This week I saw an 11-year-old African American male whose father brought him in due to light colored spots on his forehead, cheeks, and chin. Father reports they noticed the spots about two weeks ago and they have been keeping the patient’s face clean but the spots are not going away. Father reported they have been using the regular soap they have at home to clean the patients face. Father reports they are also putting lotion on the patient’s face as well. Patient reported mild itching. Father reported the patient has recently started playing football. Father states that the patient has his own helmet that he uses. I assessed the areas in question and did make note of the discoloration on the patient’s forehead, cheeks, and chin. Another area I am not great at – derm. I will be honest again; I call most rashes on children contact dermatitis and that is what I went with for this patient as well. Once my preceptor visited with the patient and assessed the discolored areas – the patient was diagnosed with tinea vesicolor. Nope, not once did this cross my mind. Skin hygiene was discussed with the patient and father. Patient was instructed to use an antibacterial soap at home AM and PM and after football practices. Patient and father were also instructed to clean out the patient’s football helmet after each practice. My preceptor instructed the patient’s father to purchase some Lotrimin AF (antifungal) and apply it to the patient’s face three to four times a day.
WHY did I not think of a fungal infection when the father mentioned football?!?! I was really disappointed in myself over this visit. The “aha” moment came when my preceptor asked me if I had thought tinea vesicolor. I told her, “No I honestly didn’t. I was going to call it contact dermatitis.” I discussed my findings with her and mentioned the discoloration and that is when she (my preceptor) stopped me. “That is your clue that it is tinea vesicolor.” My preceptor printed me off some information about tinea vesicolor and other tinea infections.
Skin discoloration is one of the first signs of tinea vesicolor. Also, tinea vesicolor becomes more noticeable when patients have a tan or are out in the sun, the yeast prevents the skin from tanning (American Academy of Dermatology [AAD], 2017). Tinea vesicolor discoloration can be so light patients may not even be aware they have it while others will mistake it for vitiligo. Vitiligo is an actual skin disease that causes the skin to lose its natural color (AAD, 2017).