Tinea cruris und corporis fungální infekce (Objednejte antifungální sprej OnycoSolve)

Tinea Corporis (Ringworm)

Medically reviewed by

More than 3 million US cases per year

  • Requires medical diagnosis
  • Symptoms: Scaly patches, itchy skin, ring- or circled-shape of raised pimples
  • Color: Typically red
  • Location: Anywhere on the skin
  • Treatment: Antifungal medication

Tinea corporis is a fungal skin infection also known as ringworm of the body. The most common cause of ringworm is infection from person to person. The disease can also be transmitted from pets to humans, and then on to other people. Ringworm is a common and very contagious disease. Epidemics sometimes occur in kindergartens.

A group of fungi called dermatophytes cause ringworm. Dermatophytes live off a substance called keratin, a tissue found in many parts of a person’s body, including the nails, skin, and hair. In ringworm of the body, the fungus infects the skin. Ringworm of the body is also called tinea corporis (the specific dermatophyte is tinea). Other related ringworm fungal infections have similar names, including:

  • tinea pedis, commonly called athlete’s foot
  • tinea cruris, also known as jock itch
  • tinea capitis, also known as ringworm of the scalp

Symptoms of Tinea Corporis (Ringworm)

The rash looks like a ring- or circled-shape of raised pimples and usually occurs on the face, arms, and legs. The surface is often scaly and the size can vary from a few millimeters to several centimeters. When the spots become larger, they begin to heal in the middle, and then get its characteristic ring shape. Symptoms of a more severe infection include rings that multiply and merge together. You may also develop blisters and pus-filled sores near the rings.

What can I do?

Applying topical fungicidal medications can relieve symptoms or treat the infection. There are over-the-counter brands you can use, including clotrimazole (Lotrimin AF), miconazole (Micatin), terbinafine (Lamisil), tolfaftate (Tinactin). Your pharmacist can help you choose which one is right for you. The following precautions should be taken to avoid ringworm infections:

  • avoid sharing towels, hats, hairbrushes, and clothing with an infected person
  • take your pet to see a vet if a ringworm infection is suspected
  • if you are infected, be sure to maintain good personal hygiene around other people and avoid scratching the affected areas of your skin
  • after a shower dry your skin well especially between the toes and where skin touches skin such as in the groin and armpits.

Should I seek medical care?

If you get an itchy rash that grows in size, you should contact your healthcare provider. Ringworm does not heal by itself and needs to be treated with fungicides. Fungicides are primarily used as topical cream, but sometimes also as tablets.

Treatment for Tinea Corporis (Ringworm)

Tinea corporis is contagious and susceptibility is increased with poor hygiene, skin and nail injuries, and excessive sweating. Creams can treat the infection. If the ringworm of the body is widespread, severe, or does not respond to the over-the-counter medicines, your doctor may prescribe a stronger topical medication or a fungicidal that you take by mouth. Griseofulvin is a commonly prescribed oral treatment for fungal infections.

Tinea corporis

Tinea corporis is a dermatophyte fungal infection caused by the genera Trichophyton or Microsporum.

Related terms:

Learn more about Tinea corporis

Cutaneous and subcutaneous mycoses

Tinea corporis

Tinea corporis refers to all the dermatophyte infections of the trunk, legs, arms, and neck, excluding the feet, hands and groin. The causative agent is usually T. rubrum (incidence ranging from 32% to 60% of cases), followed by T. tonsurans (in 17.7–34.3% of cases). 2,17 Tinea corporis is more frequent in tropical and subtropical areas. 29 The infections are usually acquired by autoinoculation from other areas of the body such as the feet or scalp or by contact with animals. 30

Clinical features

Usually the patient presents with lesions on the body lasting from days to months with mild pruritus or even no symptoms. The typical presentation is an annular plaque that expands in a centrifugal pattern. The border is usually “active” with an erythematous elevated shape and occasionally small papules. The center of the lesion is paler ( Fig. 24-3 ). Sometimes it presents with granulomatous plaques and is designated Majocchi’s granuloma. The lesions are more inflammatory if the cause is a zoophilic infection and usually present with vesiculation and crusted margins. 30

Differential diagnosis

The differential diagnoses include atopic dermatitis, allergic contact dermatitis, psoriasis, pityriasis versicolor, pityriasis alba, erythema migrans, subacute lupus erythematosus, annular erythema and mycosis fungoides.

