A school-age child has several annular lesions on the abdomen with central clearing and scaly borders. What is the first step in management?

A school-age child has several annular lesions on the abdomen with central clearing and scaly borders. What is the first step in management?

• A. Fluoresce the lesions with a Wood's lamp
• B. Obtain fungal cultures of the lesions
• C. Perform KOH-treated scrapings of the lesion borders
• D. Treat empirically with antifungal cream

Answer: (D)

This is a classic presentation of tinea corporis (dermatophyte infection) with annular plaques, central clearing, and scaly borders on the trunk. For a school-age child with several lesions that look like ringworm, the best first step is to start topical antifungal therapy now. Prompt treatment helps hasten clearance and prevent spread, and you don’t have to wait for lab confirmation when the clinical picture is so typical. Lab tests like KOH scraping or fungal culture can be useful if the diagnosis is uncertain, if the infection is extensive, or if there is no response to initial therapy. A Wood’s lamp may help identify some dermatophyte species (certain Microsporum infections fluoresce), but many dermatophytes do not fluoresce, so a normal Wood’s lamp does not exclude tinea. Systemic therapy is reserved for more widespread disease, tinea capitis, nail involvement, or cases not responding to topical treatment.

This is a classic presentation of tinea corporis (dermatophyte infection) with annular plaques, central clearing, and scaly borders on the trunk. For a school-age child with several lesions that look like ringworm, the best first step is to start topical antifungal therapy now. Prompt treatment helps hasten clearance and prevent spread, and you don’t have to wait for lab confirmation when the clinical picture is so typical.

Lab tests like KOH scraping or fungal culture can be useful if the diagnosis is uncertain, if the infection is extensive, or if there is no response to initial therapy. A Wood’s lamp may help identify some dermatophyte species (certain Microsporum infections fluoresce), but many dermatophytes do not fluoresce, so a normal Wood’s lamp does not exclude tinea. Systemic therapy is reserved for more widespread disease, tinea capitis, nail involvement, or cases not responding to topical treatment.