65(10):2095–2102.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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