Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Tinea Corporis
Ringworm of the body; a superficial fungal infection of the nonhairy skin.
I. Etiology: Trichophyton and Microsporum dermatophyte fungi
II. Incidence
A. Most prevalent in hot, humid climates
B. Children are the most susceptible.
III. Incubation period: 4 to 10 days
IV. Subjective data
A. Pruritic or asymptomatic lesions
B. Complaint of rash, round sores, or ringworm
C. History of exposure to infected person or animal
V. Objective data
A. Lesions
1. Flat, erythematous papules
2. Spread peripherally
3. Clear centrally
4. Develop into circinate or oval lesions with scaling papular or vesicular advancing borders
B. Distribution: Most commonly seen on face, neck, arms, but may affect any part of the body, sparing palms and soles
C. Check feet and scalp for tinea pedis (interdigital scaling, maceration, and fissures) and tinea capitis (patchy hair loss with broken stumps in oval or circinate lesions with central clearing).
VI. Assessment
A. Diagnosis
1. History and physical findings are generally adequate for diagnosis.
2. Scrapings from borders of lesions in potassium hydroxide fungal preparation demonstrate hyphae.
B. Differential diagnosis
1. Pityriasis rosea: Herald patch may resemble tinea corporis.
2. Candidiasis: Lesions more inflamed; no central clearing; satellite lesions present
3. Psoriasis: Lesions erythematous, circumscribed, and covered with silvery scales
VII. Plan
A. Use one of the following topical creams:
1. Spectazole 1% Cream: Apply once daily for 4 weeks.
2. Oxistat Cream 1%: Apply once daily for 4 weeks.
3. Lotrimin (Clotrimazole AF): Apply tid for 4 weeks.
B. Systemic treatment for severe or unresponsive cases:
1. Grifulvin V
a. Weight 30 to 50 lb: 125 to 250 mg daily
b. Weight over 50 lb: 250 to 500 mg daily
c. Continue treatment for 2 to 4 weeks.
2. Fluconazole (Diflucan)
a. 150 mg/wk for 4 weeks
C. Warm compresses tid for acute, inflammatory lesions.
VIII. Education
A. Transmitted by direct and indirect contact
B. Communicable as long as lesions are present
C. Observe for involvement of other family members or sexual contacts.
D. Ringworm lives on humans and animals; avoid contact with pets.
E. Check dog or cat for Microsporum canis.
F. Do not lend or borrow clothing.
G. Bathe or shower daily.
H. Use talcum or antifungal powder (Caldesene, Tinactin) in intertriginous areas.
I. Keep skin dry; ringworm thrives in moist areas.
J. Do not wear tight, constricting clothing; absorbent cotton is preferable.
K. Launder clothing and linens in hot water.
L. May see no improvement for 5 to 6 days; generally takes 1 to 3 weeks for effective cure
M. Continue treatment for 4 weeks after to prevent relapse.
N. Use of corticosteroids will exacerbate lesions.
IX. Follow-up
A. Telephone call in 4 to 5 days to report progress
B. Recheck in 7 to 9 days if no significant improvement.
C. Return sooner if lesions appear worse or become inflamed.
X. Complications
A. Secondary bacterial infection
B. Sensitivity to topical antifungal cream
XI. Consultation/referral
A. If severe or extensive, may require treatment with griseofulvin
B. If tinea capitis is present