Diagnosis: Tinea corporis (tinea gladiatorum)
A 17-year-old male high school wrestler presents with an annular scaly plaque on his shoulder that has persisted for two weeks. The lesion is pruritic, and the patient reports increased skin-to-skin contact during wrestling practice. The clinical findings are consistent with a common dermatophyte infection seen in athletes, particularly wrestlers.
The patient is a 17-year-old male high school wrestler who presents with a two-week history of a pruritic annular scaly plaque on his right shoulder. On examination, the lesion is well-circumscribed, erythematous, and has a raised border with central clearing.Location: Right shoulder, consistent with areas prone to friction and contact.Appearance: Annular, erythematous plaque with scaling and central clearing.Symptoms: Pruritus that worsens with sweating and physical activity.Risk factors: Participation in wrestling, with frequent skin-to-skin contact and possible exposure to infected individuals.Other findings: No systemic symptoms or other lesions noted on the body.
The lesion began approximately two weeks prior, following an increase in wrestling practice sessions leading up to a tournament. The patient reports that the area itches and has become increasingly noticeable over time. He has not tried any treatments prior to this visit. There is no significant past medical history, and he denies any known allergies. The patient shares that some teammates have had similar skin issues recently, raising concerns about transmission.Onset: Lesion developed two weeks ago after increased wrestling activity.Triggers: Increased sweating and skin-to-skin contact during practices.Prior treatments: None attempted; patient sought medical advice due to worsening symptoms.Family history: No significant dermatologic conditions reported.Social history: Active participant in wrestling; no history of recent travel or exposure to animals.
Acute / First-Line ManagementTopical antifungals: Clotrimazole 1% cream applied twice daily for 2-4 weeks or terbinafine 1% cream applied once daily for 1-2 weeks.Oral antifungals: In cases of extensive involvement or failure of topical therapy, consider terbinafine 250 mg once daily for 2 weeks.Adjunctive care: Advise the patient to maintain good hygiene and keep the affected area dry.Workup and Diagnostic ConfirmationClinical diagnosis: Typically based on characteristic appearance and history.KOH preparation: Skin scraping from the edge of the lesion to identify hyphae or spores.Culture: If KOH is negative and suspicion remains, a fungal culture may be performed.Long-Term ManagementPrevention: Educate on proper hygiene practices, including regular washing of wrestling gear and avoiding sharing personal items.Monitoring: Follow-up in 2-4 weeks to assess treatment efficacy and resolution of symptoms.Recurrence: Advise on the risk of recurrence given the nature of the sport and potential for reinfection.
Granuloma annulare: Presents with annular plaques but typically lacks the scale seen in fungal infections and is often asymptomatic.Nummular eczema: Characterized by coin-shaped lesions that are often itchy and may have a crusted appearance, usually more widespread.Psoriasis: May present as well-defined plaques with silvery scale, often on extensor surfaces, and may have associated nail changes.Contact dermatitis: Can cause annular lesions but is usually associated with exposure history and may have vesicles or oozing.Impetigo: Bacterial infection that may mimic tinea but often presents with honey-colored crusting and is more acute in onset.Scabies: Can present with pruritic papules and may show linear burrows; typically involves web spaces and is more generalized.Secondary syphilis: May present with annular lesions but is often associated with systemic symptoms and other mucocutaneous findings.Folliculitis: Infection of hair follicles can mimic tinea but typically has a pustular component and is localized to hair-bearing areas.
High-Yield PearlsCommon presentation: Tinea corporis often presents as annular, scaly patches, particularly in individuals with increased skin-to-skin contact, such as wrestlers.Diagnosis: A clinical diagnosis is often sufficient, but KOH preparation can confirm fungal elements.Topical therapy: First-line treatment typically includes topical antifungals, with oral agents reserved for extensive cases or treatment failures.Preventive measures: Educating athletes on hygiene and the avoidance of shared personal items is crucial in preventing outbreaks.Recurrence: Athletes in contact sports are at higher risk of recurrence; ongoing education about transmission is essential.Consider tinea corporis in any athlete presenting with an annular, scaly lesion, particularly in contact sports.
Tags: tinea corporis, ringworm, wrestler