Localized tinea corporis can be treated by topical imidazoles (e.g., clotrimazole), and butenafine or terbinafine. 31,32 Oral treatment is also useful as a short course of oral terbinafine. 33

Dermatophytes and dermatophytoses

Tinea corporis

Tinea corporis refers to annular lesions with raised borders originating on the glabrous skin. Lesions may be singular, multiple or confluent, and exhibit a range of inflammatory responses, ranging from scaling and minimal erythema to highly inflammatory lesions composed of pustules, vesicles, and marked erythema. Inflammation is often greatest at the advancing edge of the lesion, with a certain amount of central clearing. The most common causes are T. rubrum, T. mentagrophytes, and M. canis. Infection of hair follicles within the lesion can lead to a deep dermal inflammatory reaction similar to kerion of the scalp, termed Majocchi’s granuloma. Tinea imbricata is caused by T. concentricum, which causes concentric rings of scaling which spread peripherally over many years.

Superficial Fungal Infections

Tinea Corporis

The clinical manifestations of tinea corporis are varied and often depend on the infective species. The disease often follows contact with infected animals, but occasionally results from contact with contaminated soil. M. canis is a frequent cause of human infection and T. verrucosum infection is common in rural districts. Infections with anthropophilic species, such as T. rubrum, often follow spread from another site, such as the feet. Infections with T. tonsurans are sometimes seen in children with tinea capitis.

The characteristic lesion is an annular scaling plaque with a raised erythematous border and central clearing. In their most florid form the lesions can become indurated and pustular ( Figure 14-2 ). This is more common in infections with zoophilic organisms. The differential diagnosis includes discoid eczema, impetigo, psoriasis and discoid lupus erythematosus. Perifollicular pustules (Majocchi's granuloma) are indicative of deep-seated follicular involvement and require systemic therapy.

Fungal infections in pediatric patients

Dermatophytoses and other superficial fungal infections

Dermatophytosis is caused by Microsporon spp., Trichophyton spp., and Epidermophyton floccosum . While tinea capitis, tinea corporis , and tinea facialis are not infrequently encountered in children, onychomycosis is unusual. The most common agent of tinea capitis in North America is the anthropophilic fungus Trichophyton tonsurans 96 whereas in several parts of Europe the zoophilic fungus Microsporum canis predominates. 97 When due to anthropophilic dermatophytes, tinea capitis is readily spread among children and, if unrecognized, can serve as a source of nosocomial tinea corporis for hospital staff. 98 The manifestations of tinea capitis vary and include non-inflammatory and inflammatory variants. Oral griseofulvin plus selenium sulfide shampoos is the traditional treatment of choice for tinea capitis and kerion. 96 More recent alternatives include systemic therapy with fluconazole, itraconazole or terbinafine. 99 These approaches may be particularly useful in immunocompromised patients who may fail conventional therapy or who have locally invasive infections extending into the dermis and causing painful erythematous, nodular or ulcerative lesions. 100

Malassezia furfur and Malassezia pachydermatis are the agents of tinea versicolor that presents with hypopigmented macules on the upper trunk. Application of long-wave UV by a Wood’s lamp aids in the clinical diagnosis, and skin scrapings reveal typical clusters of blastoconidia and hyphae in the classic ‘spaghetti and meatballs’ pattern. Treatment is accomplished with selenium sulfide shampoo or topical agents; newer alternatives include oral itraconazole or fluconazole.

