Questionnaire/history: Scaly, itchy skin? Past medical history? Current medication? Drug allergies? Examination: Tinea corporis: Single or multiple red or pink, flat or slightly raised annular (ring-shaped) patches of varying sizes (usually 1–5 cm) which enlarge outwards? Active red, scaly advancing edge and a clear central area (so-called 'central clearing')? Asymmetrical in distribution? Larger lesions and coalescence of lesions? Tinea cruris: Involvement of: - Inguinal folds? - Proximal medial thighs? - Perianal skin? - Buttocks? - Above the waistline? Skin lesions red to red-brown, flat or slightly raised plaques with active borders (+/- pustules or vesicles within lesions)? Diagnosis: Skin samples for fungal microscopy and culture if: - Severe or extensive disease in adults - Diagnosis uncertain or atypical appearance Scraped skin from the advancing edge of the lesion(s) with a blunt scalpel blade to collect skin scale, sampled the edge of lesions which may provide a higher yield of dermatophyte, collected at least 5 mm2 of skin flakes into folded dark paper squares secured with a paper clip. Management: Advised on self-care management strategies: - To wear loose-fitting clothes made of cotton or a material designed to keep moisture away from the skin - To maintain good hygiene by washing affected skin areas daily - After washing to dry thoroughly, especially in the skin folds - To avoid scratching affected skin, as this may spread infection to other sites - To not share towels, and wash them frequently, to reduce the risk of transmission - To wash clothes and bed linen frequently to eradicate fungal spores - If a child is affected, it is not necessary to exclude them from school or nursery - Terbinafine or an imidazole (eg clotrimazole, miconazole or econazole) cream (+/- hydrocortison 1% once daily for a maximum of one week) - If severe or extensive disease: oral terbinafine or if not tolerated itraconazole or oral griseofulvin - Review if worsening symptoms, no improvement or ongoing symptoms Reference(s): NICE CKS: Fungal skin infection - body and groin

Information for parents/carers: NHS Health A to Z: Ringworm Patient UK: Fungal groin infection (Tinea cruris) Patient UK: Ringworm - Tinea corporis