Case Report

DERMATO
MEDICAL FACULTY OF SYIAH KUALA UNIVERSITY
Dr. ZAINOEL ABIDIN GENERAL HOSPITAL
TINEA FACIALIS

By :
AULIA RAHMATUN NUFUS
RAIHANUN NISA DINUR
SRI RIZKI




Supervisor :
NANDA EARLIA









DERMATO-VENEREOLOGY DEPARTEMENT
MEDICAL FACULTY OF SYIAH KUALA UNIVERSITY
Dr. ZAINOEL ABIDIN GENERAL HOSPITAL
BANDA ACEH
JANUARY 2014
VENEREOLOGY DEPARTEMENT
MEDICAL FACULTY OF SYIAH KUALA UNIVERSITY
Dr. ZAINOEL ABIDIN GENERAL HOSPITAL

ii

PREFACE
All praise be to Allah, the Lord of the world and peace and prayers be upon
Muhammad, his family and companions and all those who follow in their footsteps
until the last day.
In finishing this case report entitled Tinea Corporis, the authors really give they
regard and thanks to dr. Nanda Earlia, Sp. KK who has given guidance and help.
Finally, the authors realize there are unintended errors in writing this case
report. The authors really allow all readers to give their suggestion to improve this
content in order to be made as one of the good examples for the next case report.


Banda Aceh, January 2014
Authors









iii

CONTENTS
Page

CONTRIBUTORS .......................................................................................... i
PREFACE ......................................................................................................... ii
CONTENTS ...................................................................................................... iii
1. Introduction ................................................................................................... 1
2. Case Report ................................................................................................... 3
2.1 Anamnesis ............................................................................................... 3
2.2 Status of Dermatology ............................................................................ 5
2.3 Clinical Test ........................................................................................... 5
2.4 Differential Diagnosis ............................................................................ 6
2.5 Resume ................................................................................................... 6
2.6 Diagnosis ................................................................................................ 7
2.7 Management ........................................................................................... 7
2.8 Education ................................................................................................ 7
2.9 Prognosis ................................................................................................. 7
3. Discussion ..................................................................................................... 8
REFERANCE ................................................................................................... 14
ATTACHMENT ................................................................................................ 15
1

INTRODUCTION
Tinea corporis is a superficial dermatophyte infection of the glabrous skin
most commonly caused by species of the genera trichophyton and mycrosporum.
When the face is affected, it is called tinea faciale whom 3%-4% of tinea corporis.
The infection as generally restricted to the stratum corneum of the epidermis. The
clinical symptoms are the result of the fungal metabolites acting as toxins and
allergens. This form of ringworm is characterized by one or more circular, sharply
cirscumscribed, slightly erithematous, dry, scaly, usually hypopigmented patches.
An advancing scalling edge is usually prominent. Progressive central clearing
procedures annular outline that give them the name ringworm. Lesions may
wider to form rings many centrimeters in diameter. In some case concentric
circles or polycyclic lesion form, making intricate patterns.
1,2
The diagnosis is relatively easily made by finding the fungus under the
microscope in skin scrapings. In addition, skin scrapings can be cultured on a
suitable medium. Growth of the fungus on the culture medium is apparent within
a week or two at most and, in most instances, is identifiable to the genus level by
the gross and microscopic appearance of the culture. In this case report, patient
diagnosed tinea corporis based on history and physical examination. The patient
with complaints the appearance of rash followed by itching on the the face, upper
back, palmars and plantars since two month ago. At first, the patient found red
spots that felt very itchy on the upper back area, the rash was getting wider and
spreaded to the face, palmars and plantars area. Itching is increasing at the time of
using pads and when the groin area is moist.
3,4

Dermatophyte infection are the most common skin fungal infection are age,
sex, genetics, racial factors, lifestyle, drug therapy, metabolic endocrine disorder
such as diabetes mellitus, contact with animals and environmental factors are
involved in these infection. Accordingly, accurate diagnosis, approprite treatment
of these infections health seeking behaviours and hygiene reduce their
transmission and complications. In some study, dermatophyte infection were more
prevalent in men and the moat frequent areas of involvement were the scalp, groin
and trunk. Most of them aged 20-29 years.
5
2

In this case the patient has metabolic endocrine disorder skin infection
accure in 20% to 50% of diabetic patients more often in those with type 2 diabetic
and often associated with poor glicemyc control. Poor microcirculation, peripheral
vascular disease, peripheral neuropathy and decreased immune response have
been implicated in the increased susceptibility to cutaneous infection. This is our
reason to pick up tinea facialis for the case report.
5
3

CASE REPORT

Identity of patient
Name : Mr. R
Sex : Male
Age : 56 years old
Weigth : 62 kg
Job : Selling Vegetables
Address : Tungkop, Aceh Besar
Phone number : 085277466610
Registration number : 87-06-35
Examination date : December 31
th
2013

History
The Chief Complain:
Rash followed by itching on the face, upper back, palmars and plantars since two
month ago.