Candida albicans is a ubiquitous agent of diaper dermatitis that may be precipitated by moisture, occlusion, fecal contact and urinary pH. Its classic presentation is that of an erythema bordered by a collarette of scale with satellite papules and pustules. Concomitant dermatophytosis may occasionally be present. Treatment consists of the correction of physiologic factors and topical antifungal treatment. 16

Matrix Metallopeptidase-19

MMP-19 and Other Pathological Conditions

MMP-19 has been implicated in several skin disorders in which proliferation and differentiation of keratinocytes is disturbed. Thus, in both tinea corporis and eczema, MMP-19 is expressed in the stratum basale and in the healthy epidermis, but also in the spinous layers [27] . Likewise, it has been reported that MMP19 is upregulated in psoriasis, a disease characterized by keratinocyte hyperproliferation, angiogenesis and infiltration of inflammatory cells [28] . MMP-19 is also dysregulated in chronic wounds where it is induced in the proliferating epithelium. However, its expression is lost during malignant transformation of the epithelium cells, being absent from invasive areas of squamous cell carcinoma [14] . Finally, MMP-19 has also been implicated in a panoply of diseases such as renal dysplasia, Dupuytren’s disease, Paget’s disease, chronic limb ischemia or Henoch-Schönlein purpura [29–33] .

Olive Oil in Botanical Cosmeceuticals

Fungal and Bacterial Infections

The following year, Al-Waili tested this same mixture in 37 patients as a treatment for the cutaneous fungal infections pityriasis versicolor, tinea cruris, tinea corporis , and tinea faciei. The honey/olive oil/beeswax mixture was applied to the various lesions three times daily for up to 4 weeks. The author observed a clinical response in terms of erythema, scaling, and pruritus in 86% of pityriasis versicolor patients, 78% of tinea cruris patients, and 75% of tinea corporis patients, with mycological cure achieved in a significant percentage of patients (75%, 71% and 62% of patients with pityriasis versicolor, tinea cruris, and tinea corporis , respectively). In addition, after 3 weeks of therapy, the lone patient with tinea faciei exhibited clinical as well as mycological resolution. Al-Waili suggested that these findings indicate that the honey/olive oil/beeswax mixture appears effective for treating these cutaneous fungi and that future controlled trials evaluating this compound are warranted ( Al-Waili, 2004 ). In 2005, Al-Waili assessed the effects of the same honey/olive oil/beeswax mixture on the growth of Staphylococcus aureus and Candida albicans isolated from humans and found that both the honey mixture as well as honey alone were effective in suppressing bacterial growth, whereas mild to moderate growth was observed on media containing olive oil or beeswax ( Al-Waili, 2005a ). That same year, Al-Waili tested the honey, olive oil, and beeswax mixture on 12 infants experiencing diaper dermatitis. The infants were treated four times daily for 7 days, and erythema was assessed on a five-point scale. A significant reduction in the mean lesion score was observed from baseline (2.91 ± 0.79) to day 7 (0.66 ± 0.98). In addition, Candida albicans was isolated in four patients prior to the treatment regimen, but only two patients after the 1-week of treatment. Overall, the honey/olive oil/beeswax compound was deemed to be a safe as well as clinically and mycologically effective therapy for diaper dermatitis ( Al-Waili, 2005b ).

A worldwide yearly survey of new data in adverse drug reactions

Antifungals

Antifungal Treatments: Literature Review

Tinea infections are fungal infections of the skin caused by dermatophytes that may affect up to 20% of the global population. These infections may be further classified as tinea corporis (ringworm) and tinea cruris (jock itch) and are generally diagnosed by appearance and confirmed with microscopy or culture. A literature review of 129 randomized controlled trials with 18 086 patients diagnosed with either tinea corporis or tinea cruris infections. The duration of treatments ranged from 1 week to 2 months, but the most common duration was 2–4 weeks. Follow-up also varied: from 1 week to 6 months. The adverse effects were minimal, occurred infrequently and were typically reports of irritation and burning. However, no conclusions could be made using the reported adverse effects as there was no clear differentiation between treatment versus placebo and between the different types of treatments. The authors concluded that terbinafine and naftifine treatments for tinea infections were the most effective with minimal side effects [ 3 R].

A worldwide yearly survey of new data in adverse drug reactions

Terbinafine [SEDA-15, 3316; SEDA-33, 541; SEDA-34, 427; SEDA-35, 483]

Immunology A generalised blistering skin eruption, meeting the criteria for Rowel syndrome, has been attributed to terbinafine [ 1 A ].

