Terbinafine Lamisil. Butenafine Mentax. Clotrimazole Lotrimin. Econazole Spectazole. Ketoconazole Nizoral. Miconazole Micatin. Oxiconazole Oxistat. Sulconazole Exelderm. Ciclopirox Loprox. Tolnaftate Tinactin. Information from references 16 through Tinea barbae involves the skin and coarse hairs of the beard and mustache area. This dermatophyte infection occurs in adult men and hirsute women.
Because the usual cause is a zoophilic organism, farm workers are most often affected. Tinea barbae may cause scaling, follicular pustules, and erythema Figure 3. The differential diagnosis includes bacterial folliculitis, perioral dermatitis, pseudofolliculitis barbae, contact dermatitis, and herpes simplex.
One clue to the diagnosis is that hair removal is painless in tinea barbae but painful in bacterial infections. Like tinea capitis, tinea barbae is treated with oral antifungal therapy.
Treatment is continued for two to three weeks after resolution of the skin lesions. Tinea faciei tends to occur in the non-bearded area of the face. The patient may complain of itching and burning, which become worse after sunlight exposure. Some round or annular red patches are present. Often, however, red areas may be indistinct, especially on darkly pigmented skin, and lesions may have little or no scaling or raised edges.
The differential diagnosis includes seborrheic dermatitis, rosacea, discoid lupus erythematosus, and contact dermatitis. A high index of suspicion, along with a KOH microscopy of scrapings from the leading edge of the skin change, may help in establishing the diagnosis. Treatment is similar to that for tinea corporis. Tinea manuum is a fungal infection of one or, occasionally, both hands Figure 4.
It often occurs in patients with tinea pedis. The palmar surface is diffusely dry and hyperkeratotic. When the fingernails are involved, vesicles and scant scaling may be present, and the condition resembles dyshidrotic eczema.
The differential diagnosis includes contact dermatitis, psoriasis, and callus formation. Topical antifungal therapy and the application of emollients containing lactic acid e. Tinea manuum, with extensive scaling, hyperkeratosis, erythema, and inflammation of the extensor surface of the hand.
This dermatophytosis is more common in men than in women and is frequently associated with tinea pedis. Tinea cruris occurs when ambient temperature and humidity are high. Occlusion from wet or tight-fitting clothing provides an optimal environment for infection.
Tinea cruris affects the proximal medial thighs and may extend to the buttocks and abdomen. The scrotum tends to be spared. Patients with this dermatophytosis frequently complain of burning and pruritus. Pustules and vesicles at the active edge of the infected area, along with maceration, are present on a background of red, scaling lesions with raised borders.
The feet should be evaluated as a source of the infection. Conditions that need to be distinguished from tinea cruris are listed in Table 3. Adjunctive treatment can include a low-dose corticosteroid e.
Rarely, systemic antifungal therapy is needed for refractory tinea cruris. Patient education on avoiding prolonged exposure to moisture and keeping the affected area dry is important. Uniformly brown and scaly, with no active edge; fluoresces a brilliant coral red. Silvery scale and sharp margination; pitted nails; knee, elbow, and scalp lesions. Information from references 20 and Tinea pedis, or athlete's foot, has three common presentations.
The interdigital form of tinea pedis is most common. It is characterized by fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes. Patients with this infection complain of itching or burning. A second form, usually caused by Trichophyton rubrum , has a moccasin-like distribution pattern in which the plantar skin becomes chronically scaly and thickened, with hyperkeratosis and erythema of the soles, heels, and sides of the feet.
The vesiculobullous form of tinea pedis Figure 5 is characterized by the development of vesicles, pustules, and sometimes bullae in an inflammatory pattern, usually on the soles. The differential diagnosis includes contact dermatitis, eczema, and pustular psoriasis. Vesiculobullous form of tinea pedis, with hyperpigmentation resulting from intense inflammation of the lesions. Streptococcal cellulitis is a potential complication of all three forms of tinea pedis.
Streptococcal infection of normal skin is unlikely. However, the presence of fungal maceration and fissuring permits streptococci to colonize the web spaces between the toes in patients with tinea pedis. The clinical features of symptomatic athlete's foot are a result of the interaction of fungi and bacteria.
