II. Etiology
- Trichophyton rubrum
- Epidermophyton floccosum
- Trichophyton tonsurans
- Trichophyton mentagrophytes
- Microsporum canis
III. Risk Factors
- Immunocompromised patients
- Allergic dermatitis and other causes of disrupted skin
- Genetic predisposition
IV. Pathophysiology
- Infection
- Exposure to contaminated soil
- Exposure to infected people (e.g. Tinea Corporis Gladiatorum)
- Exposure to infected animals (e.g. dogs, cats, rabbits, rodents)
- Will appear on dog skin as red lesions with Alopecia and crusting
- Typically Microsporum canis
- Growth and transmission facilitating factors
- Warm and moist environments (showers and pools)
- Shared towels or clothing
V. Signs
- Location: Glabrous skin (excludes palms, soles, groin)
- Characteristics
- Round, erythematous, Scaling, pruritic Plaques
- Annular Lesion (hence the name Ringworm)
- Raised, advancing border
- Plaque with central clearing
- No central clearing after Corticosteroid use
- Postinflammatory pigmentation changes
VI. Precautions
- Widespread Ringworm suggests underlying disease
VII. Lab
-
Potassium Hydroxide (KOH 20%)
- Scrape from active border
- Chlorazol black
- Highlights fungal hyphae
-
Fungal Culture
- Suspected dermatophyte infection despite negative KOH
- Dermatophyte testing medium (DTM)
- Biopsy
- PAS stain will show hyphae in Stratum Corneum
VIII. Differential Diagnosis
- See Annular Lesion
- Pityriasis Rosea (especially the herald patch)
- Nummular Eczema (Atopic Dermatitis)
- Drug allergy or Fixed Drug Eruption
- Guttate Psoriasis (annular Psoriasis)
- Erythema Annulare Centrifugum
- Erythema Multiforme
- Contact Dermatitis
- Discoid Lupus
- Bowen's Disease
- Parapsoriasis
- Mycosis Fungoides (Cutaneous T Cell Lymphoma)
- Granuloma Annulare
- Secondary Syphilis
- Seborrheaic dermatitis
IX. Management
- Prevent re-infection (see pathophysiology above)
-
Topical Antifungal applied twice daily for 2-3 weeks
- Technique
- Apply to infected and normal skin 2 cm beyond affected area
- Continue for 7 days after symptom resolution
- First line: Imidazoles (e.g. Clotrimazole)
- Refractory cases: Naftin, Lamisil, Loprox, Mentax
- Technique
- Systemic Antifungal
- Indications
- Immunocompromised patient
- Disabling or widespread lesions
- Chronic infection
- Hyperkeratotic area involvement (palms or soles)
- Duration
- Start with 2-4 week course
- Consider extending prescription for additional 2-4 week course
- Preparations
- Terbinafine 250 mg orally daily
- Fluconazole 150 mg orally once per week
- Itraconazole (Sporanox)
- Griseofulvin 0.5-1.0 grams per day
- Ketoconazole 200 mg orally daily
- Indicated only for severe, refractory cases due to Ketoconazole hepatotoxicity
- If Ketoconazole is used, requires Liver Function Tests at baseline and again weekly
- Indications
-
Return to School and sports
- May Return to School and daycare once treatment is started
- Avoid sports with person-to-person contact (e.g. wrestling) for 72 hours after treatment starts (or cover wound)
X. Complications
- Deep follicular Tinea Infection (Majocchi's Granuloma)
- Complication of Topical Corticosteroid use
- More commonly affects women, and most often on legs
XI. References
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Related Studies
| Definition (MSH) | Fungal infection of keratinized tissues such as hair, skin and nails. The main causative fungi include MICROSPORUM; TRICHOPHYTON; and EPIDERMOPHYTON. |
| Definition (MEDLINEPLUS) |
Tinea is the name of a group of diseases caused by a fungus. Types of tinea include ringworm, athlete's foot and jock itch. These infections are usually not serious, but they can be uncomfortable. You can get them by touching an infected person, from damp surfaces such as shower floors, or even from a pet. Symptoms depend on the affected area of the body:
