TOACS FCPS Station · Annular Rash in Tinea faciei

📷 Clinical Photograph – Annular Rash (Tinea faciei)

Clinical photograph showing an annular erythematous plaque with central clearing and an active scaly border on the arm, characteristic of tinea corporis (ringworm)

Figure 1 · Tinea faciei · Dermatophyte infection (ringworm)

🔍 Key clinical features:

✓ Annular (ring-shaped) plaque – well-demarcated
✓ Central clearing – classic 'ringworm' appearance
✓ Active scaly border – erythematous, elevated edge
✓ Mild pruritus – variable
✓ Can affect any body surface – trunk, extremities, face

📋 Clinical scenario (examiner prompt)

A 7‑year‑old child is brought in with a ring-shaped rash on the face that has been slowly enlarging over the past few weeks. The lesion is erythematous with a scaly, elevated border and central clearing. The child reports mild itching. The family has a new kitten at home. The child is otherwise healthy and has no other skin lesions.

Annular plaque with central clearing Scaly, elevated border Contact with kitten Mild pruritus

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the clinical image and context.

2. Describe the clinical features (annular plaque, central clearing, active scaly border).

3. Explain the etiology and transmission (dermatophytes, contact with animals/fomites).

4. Discuss diagnosis and management (KOH prep, topical antifungals, when to use systemic).

⚠️ Key concept: Tinea faciei (ringworm) is a dermatophyte infection of the glabrous skin, characterized by an annular, erythematous plaque with central clearing and an active scaly border. Causative organisms include Trichophyton rubrum, Microsporum canis (from animals), and Epidermophyton floccosum. Diagnosis is confirmed by KOH prep (septate hyphae). Treatment is with topical antifungals (azoles or terbinafine) for 2-4 weeks. Systemic therapy is needed for extensive, resistant, or Majocchi granuloma.

🎯 Expected answers (for examiners)

• Diagnosis: Tinea Corporis (dermatophyte infection, ringworm)
• Clinical features: Annular (ring-shaped) erythematous plaque with central clearing, active scaly border (elevated, erythematous), mild pruritus, slowly enlarging
• Etiology: Dermatophytes: Trichophyton rubrum (most common), Microsporum canis (from animals), Epidermophyton floccosum; transmission via direct contact with infected humans, animals, or fomites
• Diagnosis: Clinical; KOH prep (septate hyphae, branching); Wood lamp (green fluorescence for Microsporum canis); fungal culture (definitive)
• Treatment: Topical antifungals: clotrimazole, miconazole, ketoconazole, terbinafine (BID) for 2-4 weeks. Systemic therapy: terbinafine or griseofulvin for extensive disease, immunosuppressed, or Majocchi granuloma
• Differential: Granuloma annulare (no scale), nummular eczema, pityriasis rosea, psoriasis, Lyme disease (erythema migrans)

📌 Tinea faciei – key points:
• Appearance: Annular plaque with central clearing and active scaly border
• Pathogens: T. rubrum (human), M. canis (animal), E. floccosum
• Diagnosis: KOH prep (septate hyphae), culture
• Treatment: Topical antifungals (2-4 weeks)
• Systemic indication: Extensive, resistant, Majocchi granuloma
• Differential: Granuloma annulare (no scale), nummular eczema

⚡ Quick FCPS‑style MCQ

A 7-year-old with a ring-shaped, erythematous plaque with central clearing and an active scaly border on the face. The most likely diagnosis and first-line treatment are:

A. Granuloma annulare – topical steroids B. Tinea faciei – topical antifungal (clotrimazole/terbinafine) C. Nummular eczema – emollients D. Psoriasis – topical corticosteroids

📌 Topic summary · Annular Rash in Tinea faciei

Definition
Dermatophyte infection of glabrous skin

Appearance
Annular plaque with central clearing

Pathogens
T. rubrum, M. canis, E. floccosum

Diagnosis
KOH prep (septate hyphae)

Treatment
Topical antifungals (2-4 weeks)

Systemic indication
Extensive, resistant, Majocchi granuloma

Feature	Tinea faciei
Definition	Superficial fungal infection (dermatophytosis) of the glabrous (non-hair-bearing) skin
Clinical appearance	Annular (ring-shaped) erythematous plaque with central clearing and active scaly border; may be single or multiple
Common pathogens	Trichophyton rubrum, Microsporum canis (animals), Epidermophyton floccosum
Transmission	Direct contact with infected humans, animals (kittens, puppies), or fomites (towels, clothing, sports equipment)
Diagnosis	KOH prep (septate hyphae, branching); Wood lamp (green fluorescence for M. canis); fungal culture
Treatment – Topical	Azoles (clotrimazole, miconazole, ketoconazole) or terbinafine cream BID for 2-4 weeks
Treatment – Systemic	Terbinafine (250 mg daily) or griseofulvin for extensive, resistant, or deep infection (Majocchi granuloma)
Differential diagnosis	Granuloma annulare (no scale), nummular eczema, pityriasis rosea, psoriasis, erythema migrans (Lyme disease)

🍄 TOACS FCPS Station · Annular Rash in Tinea faciei

📷 Clinical Photograph – Annular Rash (Tinea faciei)

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary · Annular Rash in Tinea faciei