A 65-year-old woman took oral terbinafine to treat tinea corporis . Three weeks later, she developed widespread targetoid lesions with blisters and denuded skin. Mucosal erosions were involved and the patient was diagnosed with Stevens–Johnson syndrome with toxic epidermal necrolysis. Raised liver enzymes were also observed. Terbinafine was withdrawn resulting in a slow recovery. Five weeks later, the patient developed lupus erythematosus-like annular erythematous lesions and facial erythema together with immunological findings. Topical treatment together with prednisolone (30 mg) resolved the symptoms.

Skin Several cases of acute generalised exanthematous pustulosis (AGEP) have been attributed to terbinafine [ 2 A , 3 A ].

A 42-year-old man and a 38-year-old man developed AGEP after taking oral terbinafine for 14 days [ 2 A ]. Both presented progressively worsening painful rash with small white pustules. Terbinafine immediately and topical steroids resolved the symptoms within a week for the first patient. The other patient received first oral steroid, then cefalexin, but the symptoms continued to develop. After obtaining emergency care, the patient was diagnosed with AGEP and was treated with intravenous methylprednisolone, which resolved the symptoms.

Two cases of AGEP and one with generalised pustular psoriasis developed after taking oral terbinafine (250 mg daily) [ 3 A ]. Methylprednisolone (1 mg/kg per day) led to rapid resolution of the AGEP patients and the third case was treated with acitretin (0.6 mg/kg per day) to which the symptoms responded.

Sensory systems, ear Six cases of hearing impairment attributed to oral terbinafine intake were reported to the Netherlands Pharmacovigilance Centre Lareb [ 4 A ]. Both male and female were involved and the latency between terbinafine use and hearing impairment was from 2 days to 6 months. Outcomes for two cases were reported and the patients recovered after withdrawal of terbinafine.

DERMATOMYCOSIS

JOANN L. COLVILLE DVM , DAVID L. BERRYHILL PHD , in Handbook of Zoonoses , 2007

DERMATOMYCOSIS IN HUMANS

It is important to remember that animals are a minor source of dermatomycosis in people. In healthy people, lesions stay on the keratinized layers of skin and hairs, but in people with suppressed immune systems, the infection can go deeper and become systemic. Fungal skin infections in people are named by where they are found on the body:

Tinea corporis is seen on the skin. The lesions appear as small, red spots that grow into large rings on the arms, legs, or chest.

Tinea pedis is also known as athlete's foot. The lesions usually begin between the toes, where the skin is moist. They become red and itchy and have a wet surface. If the fungus spreads to the toenails, it becomes tinea unguium. The toenails become thick and crumbly. Scratching the area can spread the infection to hands and fingernails.

Tinea cruris, also known as jock itch, is caused by fungus growing in the moist, warm area of the groin. The lesions are found most often in men who frequently wear athletic equipment.

Tinea capitis, also known as ringworm, is found on the head. The lesions begin as itchy, red areas where eventually the hair is destroyed, leaving bald patches. Ringworm is the most common dermatomycosis in children.

Dermatophytosis

Clinical Presentation of Humans

Incidence in Humans

The cumulative incidence of zoophilic dermatophytosis in the United States has been estimated at 2 million people per year.

Disease Forms/Subtypes

Dermatophytosis in humans is typically classified according to the location of the lesion(s).

Tinea capitis is dermatophytosis of the scalp. Three subtypes have been identified: ○

Extothrix: with follicular destruction and arthoconidia formation on the outside of hair shafts. This form is often caused by zoophilic species such as M. canis, M. gypseum, T. equinum, and T. vericosum.

Endothrix: arthroconidia occur within the hair shaft. This form is caused by anthropophilic species.

Favus: crusting form of scalp dermatophytosis caused by anthropophilic strains

Tinea corporis affects the glabrous skin of the body and may be caused by anthropophilic or zoophilic species.

Tinea cruris affects the medial thighs, perineum, and buttocks. This is often caused by anthropophilic species.

Tinea pedis and tinea unguium affect the feet and nails, respectively. These forms are most often caused by anthropophilic species.