History of present illness:
The patient came to the hospital complaint the appearance of rash followed by
itching on the face, upper back, palmars and plantars since two month ago. At
first, the patient found red spots that felt very itchy on the upper back area, the
rash was getting wider and spreaded to the face, palmars and plantars area. Then,
about one month ago the appearance of rash following itching on the upper back
was disappeared. Itching is felt everytime not induced with environment
temperature, but itching is increasing at the time of using pads and when the groin
area is moist.

History of previous illness:
The patient had the same complaint before since two month ago. Patient
were also informed having a history of diabetic since twelve year ago.

4

History of Family disease:
None of his family had this kind of disease.

History of Treatment:
Since the patient have complaint he was getting treatment from a doctor and take
medication regularly but not healed.





















5

Status of Dermatology






Clinical Test
1. KOH examination
Procedure :
a) Place the material to be examination onto a clean glass slide
b) Add a drop of 10% KOH to the material and mix
c) Pace a cover glass over the preparation
d) Allow the KOH preparation to sit at room temperature until the material has
been cleared. The slide may be warmed to speed the clearing process. Slide
that are initially negative for fungi may be re-examined the following day.
On facial and palmars dextra and
sinistra region, found
erythematous patches and
hypopigmentation with
circumpscripta boundary,
irregular and polycyclic edges,
there are papules and scales on
the edge of lesions, multiple
lesions, plaque size, there are
central healings, disseminated
arrangement, and generalized
distribution.

Figure 1. Dermatological Status

6

e) Observe the preparation by brightfield or phase-contrast microscopy. The
illumination on a brightfield or phase-contrast microscope should be
carefully adjusted using the K holder method. Hyaline fungi will be difficult
to see if the illumination is improperly adjusted. Refer to the table in the
examination of specimen for interpretation of positive result.

Figure 2. Microscopic examination of skin scrapings (scales) with 10% potassium
hydroxide (KOH) showed long, septate and branching hyphae.

Differential Diagnosis
1. Tinea facialis
2. Seborrheic dermatitis
3. Cutaneus candidiasis
4. Granulloma anulare
5. Morbus Hansen type pausibasiler

Resume
A 56 years old man came to the hospital complaint the appearance of rash
followed by itching on the face, upper back, palmars and plantars since two month
ago. On dermatological status was found hypopigmented patches with advancing
red, vesiculated border and central scaling and pruritic. On microscopic
examination of skin scrapings (scales) with 10% potassium hydroxide (KOH)
showed long, septate and branching hyphae and woods lamp examination did not
found fluoresce, or shine under the ultraviolet light.
7

Diagnosis
Tinea facialis

Management
Systemic Medication :
1. Ketoconazole 200 mg tab once daily for 2 to 3 weeks

Topical Medication :
1. Ketoconazole salp once daily at night for 2 to 4 weeks
2. Myconazole cream once daily in the morning for 2 to 4 weeks.

Education
1. Taking medicine regularly
2. Do not scratch the rash to prevent the secondary infection
3. Change clothes when the body is sweating
4. Wearing loose clothing and materials that easily absorb sweat
5. Dry off after a shower and sweating

Prognosis
Quo ad vitam : dubia ad bonam
Quo ad functionam : dubia ad bonam
Quo ad sanactionam : dubia ad bonam

