S74 Dermatophytosis (ICD-10:B35.9)

Introduction

Dermatophytosis, also known as ringworm, is a common fungal infection of the skin, hair, and nails. It is caused by various species of dermatophytes, including Trichophyton, Microsporum, and Epidermophyton^[1]. This guide aims to provide healthcare professionals with a comprehensive overview of dermatophytosis, including its symptoms, causes, diagnostic steps, possible interventions, and patient education.

Codes

• ICPC-2 Code: S74 Dermatophytosis
• ICD-10 Code: B35.9 Dermatophytosis, unspecified^[2]

Symptoms

• Itchy, red, and scaly patches on the skin^[3]
• Circular or ring-shaped rash with raised edges
• Blister-like lesions that may ooze or crust over
• Hair loss or brittle nails in cases of scalp or nail involvement^[4]

Causes

• Direct contact with an infected person or animal^[5]
• Contact with contaminated objects, such as towels, clothing, or combs
• Walking barefoot in public areas, such as locker rooms or swimming pools
• Weakened immune system
• Excessive sweating or humidity^[6]

Diagnostic Steps

Medical History

• Inquire about the patient’s symptoms, including the duration and progression of the rash.
• Ask about any recent exposure to potential sources of infection, such as infected individuals or contaminated objects.
• Assess the patient’s medical history, including any underlying conditions or medications that may predispose them to dermatophytosis.
• Determine if the patient has any risk factors for recurrent or severe infections, such as diabetes or immunosuppression^[7].

Physical Examination

• Inspect the affected area(s) for characteristic signs of dermatophytosis, such as redness, scaling, and circular lesions with raised edges.
• Examine the hair and nails for any signs of involvement, such as hair loss or brittleness.
• Check for any secondary bacterial infections, which may present as pustules or crusting^[8].

Determine Severity

• Classify the disease based on severity and depth of involvement, which may include the following categories:
  • Superficial dermatophytosis: Limited to the outermost layers of the skin.
  • Subcutaneous dermatophytosis: Involves deeper layers of the skin, including the subcutaneous tissue.
  • Systemic dermatophytosis: A rare and severe form of the disease that affects multiple organs and requires immediate medical attention^[9].

Laboratory Tests

• Microscopic examination of skin scrapings or nail clippings: Direct visualization of fungal elements under a microscope.
• Fungal culture: Isolation and identification of the causative organism from a sample collected from the affected area.
• Polymerase chain reaction (PCR): Molecular testing to detect specific fungal DNA or RNA sequences.
• Wood’s lamp examination: Ultraviolet light examination to assess fluorescence of affected areas (e.g., Microsporum infections)^[10].

Diagnostic Imaging

• No diagnostic imaging is necessary for the diagnosis of dermatophytosis.

Other Tests

• KOH (potassium hydroxide) preparation: Microscopic examination of skin scrapings treated with KOH to enhance visualization of fungal elements.
• Dermoscopy: Examination of the skin using a handheld device with magnification and light to aid in the diagnosis of certain types of dermatophytosis.

Follow-up and Patient Education

• Schedule a follow-up appointment to monitor the patient’s response to treatment and ensure complete resolution of the infection.
• Educate the patient about proper hygiene practices, such as avoiding sharing personal items and keeping the affected area clean and dry.
• Emphasize the importance of completing the full course of prescribed antifungal medication to prevent recurrence.
• Advise the patient to seek medical attention if the infection worsens or does not improve after treatment.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Dermatophytosis:

1. Terbinafine:
   • Cost: $10-$50 for a 30-day supply.
   • Contraindications: Known hypersensitivity to terbinafine.
   • Side effects: Headache, gastrointestinal upset, rash.
   • Severe side effects: Liver toxicity, blood disorders.
   • Drug interactions: Cimetidine, rifampin, fluconazole.
   • Warning: Liver function tests may be required during treatment.
2. Itraconazole:
   • Cost: $20-$100 for a 30-day supply.
   • Contraindications: Known hypersensitivity to itraconazole.
   • Side effects: Nausea, vomiting, diarrhea.
   • Severe side effects: Liver toxicity, heart failure.
   • Drug interactions: Cisapride, pimozide, rifampin.
   • Warning: Liver function tests and ECG monitoring may be necessary.
3. Fluconazole:
   • Cost: $10-$50 for a 30-day supply.
   • Contraindications: Known hypersensitivity to fluconazole.
   • Side effects: Nausea, headache, abdominal pain.
   • Severe side effects: Liver toxicity, severe skin reactions.
   • Drug interactions: Cisapride, quinidine, rifampin.
   • Warning: Liver function tests may be required during treatment.
4. Griseofulvin:
   • Cost: $10-$50 for a 30-day supply.
   • Contraindications: Porphyria, hepatocellular failure.
   • Side effects: Gastrointestinal upset, headache, fatigue.
   • Severe side effects: Severe skin reactions, blood disorders.
   • Drug interactions: Alcohol, barbiturates, oral contraceptives.
   • Warning: May decrease the effectiveness of oral contraceptives.
5. Ciclopirox:
   • Cost: $20-$100 for a 30-day supply.
   • Contraindications: Known hypersensitivity to ciclopirox.
   • Side effects: Burning or stinging at the application site.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: None reported.

Alternative Drugs:

• Naftifine: An antifungal cream or gel used for topical treatment.
• Butenafine: Another topical antifungal medication available as a cream or spray.
• Tolnaftate: An over-the-counter antifungal cream or powder.
• Clotrimazole: Available as a cream, lotion, or solution for topical use.
• Econazole: A topical antifungal cream or foam.

Surgical Procedures:

• Surgical intervention is not typically required for the treatment of dermatophytosis.

Alternative Interventions

• Tea tree oil: Apply diluted tea tree oil topically to the affected area. Cost: $10-$20 for a bottle of tea tree oil.
• Apple cider vinegar: Soak the affected area in a mixture of apple cider vinegar and water. Cost: $5-$10 for a bottle of apple cider vinegar.
• Garlic: Apply crushed garlic cloves or garlic oil topically to the affected area. Cost: $2-$5 for a bulb of garlic.
• Aloe vera: Apply aloe vera gel topically to soothe the affected area. Cost: $5-$10 for a bottle of aloe vera gel.

Lifestyle Interventions

• Keep the affected area clean and dry to prevent the growth of fungi.
• Avoid sharing personal items, such as towels, clothing, or combs.
• Wear loose-fitting clothing and breathable footwear to reduce moisture and promote airflow.
• Use antifungal powders or sprays in shoes and socks to prevent reinfection.
• Maintain good overall hygiene practices, including regular handwashing and bathing.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – S74 Dermatophytosis (ICD-10:B35.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Dermatophytosis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Dermatophytosis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008;51 Suppl 4:2-15.
2. World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for 2019.
3. Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and management of tinea infections. Am Fam Physician. 2014;90(10):702-710.
4. Gupta AK, Mays RR, Versteeg SG, et al. Tinea capitis in children: a systematic review of management. J Eur Acad Dermatol Venereol. 2018;32(12):2264-2274.
5. Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology – an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014;12(3):188-209.
6. Hayette MP, Sacheli R. Dermatophytosis, trends in epidemiology and diagnostic approach. Curr Fungal Infect Rep. 2015;9(3):164-179.
7. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J. 2016;7(2):77-86.
8. Hay RJ. Tinea Capitis: Current Status. Mycopathologia. 2017;182(1-2):87-93.
9. Rouzaud C, Hay R, Chosidow O, et al. Severe dermatophytosis and acquired or innate immunodeficiency: a review. J Fungi (Basel). 2015;2(1):4.
10. Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment. J Cutan Med Surg. 2017;21(6):525-539.