Tinea

Definition :
• "Tinea" refers to a skin infection with a dermatophyte
(ringworm) fungus.

Types:
Depending on which part of the body is affected, it is given a specific
name.

• Tinea barbae (beard)

• Tinea capitis (head)
• Tinea corporis (body)
• Tinea cruris (groin)
• Tinea faciei (face)
• Tinea manuum (hand)
• Tinea pedis (foot)
• Tinea unguium (nail)

Sometimes, the name gives a different meaning.

•Tinea versicolor, also more accurately called Pityriasis

versicolor, a common yeast infection on the trunk
•Tinea incognito when the clinical appearance has changed
because of inappropriate treatment
•Tinea nigra affects the palms or soles which appear brown (on
white skin) or black (on dark skin)

Frequency
.International prevalence of tinea has ranged from 1-14%
In Egypt 13.66% in upper Egypt
In Egypt the most common types are tinea versicolor, tinea
corposis, tinea cruris
Causes
The various tinea infections are caused chiefly by species of the
genera Microsporum, Trichophyton, and Epidermophyton.

Tinea corporis is mainly caused by T tonsurans and also by M

canis and T rubrum.

Risk factors for tinea infection include the following:

• Moist conditions
• Communal baths
• Immunocompromised states
• Cushing syndrome
• Atopy
• Genetic predisposition
• Athletic activity that causes skin tears, abrasions, or
trauma such as wrestling, judo, or soccer

Clinical manifestations:
History
• It takes about 2 weeks from inoculation to subsequent
skin changes that are clinically visible.
• Pruritus (itching) is the main symptom in most forms of
tinea. Findings can be subtle and care must be taken in
examination, as a novel form of delusional tinea has been
described in several reports.
• Patients with tinea capitis have hair loss. Infected hairs
are brittle and break easily.
• Asking the patient about participation in sports, such as
judo, karate, wrestling, and other contact sports, is important.
Likewise, asking the patient about military enrollment and any
contacts with similar skin disease is important.
Physical
At physical examination, the various types of tinea may have
different findings, as follows:

• Tinea capitis
o The clinical appearance of fungal infection of the
scalp varies depending on the type of hair invasion.
o Alopecia (hair loss), with hairs breaking at the
scalp surface, usually is present.
• Tinea corporis
o Infection typically is on the exposed skin of the
trunk and extremities.
o It is characterized by annular scaly plaques with
raised edges, pustules, and vesicles. It can also have
geometric patterns. This is usually tinea imbricata
(Trichophyton concentricum).
o Tinea corporis gladiatorum is seen on the head,
neck, and arms, in a distribution consistent with the areas
of skin-to-skin contact in wrestling.
• Tinea pedis
o This is a fungal infection of the toe webs and
plantar surface and often affects only one foot.
o Toe-web scaling, fissuring, and maceration; scaling
of soles and lateral surfaces; erythema; vesicles;
pustules; and bullae may be present.
• Tinea manuum
o This is a fungal infection of the palms and finger
webs that usually occurs in association with tinea pedis.
o Usually, only one hand is involved.
o Scaling and erythema may be present.
• Tinea cruris
o It is a dermatophytic infection of the groin and
pubic region.
o It is characterized by erythematous lesions with
central clearing and raised borders.
o Tinea cruris often co-occurs with tinea pedis or
tinea unguium.
• Tinea barbae
o The beard and neck area are affected.
o Erythema, scaling, and pustules are present.
• Tinea unguium
o Tinea unguium is also called onychomycosis; this
is an infection of the nail.
o It is characterized by onycholysis (nail plate
separation from nail bed) and thickened, discolored
(white, yellow, brown, black), broken, and dystrophic
nails.
• Tinea incognito: This is a common difficult diagnosis to
make without history. It is often present as a result of prior
treatment with hydrocortisone causing atypical appearance
Pityriasis versicolor :
Pityriasis versicolor is a common skin complaint in which
flaky discoloured patches appear mainly on the chest and back.
The term ‘pityriasis’ is used to describe skin conditions in
which the scale appears similar to bran. The multiple colours
arising in the disorder give rise to the second part of the name,
‘versicolor’.
It sometimes called ‘tinea versicolor’, although the term
‘tinea’ should strictly refer to infection with a dermatophyte
fungus. Pityriasis versicolor affects the trunk, neck, and/or
arms, and is uncommon on other parts of the body.
The patches may be pink, coppery brown or paler than
surrounding skin. They may be mildly itchy. Pale patches may
be more common in darker skin; this appearance is known as
pityriasis versicolor alba and is less likely to itch. Sometimes
the patches start scaly and brown, and then resolve through a
non-scaly and white stage.
Diagnosis of Ringworm (Tinea)

Diagnosis must rule out other possible causes of the signs and
symptoms, which may include eczema, psoriasis and contact
dermatitis.

A microscopic examination of some lesion scrapings usually will

confirm tinea infection. This is called a KOH (potassium hydroxide)
preparation. Culture of the affected area, which may take weeks,
may help identify the infecting organism.

Management :

Medication
o Tinea corporis infections may be treated with topical
agents (ie, creams, lotions, solutions, powders, sprays) as
the drug of choiceor with oral antifungals in extensive or
recalcitrant disease.
o For tinea capitis and nail infections, topical therapy is
ineffective. Findings with onychomycosis treatment were
discouraging because of the need for prolonged therapy
and the low success rate. However, in recent years, new
oral antimycotic drugs have been developed as the drug
of choice; these have greatly improved the outlook
(especially for patients with fungal toenail infection).
o Use of oral medications requires baseline LFT checks as
well as repeat labs half way through the typical 3 month
course. Cultures are also recommended when managing
children, as oral medications are more difficult for this
age group.
Levels of Prevention of Ringworm
(Tinea):
Primary prevention:
1. The skin should be kept dry, since moist skin favors the
growth of fungi. Dry the skin carefully after bathing and
let it dry before dressing.
2. Loose-fitting underwear is recommended. Socks should
be changed daily.
3. Sandals or open-toed shoes may be beneficial.
4. Talc or other drying powders may also be helpful.

:Secondary prevention