8

DISCUSSION

Superficial fungal infection which are confined to the stratum corneum,
hair and nail can be subdivided into infections that induced an inflammatory
response such as those caused by the dermatophytes. They are the group of
taxonomically related fungi. Their ability to form molecular attachments to
keratin and use it as a source of nutrients allows them to colonize keratinized
tissues, including the stratum corneum of the epidermis, hair , nails and the horny
tissues of the animal. Superficial infection caused by a dermatophyte is termed
dermatophytosis, wheres dermatomycosis refers to a fungal infection by any
fungi.
6
Nomerous way of classifying superficial fungi exist, including habitat and
pattern of infection : 1) Geophilic (earth-loving) organism originate in the soil and
only sporadically infect humans usually by direct contact with the soil. 2)
Zoophilic (Animal-Loving) species are usually found on animals, but also
transmitted to humans. 3) Anthropophilic (man-loving) species have adapted to
humans as hosts are transmitted from person to person via direct contact or
fomites. An estimated 20-25 % of the world`s population has some form of fungal
infection usually an anthropophili, Trichophyton infection making fungal
infections the comman type of infection worldwide. They are classified in three
genera: mycrosporum, trichophyton, epidermophyton.
1,6
The infections caused by dermatophytes are commonly referred to as
tinea or ring-worm infections due to the characteristic ringed lesions. Based
on the site of infection the tinea infections are referred to as tinea capitis (scalp),
tinea corporis or tinea circinata (non-hairy, glaborous region of the body), tinea
pedis (Athletes foot; foot), tinea ungium (onychomycosis; nail), tinea
mannum (hands), tinea barbae (Barbers itch; bearded region of face and neck),
tinea incognito (steroid modified), tinea imbricata (modified form of tinea
corporis), tinea gladiatorium (common among wrestlers) and tinea cruris
(Jocks itch; groin).
7,8

9

Tabel 1.Some of Clinical Features of Dermatophytes Infection.
4
Skin Disease Location of
lesions
Clinical Features Fungi Most
Frequently
Responsible
Tinea corporis
(ringworm)
Nonhairy, smooth
skin.
Circular patches with advancing
red, vesiculated border and central
scaling. Pruritic.
T. rubrum,
E.floccosum
Tinea pedis
(athlete`s foot)
Interdigitalis
spaces on feet of
persons wearing
shoes.
Acute: itching, red vesicular.
Chroni: itching, scaling, fissures
T. rubrum, T.
mentagrophytes,
E.floccosum
Tinea cruris
(jork itch)
Groin. Eritematous scaling lesion in
intertridiginous area. Pruritic.
T. rubrum, T.
mentagrophytes,
E.floccosum
Tinea capitis Scalp hair.
Endothrix: fungus
inside hair shaft.
Ectothrix: fungus
on surface of hair.
Circular bald patches with short
hair stubs or broken hair within
hair follicles. Kerion rare.
Microsporum-infected hairs
fluoresce.
T.
mentagrophytes,
M.canis
Tinea barbae Beard hair. Edematous, erythematous lesion. T.
mentagrophytes
Tinea Unguium
(onychomycosi)
Nail. Nails thickened or crumbling
distally;discolored;lusterless.
Usually associated with tinea
pedis.
T. rubrum, T.
mentagrophytes,
E.floccosum
Dermatophytid
(id reaction)
Usually sides and
flexor aspects
fingers. Palm.
Anysite on body.
Pruritic vesicular to bullous
lesions. Most commonly
associated with tinea pedis.
No fungi present
in lesion. May
become
secondarily
infected with
bacteria.
According to the World Health Organization (WHO) survey on the
incidence of dermatophytic infection, about 20% the people worldwide present
with cutaneous infections. The disease does not spare people of any age. Among
the tinea infections the most predominant type of infection is tinea corporis or
tinea circinata followed by tinea cruris, tinea pedis and Onychomycosis. Tinea
corporis accounts for about 70% of the dermatophytic infection.
8
Tinea corporis is a superficial dermatophyte infection of the glabrous skin
most commonly caused by species of the genera trichophyton and mycrosporum.
When the face is affected, it is called tinea faciale whom 3%-4% of tinea corporis.
The infection as generally restricted to the stratum corneum of the epidermis. The
clinical symptoms are the result of the fungal metabolites acting as toxins and
allergens. This form of ringworm is characterized by one or more circular, sharply
10

