bubble_chart Overview

Tinea is a fungal infectious skin disease caused by molds, which can be divided into superficial mycosis and deep mycosis, with perianal tinea being a type of superficial mycosis. It is often caused by the spread of tinea cruris to the anus, perineum, and buttocks. It is more common in summer and rare in winter. Traditional Chinese medicine records conditions such as inguinal tinea, round tinea (tinea circinata), pestilent qi sores, and tinea versicolor, which are similar to this disease.

bubble_chart Etiology

In Chinese medicine diagnosis, this disease is caused by external exposure to wind toxins, which congeal in the skin, leading to the skin's inability to be nourished and moistened; or due to the invasion of wind-cold, resulting in the imbalance of nutrient-defense; or the penetration of wind-heat into hair follicles, leading to prolonged stagnation and blood dryness; or the disharmony of the thoroughfare and conception vessels, depletion of nutrient-blood, and blood deficiency producing wind that transforms into dryness, all of which cause the skin to lose nourishment; or the invasion of wind-dampness, which lingers in the striae and interstices; or prolonged residence in damp environments, immersion in water, and external infiltration of dampness, stagnating in the skin; or due to sweat-soaked clothing drenching the skin, combined with sun exposure, allowing summerheat dampness to invade the hair follicles, thus causing this disease.

Modern medicine believes that this disease is caused by fungi, of which there are numerous types, with the vast majority being non-pathogenic. A small portion are opportunistic pathogens that can reside on human skin, mucous membranes, intestines, etc. Under normal circumstances, these microbial communities interact and constrain each other, maintaining a balanced metabolism. However, prolonged use of antibiotics can disrupt the body's microbial balance. When the skin is damaged and resistance is weakened, pathogenic fungi proliferate excessively, invading the skin and subcutaneous tissues, leading to the onset of tinea. This disease is often transmitted through contact with fomites, such as clothing, utensils, or one's own tinea infections of the hands or feet. Environmental conditions also play a role, such as in warm seasons and humid regions, where minor injuries to the anal skin can easily lead to the disease.

bubble_chart Clinical Manifestations

Perianal dermatophytosis is mainly caused by the spread of tinea cruris and tinea versicolor to the perianal area.

(1) Tinea cruris: It occurs on the inner side of the thighs and often spreads to the perianal area, buttocks, etc. The skin lesions are coin-shaped erythema with clear edges, slightly raised above the skin surface. The center of the lesion often tends to heal spontaneously, with papules, blisters, pustules, crusts, and scales around the edges. The patient experiences cutaneous pruritus, mostly occurring in summer and alleviating or resolving in winter.

(2) Tinea versicolor: The skin lesions are round patches ranging from the size of a soybean to larger, varying in size with clear edges, sometimes merging into larger areas. They appear grayish-brown, light brown, or dark brown, or show grade I hypopigmentation, accompanied by fine, shiny bran-like scales. It mostly occurs in summer and resolves in winter. Microscopic examination can reveal fungal spores and hyphae in the scales.

bubble_chart Treatment Measures

(1) Chinese Medicine Treatment:

1. Internal Treatment: The treatment should focus on nourishing blood and harmonizing the camp to dispel wind. The prescription used is Xian Fu Kang. For wind-cold type, add 9g each of Aconite Mother Root and Ephedra; for wind-heat type, add 15g of Unprocessed Rehmannia Root, 12g of Chrysanthemum Flower, and 15g of Sophora; for Chong-Ren disharmony type, add 9g of Deer Horn slices, 12g of Dodder Seed, and 6g of Morinda. For yin deficiency with internal heat, use modified Unprocessed Rehmannia Root Decoction. For dampness-heat excess syndrome, use Gentian Liver-Draining Decoction with Phellodendron Bark, Atractylodes Rhizome, and Coix Seed.

2. External Treatment: The following prescriptions can be selected based on the condition: ① Xian Yao Shui: Apply with a brush to the affected area 2-3 times daily. ② Mie Xian Ling: Mix with vinegar into a paste and apply to the affected area. ③ Xian Ke Jing: Decoct with water for sitz bath. ④ Tinea Versicolor Formula: Apply as needed. ⑤ Jin Jiu Liniment: Apply externally 1-2 times daily. ⑥ Realgar Removing Toxin Powder: Mix with vinegar and apply.

(2) Western Medicine Treatment:

1. Internal Treatment: Take Nystatin tablets 1 million units, 3 times daily, orally. Also take compound vitamin B or oral clotrimazole and trichomycin.

2. External Treatment: Commonly used medications include 10-20% glacial acetic acid solution, compound resorcinol liniment, 20-40% sodium sulfate, 5% salicylic acid alcohol, 1% clotrimazole cream, tinea versicolor medication, compound benzoic acid ointment, salicylanilide ointment, 2% miconazole cream, 10% undecylenic acid solution, 10% thiabendazole cream, 5% lauric acid alcohol, etc.

3. Ultraviolet irradiation, once daily for 20-30 minutes each time.

bubble_chart Differentiation

The diagnosis can be confirmed based on clinical manifestations, lesion morphology and location, and microscopic examination. However, it should be differentiated from neurodermatitis and chronic eczema:

(1) Neurodermatitis: There is obvious lichenification, no blisters, and fungal microscopy is negative.

(2) Chronic eczema: There is no raised, bank-like edge, the boundary is unclear, and fungal examination is negative.