History, Chief Complaint

Anthropophilic species: use of communal change rooms and showers, contact sports—particularly wrestling

Zoophilic species: contact with animals, environments shared with animals, or fomites that have contacted infected animals

Chief complaint

One or more erythematous, pruritic, and potentially exudative lesions

Lesions may have failed to respond to treatment with steroids or antimicrobial therapy.

Physical Findings in Infected Humans

Lesions often start as erythematous, scaly plaques. Lesions may progress to form extensive crusts, papules, vesicles, and potentially even bullae.

Lesions vary in size, shape, and distribution; however, zoophilic dermatophytosis tends to affect areas that come into direct or indirect contact with animals, such as hands, arms, legs, face, scalp, or neck.

Severe, pustular lesions known as kerion are most likely to occur in cases of zoophilic dermatophytosis.

Incubation Period

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Tinea corporis

Tinea corporis is a dermatophyte disease of the glabrous skin, excluding the scalp, beard, face, hands, feet, and groin.

Related terms:

Learn more about Tinea corporis

Tinea Corporis

Basic Information

Definition

Tinea corporis is a superficial dermatophyte fungal infection of the glabrous skin. Several areas of the body are excluded in the definition and have other names, such as the scalp (i.e., tinea capitis), bearded areas (i.e., tinea barbae), the groin (i.e., tinea cruris), hands (i.e., tinea manuum), feet (i.e., tinea pedis), and nails (i.e., onychomycosis).

ICD‐9‐CM Code

110.5 Tinea corporis

Epidemiology & Demographics

Tinea corporis is often acquired by close person‐to‐person contact, as occurs in a household, day care, or school.

The index case may have tinea corporis , capitis, or pedis.

Contact with domestic animals, particularly young kittens and puppies, is a common cause.

There have been several reports of epidemics among high school wrestlers (i.e., tinea gladiatorum).

Individuals with certain immunologic abnormalities, such as atopic dermatitis, presumably caused by a decreased cell‐mediated delayed sensitivity and an increased humoral (IgE) response, are particularly prone to chronic and recurrent dermatophyte infections.

Clinical Presentation

A round lesion that may be expanding is discovered by a caretaker or the patient.

The area may be mildly pruritic.

There are no associated systemic symptoms.

Physical Examination

The classic lesion is annular, oval, or circinate. It is minimally inflamed, with a sharply defined papulovesicular border and often with some central clearing.

The lesions typically begin as red papules or pustules that rupture and evolve to form papulosquamous lesions.

These lesions then spread out from the periphery as new vesicles form and begin to clear centrally.

Over a period of weeks, the patches may expand up to 5 cm in diameter.

The pattern can vary and may mimic many conditions. Lesions may be eczematous, vesicular, pustular, and less often, granulomatous.

Sites of predilection include the nonhairy areas of the face, trunk, and limbs.

Lesions are usually solitary but can be multiple.

Inappropriate treatment with topical steroids decreases the inflammation and alters the clinical appearance while the infection persists, a condition referred to as tinea incognito.

An uncommon but distinctive variant of tinea is a deeper granulomatous folliculitis and perifolliculitis disorder (i.e., Majocchi's granuloma). ○

Usually occurs on one lower leg or dorsum of a foot

Nodular lesions: sometimes several in one area

Often occurs on the legs of girls who shave their legs closely and get an infected ingrown hair

Caused by Trichophyton rubrum or Trichophyton mentagrophytes

Primary focus: diffuse T. rubrum infection of the foot

The species of dermatophyte causing tinea corporis depends on the source of the infection.

T. rubrum is the most common cause worldwide, probably because it spreads from the feet of those with tinea pedis.

In areas where tinea capitis is endemic, tinea corporis is more commonly caused by Trichophyton tonsurans, the most common cause of tinea capitis.

Microsporum canis is the usual cause if the spread is from a pet.

Other causative dermatophytes include Microsporum audouinii, T. mentagrophytes, Trichophyton verrucosum, and Epidermophyton floccosum.

