Tinea

• Tinea:

  • Ringworm is a common superficial fungal infection which affects the skin
  • Often circular shaped lesions
  • Ringworm is also known as tinea or dermatophytosis
  • More common in hot, humid environments
• Aetiology:

  • Tinea (ringworm) is caused by dermatophytes - a type of fungus
  • Depending on the location it can be referred to as:
  • Tinea capitis - scalp
  • Tinea pedis - feet
  • Tinea cruris - groin
  • Tinea corporis - body
  • Tinea unguium/onchomycosis - nail
• Ringworm is spread by skin-skin contact or contact with an infected surface.

  Risk factors include:

  • Male sex
  • Contact with an infected person
  • Frequent use of communal shower facilities
  • Not drying feet adequately (risk of tinea pedis)
• The most at-risk groups include children attending daycare and early school and households of an infected person.
• Medical risk factors are those primarily relating to an immunocompromised state or skin condition affecting the skin’s barrier, and include:

  • Previous tinea infections
  • Diabetes mellitus
  • Hyperhidrosis
  • Xerosis (dry skin)
  • Ichthyosis
• Typical symptoms of tinea corporis include:

  • An asymmetrical rash consisting of solitary circular erythematous patches with a raised scaly leading edge and a clearing centre (hypopigmentation within the ring)
  • Itch
• Other important areas to cover in the history include:

  • Social history: usually affects children in daycare or early school years
  • Infectious contacts: either as a classmate, carer or household contact
  • Other risk factors: frequent use of communal showers, pools or gyms, athletes
  • Contact with animals
• Tinea corporis:

  asymmetrical rash that appears as solitary circular erythematous patches with a raised scaly leading edge and hypopigmentation within the ring.
• Tinea capitis (scalp):

  • often begins as a pimple that grows, creating dry, scaly, bald patches of skin
  • Associated with brittle hair and hair loss at sites of infection.
  •  It can crust over and often be mistaken for dandruff.
• Tinea pedis:

  • results in dry and cracked skin between the toes, with a scaling rash that can move proximally if not treated.
• Tinea ungium (nails):

  •  results in nail beds that are thickened, keratotic, dry, brittle and cracking
• Tinea cruris (groin):

  • appears as annular plaques over the groin folds
• Investigations:

  • Clinical diagnosis
  • Skin scraping for MCS of the leading edge may be taken in cases that fail to respond to initial anti-fungal treatment - topical therapy must be removed first
  • Hair and nail cuttings may also be used
  • A Wood's lamp can examine hair as affected hairs with fluoresce green
  • Treatment resistant or atypical presentations may require a skin biopsy
• First line management:

  • Topical terbinafine 1% - antifungal - once or twice daily for 1-2 weeks
  • Econazole cream
• Oral therapy:

  • 2nd line treatment
  • If infection is severe, affecting multiple sites, recurrent, or not responding to topical treatment
  • Oral terbinafine is first choice
  • LFTs need to be monitored
• Mild topical steroid cream can be given alongside anti-fungal to help with itch
• Complications most commonly arise in the immunocompromised:

  • Most common complication is secondary bacterial co-infection with staphylococcus aureus
  • Those with untreated HIV/AIDs can experience a disseminated infection that can affect any organ, including the brain leading to serious cerebral complications and even death