Answers To Clinical Application Questions

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History Review

A 50-year-old male diabetic presents with an extensive eruption on the lower back and buttock areas. He complains of intermittent pruritus and occasional tender deep pimplelike lesions.

1. List the disorders that you should consider in the differential diagnosis of this patient's eruption.

Answer:

a. Tinea corporis.

b. Nummular eczema.

c. Psoriasis.

d. Mild atopic eczema (pityriasis alba).

2. How would you distinguish tinea corporis from the other disorders in your differential diagnosis?

Answer: Only tinea corporis has a positive KOH preparation. If KOH preparation is negative but you strongly suspect tinea corporis, a fungal culture should be done.

3. Where else on this patient's body is fungal infection likely to be found?

Answer: Tinea corporis is commonly associated with tinea pedis, tinea cruris, and nail infections. These sites should be examined.

4. If a diagnosis of fungal infection is established, what treatment is appropriate for this patient?

Answer: Extensive fungal infections and those with follicular lesions should be treated with systemic antifungal medication.

5. What is this patient's prognosis?

Answer: With the newer systemic antifungal agents, prospects for cure are excellent. Because of the complicating diabetes, occasional new infections may be encountered.

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