Etiologic Agents of Infectious Diseases

Microbiology and Clinical Manifestations

Tinea corporis is a superficial skin infection that occurs worldwide in all age groups. It has a predilection for males and almost 50% of cases in the U.S. occur in children <15 years of age. 36 Any dermatophyte can cause disease, but the predominant pathogen varies geographically. T. rubrum, T. tonsurans, T. mentagrophytes, M. canis, and E. floccosum are the most common causes of tinea corporis in the U.S. Acquisition is through direct contact with infected humans or animals (primarily dogs and cats) and, less commonly, contaminated fomites. Infectivity and inflammatory potential vary by species. Outbreaks among wrestlers are common and have been termed tinea gladiatorum (tinea capitis also can be present in affected individuals). 37 T. tonsurans is the most common cause of tinea gladiatorum in the U.S. 38

Three forms of clinical disease can occur. Papulosquamous disease, the most common, manifests as an erythematous papule or plaque that transforms rapidly into an annular ring lesion with well-defined margins – the classic ringworm. Infection spreads similarly to involve the surrounding normal skin, often with central skin clearing. Inflammatory tinea corporis , such as occurs especially with M. canis, manifests with fine vesicular lesions at the plaque's advancing edge. Generally, lesions remain discrete; however, coalescence can occur. Granulomatous tinea corporis , the least common, occurs predominantly in children whose initial infection was misdiagnosed and treated with topical corticosteroid agents, in immunocompromised hosts, or in females who have re-inoculated the fungus while shaving their legs. 39 The granulomas occur when dermatophytes in hair follicles subsequently rupture into the dermis, causing an inflammatory response. The infection is subacute or chronic and manifests as firm, nontender skin nodules with an overlying crust or plaque; lesions associated with leg shaving are follicular or perifollicular and often have a circumferential scale on an erythematous base.

Isolated lesions of nummular eczema can mimic tinea corporis , as can the herald patch of pityriasis rosea. If tinea corporis is erroneously treated with topical corticosteroids, the classic features of ringworm may not be evident. In such cases, the term tinea incognito has been coined; KOH examination will help identify the dermatophyte. Granuloma annulare can be mistaken for tinea corporis and often is the cause of “resistant tinea corporis ”. Granuloma annulare is distinguished by the absence of scale; a KOH preparation or biopsy is useful in equivocal cases.

Cutaneous and subcutaneous mycoses

Tinea corporis

Tinea corporis refers to all the dermatophyte infections of the trunk, legs, arms, and neck, excluding the feet, hands and groin. The causative agent is usually T. rubrum (incidence ranging from 32% to 60% of cases), followed by T. tonsurans (in 17.7–34.3% of cases). 2,17 Tinea corporis is more frequent in tropical and subtropical areas. 29 The infections are usually acquired by autoinoculation from other areas of the body such as the feet or scalp or by contact with animals. 30

Clinical features

Usually the patient presents with lesions on the body lasting from days to months with mild pruritus or even no symptoms. The typical presentation is an annular plaque that expands in a centrifugal pattern. The border is usually “active” with an erythematous elevated shape and occasionally small papules. The center of the lesion is paler ( Fig. 24-3 ). Sometimes it presents with granulomatous plaques and is designated Majocchi’s granuloma. The lesions are more inflammatory if the cause is a zoophilic infection and usually present with vesiculation and crusted margins. 30

Differential diagnosis

The differential diagnoses include atopic dermatitis, allergic contact dermatitis, psoriasis, pityriasis versicolor, pityriasis alba, erythema migrans, subacute lupus erythematosus, annular erythema and mycosis fungoides.

Localized tinea corporis can be treated by topical imidazoles (e.g., clotrimazole), and butenafine or terbinafine. 31,32 Oral treatment is also useful as a short course of oral terbinafine. 33

Dermatophytosis

Tinea Corporis

Tinea corporis results from colonization of the glabrous skin by a dermatophyte. The fungus grows principally in the stratum corneum and usually does not enter viable tissue. While species of Trichophyton, Microsporum, and Epidermophyton all can produce tinea corporis , T. rubrum and T. mentagrophytes are the most common etiologic agents.