cirscumscribed, slightly erithematous, dry, scaly, usually hypopigmented patches.
An advancing scalling edge is usually prominent. Progressive central clearing
procedures annular outline that give them the name ringworm. Lesions may
wider to form rings many centrimeters in diameter. In some case concentric
circles or polycyclic lesion form, making intricate patterns.
1,2
In this case report, patient diagnosed tinea facialis based on history and
physical examination. The patient with complaints the appearance of rash
followed by itching on the the face, upper back, palmars and plantars since two
month ago. At first, the patient found red spots that felt very itchy on the upper
back area, the rash was getting wider and spreaded to the face, palmars and
plantars area. Itching is increasing at the time of using pads and when the groin
area is moist.
4
In this case, microscopic examination of skin scrapings specimen using 10
% KOH solution showed long, septate and branching hyphae. This is accordance
with the literature that diagnosis of dermatophyte infection can be confirmed by
microscopic examination or culture. Although microscopic examination of KOH
treated samples of scale does not allow for speciation or characterization of
susceptibility profile, it is used or underused as a quick and inexpensive bedsite
tool to provide evidence of dermatophytosis. Direct microscopic examination of
skin scrapings specimens using 10 % KOH will show septate hyphae and squared
or rounded, irregularly arranged arthroconidia. All superficial dermatophytes
appear identical when visualized in this manner. Because KOH examination may
yield false-negative results in up 15 % of cases. Patients suspected of having
dermatophytosis on clinical impression should be treated. Curtures should always
be taken. In the experience, the number of culture-positive cases when the KOH
was negative ranges from 5 to 15 %.
2,6
Differential diagnose are tinea facialis, seborrheic dermatitis, cutaneous
candidiasis, granulloma anulare and morbus Hansen. Seborrheic dermatitis is a
common chronic papulo squamous dermatosis that is usually easily recognized. It
affects infants and adults and is often associated with increased sebum production
(seborrhea) of the scalp and the sebaceous follicle rich area. The sites of
11

predilection are face, ears, scalp, and upper part of the trunk. The affected skin is
pink, edematous, and covered with yellow-brown scales and crusts. In all patient
with seborrheic dermatitis is called seborrheic stage, whice is often combined
with a grey white or yellow res skin discoloration, prominent follicular openings
and mild to severe pityriasiform scales. Several form can be distinguished.
6
Cutaneous candidiasis has a predilection for colonizing moist, macerated
folds of skin. Intertrigo is the most common clinical presentation on glabrous skin.
Usual locations for intertrigo include the genitocrural, axilary, gluteal, interdigital,
and inframammary areas and between folds of skin on the abdominal wall.
Cutaneous candidiasis appears as pruritic, erytematous, macerated skin in
intertriginous areas with satellite vesicopustules. These pustules break open,
leaving an erythematous base with collarette of easily detachable necrotic
epidermis. Cutaneous candidiasis diagnosed by the typical appearance of skin
lesions and the presence of satellite vesicopustules.

Of all the clinical symptoms
found such lesions form.
6
Based on the shape of lesion Granuloma annulare starts as a ring of small,
firm, flesh-colored or red papules. As the condition progresses, there is some
central involution, and the ring of papules slowly increases from 0.5 to 5.0 cm in
diameter. The lesions may be isolated or coalesce into plaques. They are found on
the lateral or dorsal surfaces of the hands and feet. Tinea facialis have different
form of lesions so differential diagnose can be removed

.
3

Morbus Hansen is painless skin patch accompanied by loss of sensation but
not itchiness.
6
Therapy in this case are oral ketoconazole 200 mg once daily for 2 to 3
weeks and ketoconazole 2% cream applied once daily at night for 2 to 4 weeks
and miconazole cream once daily in the morning for 2 to 4 weeks. This is
accordance with literature that systemic antifungal therapy is indicated if the
lesions are extensive or fails to topical treatment, recurrent or chronic, or if the
skin condition gets worse. Ketoconazole and miconazole is an antifungal azole
class, broad-spectrum imidazole group, fungistatic and can be given to patients
who do not respond to topical therapy. Mechanism of action of this drug to inhibit
ergosterol biosynthesis enzyme cytochrome P-450, C-14--dimethylase
12

responsible transform lanosterol to ergosterol resulting in fungal cell walls
become permeable and the destruction of the fungus occurs. Imidazole group is
quite effective either as lotions, solutions, or creams for lesions of limited size in
accessible areas.
2,9

