II. Etiology

  1. Trichophyton rubrum
  2. Epidermophyton floccosum
  3. Trichophyton tonsurans
  4. Trichophyton mentagrophytes
  5. Microsporum canis

III. Risk Factors

  1. Immunocompromised patients
  2. Allergic dermatitis and other causes of disrupted skin
  3. Genetic predisposition

IV. Pathophysiology

  1. Infection
    1. Exposure to contaminated soil
    2. Exposure to infected people (e.g. Tinea Corporis Gladiatorum)
    3. Exposure to infected animals (e.g. dogs, cats, rabbits, rodents)
      1. Will appear on dog skin as red lesions with Alopecia and crusting
      2. Typically Microsporum canis
  2. Growth and transmission facilitating factors
    1. Warm and moist environments (showers and pools)
    2. Shared towels or clothing

V. Signs

  1. Location: Glabrous skin (excludes palms, soles, groin)
  2. Characteristics
    1. Round, erythematous, Scaling, pruritic Plaques
    2. Annular Lesion (hence the name Ringworm)
      1. Raised, advancing border
      2. Plaque with central clearing
        1. No central clearing after Corticosteroid use
    3. Postinflammatory pigmentation changes

VI. Precautions

  1. Widespread Ringworm suggests underlying disease

VII. Lab

  1. Potassium Hydroxide (KOH 20%)
    1. Scrape from active border
  2. Chlorazol black
    1. Highlights fungal hyphae
  3. Fungal Culture
    1. Suspected dermatophyte infection despite negative KOH
    2. Dermatophyte testing medium (DTM)
  4. Biopsy
    1. PAS stain will show hyphae in Stratum Corneum

IX. Management

  1. Prevent re-infection (see pathophysiology above)
  2. Topical Antifungal applied twice daily for 2-3 weeks
    1. Technique
      1. Apply to infected and normal skin 2 cm beyond affected area
      2. Continue for 7 days after symptom resolution
    2. First line: Imidazoles (e.g. Clotrimazole)
    3. Refractory cases: Naftin, Lamisil, Loprox, Mentax
  3. Systemic Antifungal
    1. Indications
      1. Immunocompromised patient
      2. Disabling or widespread lesions
      3. Chronic infection
      4. Hyperkeratotic area involvement (palms or soles)
    2. Duration
      1. Start with 2-4 week course
      2. Consider extending prescription for additional 2-4 week course
    3. Preparations
      1. Terbinafine 250 mg orally daily
      2. Fluconazole 150 mg orally once per week
      3. Itraconazole (Sporanox)
      4. Griseofulvin 0.5-1.0 grams per day
      5. Ketoconazole 200 mg orally daily
        1. Indicated only for severe, refractory cases due to Ketoconazole hepatotoxicity
        2. If Ketoconazole is used, requires Liver Function Tests at baseline and again weekly

X. Complications

  1. Deep follicular Tinea Infection (Majocchi's Granuloma)
    1. Complication of Topical Corticosteroid use
    2. More commonly affects women, and most often on legs

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Related Studies

Ontology: Tinea (C0040247)

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:

  • Ringworm is a red skin rash that forms a ring around normal-looking skin. A worm doesn't cause it.
  • Scalp ringworm causes itchy, red patches on your head. It can leave bald spots. It usually affects children.
  • Athlete's foot causes itching, burning and cracked skin between your toes.
  • Jock itch causes an itchy, burning rash in your groin area.

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
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, タイブハクセン
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