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 always being superficial mycosis. It is mostly 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, tinea circinata, pestilent qi, 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 accumulate 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 intrusion 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 transforming into dryness, all of which cause the skin to lose nourishment; or the invasion of wind-dampness, lingering in the striae and interstices; or prolonged residence in damp environments, immersion in water, external infiltration of damp pathogens, stagnating in the skin; or due to sweat-soaked clothing dampening the skin, combined with sun exposure, summerheat-dampness invading the hair follicles, thus forming this disease.

Modern medicine believes that this disease is caused by fungi, and there are numerous types of fungi, the vast majority of which are non-pathogenic, with a small portion being opportunistic pathogens that can reside on human skin, mucous membranes, intestines, etc. Under normal circumstances, various microbial communities interact and constrain each other, maintaining metabolic balance. However, prolonged use of antibiotics can disrupt the internal microbial balance, and when the skin is damaged and resistance is lowered, pathogenic fungi proliferate extensively, 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 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 onset of the disease.

bubble_chart Clinical Manifestations

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

(1) Tinea cruris: Occurs on the inner thighs and often spreads to the perianal area, buttocks, etc. The skin lesions present as coin-shaped erythema with clearly defined edges, slightly raised above the skin surface. The center of the lesion often shows a tendency to self-heal, while the surrounding edges may exhibit papules, vesicles, pustules, crusts, and scales. Symptoms include cutaneous pruritus, with frequent flare-ups in summer and alleviation or spontaneous resolution in winter.

(2) Tinea versicolor: The skin lesions appear as round patches ranging from the size of a soybean to larger, varying in size with clearly defined edges. Sometimes they merge into larger patches, presenting as grayish-brown, light brown, or dark brown, or showing grade I hypopigmentation, accompanied by fine, shiny bran-like scales. It commonly occurs in summer and resolves spontaneously in winter. Microscopic examination can reveal fungal spores and hyphae in the scales.

bubble_chart Treatment Measures

㈠ Chinese medicine treatment:

1. Internal treatment: The treatment should aim to nourish blood and harmonize the nutrient qi to dispel wind, using the prescription Xuan Fu Kang. For wind-cold type, add 9g each of Prepared Aconite Mother Root and Ephedra; for wind-heat type, add 15g of Unprocessed Rehmannia Root, 12g of Chrysanthemum Flower, and 15g of Sophora; for disharmony of the thoroughfare and conception vessels, add 9g of Deer Horn slices, 12g of Dodder Seed, and 6g of Morinda. For yin deficiency with internal heat, use Unprocessed Rehmannia Root Drink with modifications. For dampness-heat excess syndrome, use Gentian Liver-Draining Decoction with Phelloendron Bark, Atractylodes Rhizome, and Coix Seed.

2. External treatment: Select the following prescriptions based on the condition: (1) Xuan Yao Shui, apply with a brush to the affected area 2-3 times daily. (2) Mie Xuan Ling, mix with vinegar into a paste and apply to the affected area. (3) Xuan Ke Jing, decoct with water for sitz bath. (4) Tinea versicolor formula, apply after mixing. (5) Hibiscus wine liniment, apply externally 1-2 times daily. (6) Realgar Removing Toxin Powder, mix with vinegar and apply.

㈡ Western medicine treatment:

1. Internal treatment: Nystatin tablets 1 million units, taken orally 3 times daily, along with compound vitamin B. Clotrimazole or trichomycin can also be taken orally.

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, salicylic acid 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 session.

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: exhibits obvious lichenification, no blisters, and negative fungal microscopy.

(2) Chronic eczema: lacks a raised, bank-like border, has unclear boundaries, and shows negative fungal examination.