Based of the the number of nitrogen atoms the azoles derivatives are
classified into 2 groups as imidazoles and triazoles. Imidazoles include miconazol,
clotrimazole, ketoconazole, econazole, bifonazole, tioconazole and oxiconazole.
In general the imidazoles exhibit side effects such as anorexia, constipation,
headache, hepatitis, pruritis, exhanthema and inhibition of synthesis of steroid
hormone. Triazoles include fluconazole, voriconazole, itraconazole, posaconazole,
teraconazole and ravuconazole. In comparison to the imidazole, the triazoles
exhibit lesser degree of side effects which includes nausea, dizziness and
gastrointertinal upset.
8
Table 2. Treatment of Dermatophytes
6
Disease Topical Treatment Systemic Treatment
Tinea capitis Only as adjuvant
Selenium sulfide
Zinc pyrithione
Povidone iodine
Ketokenazole
Griseofulvin, 20-25 mg/kg/day
Fluconazole,6 mg/kg/day
Itraconazole,3-5 mg/kg/day
Terbinafine,3-6 mg/kg/day
Tinea barbae Only as adjuvant
Topical antifungal
Griseofulvin 1g/day
Itraconazole 200 mg/day
Terbinafine 250 mg/day
Fluconazole 200 mg/day
Tinea
corporis/kruris
Allylamines
Imidazoles
Tolnaffate
Butenafine
Ciclopirox
Adults:
Fluconazol 150 mg/week
Itraconazole 100 mg/day
Terbinafin 250 mg/day
Griseovulvin 500 mg/day
Children:
Griseovulvin 10-20 mg/kg/day
Itraconazole 5 mg/kg/day
Terbinafrin 3-6 mg/kg/day
Tinea pedis/
manum
Allylamine
Azole
Ciclopirox
Benzylamine
Tolnaftate
Undecenoic acid
Adults:
Terbinafine 250 mg/day
Itraconazole 200 mg twice/day
Fluconazole 150 mg/week
Children:
Itraconazole 5 mg/kg/day
Onychomycosis Ciclopirox
Amorolfine
Terbinafine 250 mg/day
Itraconazole 200 mg/day
Fluconazole 150-300 mg once/week

13

Based literature for systemic treatment, the imidazole preparations have the
advantage of being broad have the adventage of being broad spectrum antibiotic
and effective againts candida spp. and some case, bacteria. In vitro ketoconazole
and the azoles in general have about the same susceptibility pattern as
griseofulvin. Infections that failed to respond to griseofulvin treatment have
sometimes responded to ketoconazole. Actual development of griseofulvin
resistance has been noted in some dermatophytes.
2
Non medicamentosa management and prevention of relapse of disease is
very important, such as reducing the predisposing factors, namely temperature,
humidity and occlusion by advocating wearing loose clothing and materials that
easily absorb sweat, dry off after a shower and sweating, and washing the clothes
that contaminated.
9,10
The prognosis in normal patients tinea facialis resolves spontaneously after
a few months. The less tendency toward chronicity than in tinea pedis and tinea
cruris. The treatment aids in the resolution of lesion and effects a clinical cure.
Reinfection of the same area may occur within a few weeks to months if the
patient is again exposed to infectious material. In some patients lesions of tinea
facialis reappear at regular interval.
2
14

REFERENCE

1. James WD, Berger TG, Elston DM. Disease Resulting From Fungi and
Yeasts In Andreaw`s Disease of the skin clinical Dermatology. 10
th
ed.
Saunders Elsevier: 2006.p. 297-331.
2. Rippon JW. Characteristics of Fungi. 3
th
ed. Saunders Compony:1988. p.
121-53.
3. Smith MD, Downie JB, DiCostanzo D. 2010. Granuloma annulare. Int J
Dermatol : 326-33.
4. Mitchell TG. Medical Mycology In Jawetz, Melnick and adelberg`s Medical
Microbiology. 24
th
ed. Mc Graw Hill Companies: 2007. p. 621-57.
5. Rassai S, Feily A, Sina N, Derakhshanmehr F. Some Epidemiological
Aspects of Dermatophyte Infections in Southwest iran. Acta
Dermatovenerol Croat. 2011. p.13-15
6. Schieke AM, Garg A. Fungal Infection In Goldsmith AG, Stephen IK,
Barbara AG, Ami SP, David JL. Fitzpatricks Dermatologiy in General
Medicine. 8
th
ed. New York: McGraw Hill: 2012.p. 2277-328.
7. Hay RJ, Moore M. Mycology In Rook Textbook of Dermatology. 7
th
ed.
Blackwell Science. 2007.p. 1277-376.
8. Lakshmipathy, Deepika. 2010. Review on Dermatomycosis: Pathogenesis
and Treatment. Biomolecules and Genetics, School of Biosciences and
Technology. VIT University, Vellore. Vol.2. No.7. 726-731
9. Risdianto A, Dirmawati K, and Safruddin A. 2013. Case Report: Tinea
Corporis and Tinea Cruris Caused By Trichopyton Mentagrophytes Type
Granular In Asthma Bronchiale Patient. Vol.2. No.2. 31-38.
10. Hand JW, Wroble RR. Prevention of Tinea Corporis in Collegiate
Wrestlers. J of Atlhletic Training. 1999. Vol: 34. p.350-52.
15