Transfer of epithelial scales containing hyphae, arthroconidia, or a combination of both originating from an infected person or animal, transmits the fungus to the skin of a susceptible person. The fungus enters the layers of cells composing the stratum corneum and spreads radially. After 1–3 weeks, clinical signs appear as the margin of the lesion expands. The fungus is eliminated from the central portion of the lesion, with concurrent formation of concentric zones of inflammation at the lesion's edge. Tinea corporis exhibits two basic types of lesions: annular and vesicular.

Anthropophilic dermatophytes such as T. rubrum and E. floccosum cause small, dry, scaly, spreading, annular patches with elevated areas of inflammation and red margins. The central areas heal as the fungus spreads radially. The lesions may resolve or remain as a chronic problem.

The second type of lesion, vesicular, is similar to the annular lesion. Vesicles form behind the advancing elevated lesion margin with subsequent crust formation. Hair invasion results in pustules. The lesions typically resolve in a few weeks; chronic lesions are uncommon. Vesicular lesions are characteristic of zoophilic dermatophytes such as T. mentagrophytes var. mentagrophytes and T. verrucosum. Pustular, well-circumscribed, elevated, crusted lesions are known as Majocchi's granuloma. Secondary bacterial infection can result in severe inflammatory lesions that can be disabling. 2

A special form of tinea corporis known as tinea imbricata is caused by Trichophyton concentricum in people living on the Pacific islands of Oceania and in Southeast Asia and Central and South America. The lesions consist of polycyclic rings of papulosquamous scales ( Fig. 82.5 ) that can be scattered over as much as 70% of the body. It is believed that the fungus is transmitted by direct, intimate contact. Genetic susceptibility to infection inherited in an autosomal recessive pattern has been demonstrated. 17

General Medical Problems of the Athlete

Julia Alleyne , Andrea Burry , in Clinical Sports Medicine , 2007

Tinea corporis (ringworm)

Tinea corporis is a superficial infection of non-hairy skin (face, trunk, limbs). It occurs as an erythematous scaling ring with raised borders. It is very pruritic and contagious, especially among wrestlers. 20

Diagnosis is usually made on clinical appearance and/or by KOH prepared skin scrapings because this is a test a team physician can do in the office ( Fig. 6.4 ).

Again topical antibiotic creams work best as with the other tinea infections. Extensive lesions should be treated with griseofulvin, 500 mg orally twice a day. All lesions should be covered with a pas-permeable membrane before a wrestler can compete so that spread is decreased. 20

Dermatophytes and dermatophytoses

Tinea corporis

Tinea corporis refers to annular lesions with raised borders originating on the glabrous skin. Lesions may be singular, multiple or confluent, and exhibit a range of inflammatory responses, ranging from scaling and minimal erythema to highly inflammatory lesions composed of pustules, vesicles, and marked erythema. Inflammation is often greatest at the advancing edge of the lesion, with a certain amount of central clearing. The most common causes are T. rubrum, T. mentagrophytes, and M. canis. Infection of hair follicles within the lesion can lead to a deep dermal inflammatory reaction similar to kerion of the scalp, termed Majocchi’s granuloma. Tinea imbricata is caused by T. concentricum, which causes concentric rings of scaling which spread peripherally over many years.

Superficial Dermatophyte Infections of the Skin

Gregory Raugi , Thao U. Nguyen , in Netter’s Infectious Diseases , 2012

Tinea Corporis

Tinea corporis typically appears as a single lesion or multiple scaly annular lesions with a slightly raised, erythematous edge with central clearing on the trunk, extremities, and face ( Figure 22-2 ). The border of the lesion may contain follicular papules, pustules, or vesicles. The intensity of itching is variable. The disease is more common in tropical climates and can occur at any age. Although it can be caused by any of the dermatophytes, T. rubrum, Microsporum canis, and T. mentagrophytes are the common organisms in the United States. Risk factors for transmission include occupational or recreational exposure, contact with contaminated clothing and furniture, and personal history of or close contact with tinea capitis or tinea pedis. The diagnosis is typically based on clinical appearance and KOH microscopy of scrapings from the active edge. The differential diagnosis includes nummular eczema, granuloma annulare, psoriasis, contact dermatitis, pityriasis rosea, and tinea versicolor.

