A 40-Year-Old Veterinarian with Scaly Lesions

Differential Diagnosis

• Granuloma annulare
• Nummular dermatitis
• Psoriasis
• Tinea corporis

Diagnosis
This patient was diagnosed with tinea corporis—sometimes termed “ring worm.” It represents a skin infection by a dermatophyte species of fungus (either Trichophyton, Microsporum, or Epidermophyton).

Learnings

• Fungal organisms are transmitted to humans by direct contact with animals (which likely occurred in this case) or other people, or through fomites
• Tinea corporis usually appears as annular, erythematous, scaling plaques
• Infection may be pruritic or asymptomatic
• Disseminated tinea corporis may be seen in patients with diabetes, Cushing syndrome, malignancy, old age, or who are immunocompromised

Pearls for Urgent Care Management and Considerations for Transfer

• Treatment is tailored toward the fungal infection, underlying predisposing factors, and keeping the intertriginous areas as dry as possible
• Initial treatment could be a 7–14-day course of a topical antifungal cream, such as miconazole or clotrimazole
• Resistant cases may require oral antifungal agents, such as ketoconazole 22 mg/day or fluconazole 100 mg/day for 4–6 weeks
• Drying agents, such as cornstarch, talcum powder, or antifungal powders may be helpful in minimizing skin fold moisture