ATTACHMENT

Table 3. Several things which found and the relationship with some theory
Case Literature Author
Anamnesis The patient found
red spots that felt
very itchy on the
upper back area,
the rash was
getting wider and
spreaded to the
face, palmars and
plantars area.
Patient diagnosed
tinea fasialis based
on history and
physical
examination. The
patient with
complaints the
appearance of rash
followed by
itching on the the
face, upper back,
palmars and
plantars since two
month ago. At
first, the patient
found red spots
that felt very itchy
on the upper back
area, the rash was
getting wider and
spreaded to the
face, palmars and
plantars area.
Itching is
increasing at the
time of using pads
and when the
groin area is
moist.
There are
similarities
between the case
and the theory
which states that
tinea facialis
symptom.
Status of
dermatology
On facial and
palmars dextra
and sinistra
region, found
erythematous
patches and
hypopigmentation
with
circumpscripta
boundary,
irregular and
polycyclic edges,
This form is
characterized by
one or more
circular, sharply
cirscumscribed,
slightly
erithematous, dry,
scaly, usually
hypopigmented
patches. An
advancing scalling
edge is usually
There are
similarities
between the case
and the theory
which states that
tinea facialis
description.
16

there are papules
and scales on the
edge of lesions,
multiple lesions,
plaque size, there
are central
healings,
disseminated
arrangement, and
generalized
distribution.

prominent.
Progressive
central clearing
procedures
annular outline
that give them the
name ringworm.
Lesions may
wider to form
rings many
centrimeters in
diameter. In some
case concentric
circles or
polycyclic lesion
form, making
intricate patterns.
Clinical test Microscopic
examination of
skin scrapings
(scales) with 10%
potassium
hydroxide (KOH)
showed long,
septate and
branching hyphae.

Direct
microscopic
examination of
skin scrapings
specimens using
10 % KOH will
show septate
hyphae and
squared or
rounded,
irregularly
arranged
arthroconidia.
There are
similarities
between the case
and the theory
which states that
tinea facialis
description.
Therapy Therapy in this
case are oral
ketoconazole 200
mg once daily for
2 to 3 weeks and
ketoconazole 2%
cream applied
once at night for 2
to 4 weeks and
than miconazole
cream once daily
in the morning.
Ketoconazole and
miconazole is an
antifungal azole
class, broad-
spectrum
imidazole group,
fungistatic and can
be given to
patients who do
not respond to
topical therapy.
There are
similarities
between the case
and the theory
which states that
tinea facialis
treatment.



17

Table 4. Differantial diagnosis
Tinea facialis One or more circular,
sharply
cirscumscribed,
slightly erithematous,
dry, scaly, usually
hypopigmented
patches. An
advancing scalling
edge is usually
prominent.
Progressive central
clearing procedures
annular outline that
give them the name
ringworm. Lesions
may wider to form
rings many
centrimeters in
diameter. In some
case concentric
circles or polycyclic
lesion form, making
intricate patterns.
Seborrheic
dermatitic
a common chronic
papulosquamous
dermatosis that is
usually easily
recognized. It affects
infants and adults and
is often associated
with increased sebum
production
(seborrhea) of the
scalp and the
sebaceous follicle
rich area. The sites of
predilection are face,
ears, scalp, and upper
part of the trunk.

18

Cutaneous
candidiasis
a predilection for
colonizing moist,
macerated folds of
skin. Intertrigo is the
most common
clinical presentation
on glabrous skin.
Usual locations for
intertrigo include the
genitocrural, axilary,
gluteal, interdigital,
and inframammary
areas and between
folds of skin on the
abdominal wall.
Cutaneous
candidiasis appears
as pruritic,
erytematous,
macerated skin in
intertriginous areas
with satellite
vesicopustules.

Granulloma
anulare
Based on the shape of
lesion Granuloma
annulare starts as a
ring of small, firm,
flesh-colored or red
papules. As the
condition progresses,
there is some central
involution, and the
ring of papules
slowly increases from
0.5 to 5.0 cm in
diameter. The lesions
may be isolated or
coalesce into plaques.
They are found on
the lateral or dorsal
surfaces of the hands
and feet.

19

Morbus Hansen Painless skin patch
accompanied by loss
of sensation but not
itchiness.