Over-the-counter creams and powders will get rid of many tinea infections, particularly athlete's foot and jock itch. Other cases require prescription medicine. |
| Definition (NCI) | A skin infection caused by a fungus. |
| Definition (CSP) | general term describing various dermatophytoses; specific types include tinea capitis (ringworm of the scalp), tinea favosa (of scalp and skin), tinea pedis (athlete's foot), and tinea unguium (ringworm of the nails). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D014005 |
| ICD10 | B35.9 |
| SnomedCT | 47382004, 154394006, 266214005, 186984003 |
| English | Ringworm, Tinea, Tineas, TINEA, Tinea infection NOS, Tinea infections, Ringworm NOS, Tinea NOS, Microsporic tinea, NOS, Tinea, NOS, Ringworm, NOS, Tinea [Disease/Finding], infection tinea, ringworm, ringworms, tineas, tinea infection, tinea infections, Dermatophytosis, Dermatophytoses, Tinea Infections, Dermatophytosis-tinea/ringworm, Tinea Infection, Tinea infection, Microsporic tinea, tinea, tinea; microsporic, Microsporic tinea NOS |
| Portuguese | TINHA, Tinha NE, Infecção de tinha NE, Dermatofitoses, Infecção por tinha, Infecções por tinha, Tinha |
| Spanish | TINA, Tiña NEOM, Infección por tiña NEOM, sérpigo, Dermatofitosis, tiña microspórica, tiña, Tiñas, Tiña |
| German | TINEA, Tinea NNB, Ringwurm NNB, Tinea-Infektion NNB, Tinea-Infektionen, Tinea-Infektion, Tinea, Trichophytie |
| Italian | Forme varie di tigna, Infezione da tigna, Infezione da tigna NAS, Tigna NAS, Tricofizia, Tigna |
| Dutch | spoelworm NAO, tinea, tinea-infectie NAO, tinea NAO, tinea; door Microsporum, tinea-infecties, tinea-infectie, Ringworm, Tinea |
| French | Teigne SAI, Infection aux teignes SAI, Teignes, TINEA, Dermatophytoses, Teigne à champignons, Teigne, Tinea |
| Japanese | 白癬ＮＯＳ, 白癬感染ＮＯＳ, 白癬感染, ﾊｸｾﾝｶﾝｾﾝ, ﾊｸｾﾝｶﾝｾﾝNOS, ﾊｸｾﾝ, ﾊｸｾﾝNOS, タムシ, 白せん, 白癬症, 表皮糸状菌症, 輪癬, たむし, 白癬 |
| Swedish | Tinea |
| Czech | tinea, Tinea, Tinea NOS, Dermatofytózy, Plísňová infekce, Plísňové onemocnění NOS, Plísňová infekce NOS, mikrosporie |
| Finnish | Tinea |
| Russian | EPIDERMOFITOZ, DERMATOFITII, DERMATOMIKOZ, TRIKHOFITOZ, ДЕРМАТОМИКОЗ, ДЕРМАТОФИТИИ, ТРИХОФИТОЗ, ЭПИДЕРМОФИТОЗ |
| Croatian | Not Translated[Tinea] |
| Polish | Liszaj obrączkowy, Grzybica powierzchowna, Liszaj obrębny, Grzybica naskórkowa |
| Hungarian | Bőrgomba k.m.n., Tinea fertőzések, Tinea fertőzés, Tinea k.m.n., Tinea, trichophytosis fertőzés k.m.n. |
| Norwegian | Tinea, Ringorm |
Ontology: Tinea corporis (disorder) (C0040252)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | B35.4 |
| SnomedCT | 186994008, 154400008, 84849002 |
| English | Ringworm of body, Tinea corporis (disorder), tinea corporis, tinea corporis (diagnosis), Ringworm of the body, tinea body, body ringworm, of body ringworm, corporis tinea, herpes circinatus, body tinea, Ringworm of body (disorder), Tinea corporis, Tinea circinata, Herpes circinatus, Tinea circinatus, Body tinea, body; ringworm, circinatus; herpes, corporis; tinea, herpes; circinatus, ringworm; body, tinea; corporis |
| Italian | Tinea corporis, Dermatofitosi del corpo, Tigna del corpo |
| Dutch | ringworm van het lichaam, tinea corporis, circinatus; herpes, corporis; tinea, herpes; circinatus, lichaam; ringworm, ringworm; lichaam, tinea; corporis, Tinea corporis, lichaamstinea |
| French | Trichophytie des parties découvertes du corps, Teignes corporelles, Dermatophytose de la peau glabre |
| Portuguese | Tinha do corpo, Tinha corporal |
| Japanese | 体部白癬, ﾀｲﾌﾞﾊｸｾﾝ |
| Czech | Plísňové onemocnění kůže těla, Tinea corporis |
| Korean | 체부 백선증 |
| Hungarian | tinea a törzsön, tinea corporis, Test bőrgombája |
| Spanish | herpes circinado, tiña circinada, tiña del cuerpo (trastorno), tiña del cuerpo, tricofitosis del cuerpo, Tiña corporal |
| German | Tinea corporis |