Clinical variants of tinea corporis include tinea incognito, tinea profunda, Majocchi granuloma, and tinea imbricata. Tinea incognito is a term applied to atypical clinical lesions produced from previous topical corticosteroid use and, less commonly, calcineurin inhibitor. Tinea profunda refers to granulomatous or verrucous appearance from an excessive inflammatory response to a dermatophyte that is analogous to a kerion on the scalp. Majocchi granuloma is characterized by perifollicular pustules or granulomas that are caused by T. rubrum, commonly seen in women who have tinea pedis or onychomycosis (also caused by T. rubrum). Tinea imbricata is caused by the anthropophilic dermatophyte Trichophyton concentricum and is limited to southwest Polynesia, Melanesia, Southeast Asia, India, and Central America. The clinical presentation consists of concentric rings of scales forming extensive patches with polycyclic borders resembling erythema gyratum repens.

Tinea corporis is usually treated with topical antifungal creams. Twice-daily application of topical terbinafine, clotrimazole, ketoconazole, or ciclopirox is usually very effective. Topical nystatin is ineffective against dermatophytes. The recurrence rate is high for those with extensive infections, who may require systemic antifungal therapy. Appropriate systemic agents include oral terbinafine 250 mg daily for 1 to 2 weeks, itraconazole 200 mg daily for 1 to 2 weeks, and fluconazole 150 mg once weekly for 2 to 4 weeks. Griseofulvin 250 mg three times daily for 2 weeks is less effective but has fewer side effects.

Superficial Mycoses and Dermatophytes

Clinical Features

Tinea corporis may appear as annular lesions, bullous lesions, Majocchi's granuloma, pustular lesions, psoriasiform plaques, or verrucous lesions. 19 The lesions usually appear as single or multiple, annular, scaly processes with central clearing, a slightly elevated, reddened edge, and sharp margination. The border of the lesion may contain pustules or follicular papules. Each lesion may have one or several concentric rings with red papules or plaques in the center. As the lesion progresses, the center may clear, leaving postinflammatory hypopigmentation or hyperpigmentation. Active growth of the dermatophyte is at the edge of the lesion. Trichophyton spp. antigens can elicit both immediate (type 1) and delayed-type (type 4) hypersensitivity skin test reactions. Immediate hypersensitivity reaction occurs in individuals who have chronic recurrent infections characterized by low-grade inflammatory lesions and immunoglobulin E (IgE) antibodies. Delayed hypersensitivity occurs in individuals who have highly inflamed lesions that spontaneously resolve and are resistant to reinfection. Cell-mediated immune responses are more effective in resolving and to some degree preventing Trichophyton disease. In immunocompromised individuals, T. rubrum has been observed to penetrate beyond the superficial keratinized epithelium of the skin and nail to dermal invasion.

Skin Problems

Tinea corporis and pedis

Tinea corporis , or ringworm, acquired from contact with infected humans or animals, is a common skin condition found in any non-hair-bearing area of skin. 27 Initially, pruritic annular lesions develop with a central clearing and surrounding ring of vesicles. With the rupture of these vesicles, the rings become scaly and erythematous. An initial lesion may spread peripherally or multiple annular lesions may coalesce to form one large area that may be several centimeters in diameter. Autoinoculation may lead to spread to other parts of the body.

Tinea pedis is confined to the feet and is acquired from direct contact with contaminated surfaces, especially in warm, moist environments such as showers, bathrooms, and locker room floors. It presents with pruritus, burning, cracking, and maceration of the skin in web spaces of the toes. Vesicular lesions and desquamation may occur, especially in the areas outside of the web spaces on the instep and dorsum of the foot.

Diagnosis is usually clinical. It can be confirmed by scraping a few scales from the margins of the lesion and examining them for fungal hyphae under low power after fixing them with 20% potassium hydroxide.

Treatment of tinea is usually by the application of topical antifungal creams and ointments such as clotrimazole, ketoconazole, or terbinafine. 28 Systemic therapy may be necessary for multiple lesions or a severe inflammatory reaction.

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