A 6-year-old child has a circular patch of skin with a clear centre and a red, scaly outer edge that is very itchy. Which of the following is the most appropriate treatment?

• A. Clotrimazole cream
• B. Hydrocortisone cream
• C. Mupirocin cream
• D. Betamethasone cream

Answer: (A)

This pattern is classic for a fungal skin infection, tinea corporis, characterized by a circular patch with a clear center and a red, scaly, intensely itchy border. The first-line treatment for mild cases in children is a topical antifungal that penetrates the outer skin layers to eradicate the fungus.

Clotrimazole cream is an azole antifungal that inhibits fungal ergosterol synthesis, weakening the cell membrane and stopping fungal growth. This directly treats the infection rather than just relieving symptoms, making it the most appropriate choice for a child with this presentation.

Using a corticosteroid alone, such as hydrocortisone or betamethasone, would only dampen inflammation and itching but would not destroy the fungus and could even worsen the infection or cause skin thinning with prolonged use. Mupirocin targets bacteria, not fungi, so it won’t clear a fungal infection. A potent steroid like betamethasone is unnecessary and risky in a child for a superficial fungal infection.

So, applying clotrimazole cream as directed until the infection clears is the best option.