Tinea — Site-Specific Variants

A 35-year-old woman presents with a 3-month history of progressive hair loss and scaling of the scalp. On examination, she has multiple well-demarcated patches of alopecia with broken hairs at the surface, erythema, and fine scaling. Fungal culture grows Trichophyton mentagrophytes. She reports no pruritus. What is the most likely diagnosis?

A 35-year-old woman presents with onycholysis, subungual hyperkeratosis, and discoloration of the toenails for 8 months. Fungal culture confirms Trichophyton rubrum. What is the preferred systemic antifungal regimen for tinea unguium (onychomycosis)?

A 32-year-old male presents with pruritic, scaly patches on the groin and inner thighs for 3 weeks. Clinical examination reveals well-demarcated erythematous plaques with a raised border and central clearing. The lesions spare the scrotum. Which investigation is most appropriate to confirm the diagnosis of tinea cruris?

A 28-year-old woman with diabetes presents with erythematous, scaly patches on the dorsal surfaces of both hands and forearms. Fungal culture confirms *Trichophyton mentagrophytes*. Regarding tinea corporis, all of the following are true EXCEPT:

A 32-year-old male farmer from rural Maharashtra presents with severe itching and maceration between the 4th and 5th toes for 3 weeks. On examination, there is erythema, scaling, and fissuring in the interdigital web space. KOH mount confirms fungal elements. He has tried topical antifungals for 1 week without improvement. What is the most appropriate next step in management?