Tinea Corporis

Skin Lesion: Annular (ring-shaped) erythematous patches with an active scaly border and central clearing. Border may be papular or pustular.

Classic Clues:

• Active Border: The redness and scale are most prominent at the edges of the ring.
• Central Clearing: The center of the lesion often looks like normal skin or is less inflamed than the edges.
• Pruritus: Usually mildly to moderately itchy.

Pityriasis Rosea

• The Clue: Presence of a Herald Patch (the first and largest lesion) followed by a "Christmas Tree" distribution on the trunk.
• Vs Tinea: Pityriasis Rosea scale is a "collarette" (attached at the periphery, loose in the center). It does not respond to antifungals.

Discoid (Nummular) Eczema

• The Clue: Coin-shaped, intensely itchy lesions that are uniformly scaly.
• Vs Tinea: Discoid eczema lacks central clearing. The entire lesion is usually thickened and scaly.

Treatment Options:

• Topical Antifungal:
  - Miconazole 2% BD for 2-4 weeks.
  - Clotrimazole 1% BD for 2-4 weeks.
• Systemic (if extensive):
  - Fluconazole 150mg once weekly for 2-4 weeks.
  - Itraconazole 200mg OD for 1week.
  - Monitor LFT if long duration.

Symptomatic Treatment:

• Cetirizine 10mg OD.
  [Child: 0.25mg/kg OD]
• Piriton 4mg ON/TDS.
  [Child: 0.1mg/kg ON/TDS]
• Desloratadine 5mg OD
  [Child: 0.1mg/kg OD] (non-drowsy)

⚠️ Tinea Incognito: Never apply topical steroids to a fungal infection. It suppresses inflammation (making it look "better" temporarily) but allows the fungus to flourish and spread deeper.

⚠️ Rule of 2: Topical antifungals should be applied 2 cm beyond the margin of the lesion for at least 2 weeks beyond clinical resolution (invisible tinea).

📸 Images