twice a day, as well as an antibiotic such as polymyxin B in combination with bacitracin
or oxytetracycline. The protocol of treatment facility for folliculitis or pseudofolliculitis
should be followed.
FUNGAL INFECTIONS OF THE SKIN
a. Tinea Capitis (Scalp Ringworm).
(1) Description/characteristics. Tinea capitis is ringworm of the scalp. It is
practically never seen in adults. There are usually no symptoms except itching.
Lesions, undetectable to the naked eye, are small, grayish patches in which hairs are
broken, scant, and lusterless.
(2) Treatment. Skin lesions can be treated effectively with microcrystalline
griseofulvin until the skin is clear. It is no longer necessary to shave the patient's head.
Advise the patient to use Kwell shampoo and to take griseofulvin orally.
b. Tinea Corporis or Tinea Circinata (Ringworm of the Body).
(1) Description/characteristics. All species of dermatophytes (fungus
capable of causing skin disease) may cause body ringworm, but some fungi are more
common than others. Skin lesions can appear on the trunk, face, upper extremities,
and in skin folds. Exposed skin areas are the most common place for lesions. The
lesions are uncommon in temperate climates. The lesions have raised borders that
spread from the outside and clear in the middle of the lesion. They must be
distinguished from dermatoses such as pityriasis rosea, seborrheic dermatitis, annular
psoriasis, and so forth. Intensive itching helps distinguish these lesions as tinea
(2) Treatment. These skin lesions can be effectively treated with
griseofulvin if the lesions are severe, but you should check first with the medical officer.
Vioform three percent may be used, and tolnaftate is effective. Miconazole (Micatin)
2 percent cream (Rx 38) is the most effective topical antitineal agent currently available
in the United States.
c. Tinea Cruris (Jockstrap Itch).
(1) Description/characteristics. Tinea cruris may be caused by a variety of
ringworm organisms and is very similar to tinea corporis. It is complicated by miliaria
(skin eruption caused by sweat in the glands), secondary bacterial or candidal infection,
and reaction to treatment. Both sides of the upper thighs may be affected, but eruption
is usually asymmetrical (not identical on both sides of a central line). Typical lesions are
usually confined to the groin and gluteal cleft (buttocks skin folds). Recurrence is
common. Athletes (persons who perspire a lot), tight clothing, and obesity tend to favor
growth of the organisms. Severe itching occurs in areas where skin rubs together; for
example, between the scrotum and the thigh. Macules in such areas will be red with
sharp margins, cleared centers, and the macules will be very active.