[NP-Clinical] help from derm experts

[Priscilla Merrill]

Old post I had saved referenced below. 

 So I have a very spry 76 yo with persistent ovoid rash under left breast in
crease area x 4 mos. Circumscribed erythematous border but no excoriation,
salmon colored oily appearance within the margin so paler than the border.
Not itchy or particularly bothersome to her but she is worried that it’s not
clearing.  Normal mammo, breasts otherwise fine.  No other fungal infections
on exam.  No hx eczema or psoriasis, joint aches, etc .

No fluorescence under Woods Lamp (thought ? erythasma but didn’t fit).  Did
KOH a couple of mos ago and saw lots of buds.  Rx’d clotrimazole with
triamcinolone 0.1% mixed bid x a week, then the plain clotrimazole.  It is
less red bud persists.  The Zeasorb AF powder has helped it fade but does
not go away.

Today, I prescribed a one time dose of diflucan but what is next step if
persists?  Trial of rx treating as seborrheic derm?  

Thanks!

 

Priscilla Merrill FNP

 

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Theodore Scott
Sent: Friday, May 11, 2007 1:48 AM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] help from derm experts

 

Well the easiest way to think of the most common pathogens we see is to
classify them into three groups based on shape when you do the KOH prep.

Hyphae, the long thin branching forms, are usually dermatophytes, typically
seen in Tinea pedis, cruris, or corporis. Budding yeast forms are usually
Candida and this can be found in thrush, vaginitis, intertrigo etc…  When
you have Hyphae and spores “Spaghetti and Meatballs”, you are looking at
Pityrosporum ovale aka Malassezia furfur which causes Tinea versicolor and
probably seborrheic dermatitis.  If you have a large inbox I can sen you a
POWERPoint I presented to our NP/PA group on the subject (about 4 MB).  

 

Ted Scott NP-C

 

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Priscilla Merrill
Sent: Thursday, May 10, 2007 3:18 AM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] help from derm experts

 

Fungal culture query.  I did one the other day and it had many buds but no
hyphae.  Like the “meatballs without the spaghetti”

Can you give us some pearls (or meatballs, or buds?) on interpreting fungal
cultures.  I’ve been to microscopy for GYN but we never really did fungal
cultures in schools and have learned along the way but still don’t feel
totally competent.

Thanks, Ted!  We’re so lucky to have you on the listserve.

 

Priscilla Merrill FNP

 

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Theodore Scott
Sent: Wednesday, May 09, 2007 11:10 PM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] help from derm experts

 

Fluconazole is OK, Itraconazole is a little better.  But before any oral
meds (usually expensive) please do a KOH prep.  Lots of conditions mimic
tinea.

 

Ted Scott NP-C

 

   _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of April Anthony
Sent: Wednesday, May 09, 2007 3:28 PM
To: np-clinical at nurse.net
Subject: [NP-Clinical] help from derm experts

 

How do you treat tinea corporis with fluconazole? Or what is the best way to
treat? I have tried the topicals and it improves but returns. I haven't
actually done a scraping but it looks very fungal. What are your thoughts?

 

April Anthony CRNP

 

  

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