Summary
Definição
História e exame físico
Principais fatores diagnósticos
- scaling scalp lesions
- patchy alopecia
- erythematous, scaling skin lesions with central clearing
- erythematous, scaling rash with follicular pustules in beard or mustache
- erythematous, annular patches on face
- vesicles and scaling of hands
- fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes
- chronically, scaly, hyperkeratotic plantar skin with erythema of the soles, heels, and sides of the feet
- folliculitis with nodules
Outros fatores diagnósticos
- thickened nail with subungual hyperkeratosis, onycholysis, and white-yellow to brown discoloration
- small, white speckled patches on the surface of the nail plate with crumbling nail
- lymphadenopathy
- black-dot alopecia
- milky white nail plate
- area of leukonychia in the proximal nail plate
Fatores de risco
- exposure to infected people, animals, or soil
- exposure to fomites, including hat, combs, hairbrushes, and upholstery
- chronic topical or oral corticosteroid use
- HIV
- diabetes mellitus and other metabolic disorders
- occlusive clothing
- hot, humid weather
- obesity
- hyperhidrosis
- frequenting public bathing areas while barefoot
- deformities of the feet
- recurrent trauma to the skin
- contact sports
- atopic dermatitis
- positive family history
- peripheral vascular disease
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- potassium hydroxide (KOH) microscopy
Investigações a serem consideradas
- dermoscopy
- fungal culture
- polymerase chain reaction (PCR)
- Wood lamp exam (ultraviolet light)
Novos exames
- reflectance confocal microscopy
Algoritmo de tratamento
tinea capitis
tinea barbae, tinea manuum, or Majocchi granuloma
tinea faciale, tinea corporis, tinea cruris, or tinea pedis
tinea unguium (onychomycosis)
Colaboradores
Autores
Antonella Tosti, MD
Professor of Clinical Dermatology
Dermatology and Cutaneous Surgery
University of Miami Health System
FL
Declarações
AT received honorarium and travel reimbursement from Valeant, PharmaDerm, and Polichem, is on the speaker bureau for PharmaDerm, and is a consultant for Erchonia Laser and Almirall.
Agradecimentos
Dr Antonella Tosti would like to gratefully acknowledge Dr Keira L. Barr and Dr Barry L. Hainer, the previous contributors to this topic.
Declarações
KLB declares that she has no competing interests. BLH is on the speaker bureaus for the vaccine programs of Merck and Sanofi-Pasteur pharmaceutical companies.
Revisores
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NY
Declarações
NS declares that she has no competing interests.
Christina M. Gelbard, MD
Department of Dermatology
UT Dermatology
Health Science Center of Houston
Houston
TX
Declarações
CMG declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Ameen M, Lear JT, Madan V, et al. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014 Nov;171(5):937-58.Texto completo Resumo
Fuller LC, Barton RC, Mohd Mustapa MF, et al. British Association of Dermatologists’ guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014 Sep;171(3):454-63.Texto completo Resumo
Fuller LC, Barton RC, Mohd Mustapa MF, et al. British Association of Dermatologists’ guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014 Sep;171(3):454-63.Texto completo Resumo
Foley K, Gupta AK, Versteeg S, et al. Topical and device-based treatments for fungal infections of the toenails. Cochrane Database Syst Rev. 2020 Jan 16;(1):CD012093.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Atopic dermatitis
- Dyshidrotic dermatitis
- Lichen simplex chronicus
Mais Diagnósticos diferenciaisDiretrizes
- Guidelines for the management of dermatomycosis
- Antifungal agents for common outpatient paediatric infections
Mais DiretrizesFolhetos informativos para os pacientes
Athlete's foot
Ringworm of the body
Mais Folhetos informativos para os pacientes
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