Treatment of tinea pedis involves application of an antifungal cream to the web spaces and other infected areas. Infrequently, systemic therapy is used for refractory infections. In several studies, twice-daily application of the allylamine terbinafine resulted in a higher cure rate than twice-daily application of the imidazole clotrimazole Lotrimin; 97 percent versus 84 percent , and at a quicker rate one week for terbinafine versus four weeks for clotrimazole.
When marked inflammation and vesicle formation occur and signs of early cellulitis are present, the addition of a systemic or topical antibiotic with streptococcal coverage is warranted. Reinfection is common, especially if onychomycosis is present. Nail infections should be treated. In addition, footwear should be disinfected, and patients with tinea pedis should avoid walking barefoot in public areas such as locker rooms. Other measures to reduce recurrence include controlling hyperhidrosis with powders and wearing absorbent socks and nonocclusive shoes.
Tinea unguium, a dermatophyte infection of the nail, is a subset of onychomycosis, which also may be caused by yeast and non-dermatophyte molds.
Onychomycosis accounts for about 40 to 50 percent of nail dystrophies. Because onychomycosis requires expensive, prolonged therapy three to four months for fingernail infections and four to six months for toenail infections , the diagnosis should be confirmed before treatment is initiated 24 , 25 Table 4. Periodic acid-Schiff staining with histologic examination of the clipped, distal free edge of the nail and attached subungual debris is the most sensitive diagnostic method and is painless for patients.
Tinea unguium, especially of the toenails, is difficult to eradicate. Topical agents have low efficacy. Mycologic cure rates for ciclopirox Penlac nail lacquer, applied daily for up to 48 weeks, have ranged from 29 to 47 percent.
Fluconazole has not been studied extensively in the treatment of onychomycosis and is not labeled by the FDA for this indication. Scrape the most proximal subungual area; examine on a KOH-treated, warmed glass slide see Table 1. Scrape the most proximal subungual area; send scrapings in a sterile container to a hospital or reference laboratory, or spread scrapings on Dermatophyte Test Medium see Table 1.
Clip the distal edge of the nail, along with attached subungual debris; place the most proximal sample in formalin for histologic examination in a hospital or reference laboratory.
Mycologic and clinical cure rates are similar for 12 weeks of treatment with itraconazole in a dosage of mg per day and terbinafine in a dosage of mg per day.
Intermittent itraconazole therapy, in a dosage of mg per day for seven days of each of four months, and intermittent terbinafine therapy are similarly effective. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Barry L. Hainer, M. Box , Charleston, SC e-mail: hainerbl musc. Reprints are not available from the author. The text just as it appears here has been distributed all over the place on the net, many times.
Here, someone has added visuals. That means it only took years for men to realize that their brain is also important. The first testicular guard cup was used in baseball in and the first helmet was used in It took 60 years for men to realize the brain is also important. A popular joke says that it was first used in hockey in The first helmet was used in It took years for men to realize that the brain is also important, except when riding motorcycles.
The first sports helmet was invented in , to provide protection for football players, though most of the games until were played without helmets. That means it only took 19 years for men to realize their brains might also be important.
A protector worn on various parts of the body by cricketers or other sportsmen. Knight Compl. Cricketer ii. A covering or shield worn by sportsmen to protect the genitals.
The decision to wear a jock strap when you work out depends on your personal preferences, what you are doing, and what other clothing you're wearing at the time. In any activity where there is a reasonable risk that the most sensitive organs of your body might sustain an injury, it makes good sense to practice caution and protect your equipment.
If you aren't sure about whether you really need a jock strap, talk to your coach, a doctor or certified personal trainer. The jock strap was born in At that time, male bicyclists were bouncing along Boston's cobblestone streets, and a company called the Bike Web Company stepped forward to support them.
For years, Bike has continued to be the world's largest supplier of jock straps. The standard jock strap consists of a supportive front panel held in place by an elastic waist band and two elastic straps that go around the sides of buttocks, leaving your backside open to the air. Some jock straps have a pouch in front to hold a hard plastic cup, which can prevent serious injury in contact sports.
The purpose of the jock strap is to hold the male genitals in place and suppress excessive motion. That's not to say you can't get the same support any other way: a supportive pair of briefs may serve the same antibouncing purpose.
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