Diagnosis
Tinea
A common superficial contagious fungal infection known as ringworm.
Also known as: Dermatophytosis, Ringworm
Etiology
Cause [iom][ze3]
Dermatophytosis (superficial mycosis) are caused by:
Trichophyton
Microsporum
Epidermophyton
Pityrosporum
Different names based on anatomical localisation [ze3]
Tinea Barbae: bearded areas of the face and neck
Tinea Capitis: skin/follicles of the scalp
Tinea Corporis: glabrous skin
Tinea Cruris: groin
Tinea Faciei: face
Tinea Manuum: hand
Tinea Nigra: hyperpigmented macule on palms and soles
Tinea Pedis: sole and interdigital
Tinea Unguium: toenail and fingernail
Tinea Versicolor: hypopigmented or hyperpigmented patches
Pathophysiology [ze3]
Transmitted by fomites, such as contaminated towels or hotel bedroom sheets, or by autoinoculation from a reservoir on the hands or feet
Using enzymes called keratinase, dermatophyte fungi invade the superficial keratin of the skin, and the infection remains limited to this layer
The competent immune response prevent deeper invasion
Clinical manifestation:
Scaly plaques
Central clearing
Erythematous border
Pruritus
Risk factors [ze3]
Old age
Tight-fitting or wet clothing
Diabetes mellitus
Obesity
Hyperhidrosis
Lymphoma
Immunocompromised state
Cushing syndrome
Complication [ze3]
Majocchi granuloma
Epidemiology
Incidence per 100.000 [5ph][pyk][awf][ysc][iom][cvo][gse][iga][avc]
Symptoms & findings
Symptoms
Alopecia, Onycholysis, Pruritus
Clinical findings
None listed.
Anamneses
None listed.
Localized findings
Approach
Dermatoscopy
Skin scrapings with potassium hydroxide microscopy (KOH) [ze3]
Biopsy
Culture
PCR
Treatment
Antifungal: depends on severity, location, extent, comorbidities, previous response
Topical applied once or twice daily for 2 to 3 weeks: [ze3]
Clotrimazole, Ketoconazole, Miconazole, Naftifine, Terbinafine
Oral: widespread infection or failed topical treatment
Terbinafine: 250 mg orally once daily for 2 weeks
Itraconazole: 100 mg once daily for 2 weeks or 200 mg once daily for 1 week
Fluconazole: 150 to 200 mg once weekly or 50 to 100 mg/day for up to 4 weeks
Griseofulvin: 500 to 1000 mg once daily for 2 to 4 weeks
Differential diagnoses
Acanthosis nigricans, Alopecia areata, Candidiasis, Contact dermatitis, Eczema, Erythema annulare centrifugum, Erythema multiforme, Erythrasma, Folliculitis, Granuloma annulare, Granuloma faciale, Impetigo, Intertrigo, Lichen planus, Malignant melanoma, Mycosis fungoides, Parapsoriasis, Pemphigus vulgaris, Pityriasis rosea, Pityriasis rubra pilaris, Pityriasis versicolor, Psoriasis, Seborrheic dermatitis, Syphilis, Systemic lupus erythematosus, Trichotillomania
References
[1] Wang H, Sun F, Wang C, Ye J, Xia P, Wang W, Wu Y. A systematic analysis of the global, regional, and national burden of fungal skin diseases from 1990 to 2021. Front Epidemiol. 2024 Dec 16;4:1489148.
[2] Yee G, Syed HA, Al Aboud AM. Tinea Corporis. Updated 2025 Feb 14: https://www.ncbi.nlm.nih.gov/books/NBK544360/
[3] McCormick TS, Ghannoum M. Time to Think Antifungal Resistance Increased Antifungal Resistance Exacerbates the Burden of Fungal Infections Including Resistant Dermatomycoses. Pathog Immun. 2024 Mar 5;8(2):158-176.
[4] Aimoldina A, Smagulova A, Batpenova G, Konnikov N, Algazina T, Jetpisbayeva Z, Azanbayeva D, Amantayev D, Kiyan V. Mycological Profile and Associated Factors Among Patients with Dermatophytosis in Astana, Kazakhstan. J Fungi (Basel). 2025 Jan 16;11(1):65.
[5] Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision. Journal of Fungi. 2017; 3(4):57.
[6] Urban K, Chu S, Scheufele C, Giesey RL, Mehrmal S, Uppal P, Delost GR. The global, regional, and national burden of fungal skin diseases in 195 countries and territories: A cross-sectional analysis from the Global Burden of Disease Study 2017. JAAD Int. 2020 Nov 30;2:22-27.
[7] Nussipov Y, Markabayeva A, Gianfaldoni S, Tchernev G, Wollina U, Lotti J, Roccia MG, Fioranelli M, Lotti T. Clinical and Epidemiological Features of Dermatophyte Infections in Almaty, Kazakhstan. Open Access Maced J Med Sci. 2017 Jun 19;5(4):409-413.
[8] Nweze EI. Etiology of dermatophytoses amongst children in northeastern Nigeria. Med Mycol. 2001 Apr;39(2):181-4.
[9] Mohammad KA, Ismail HM, Shekhany KAM, Yashooa RK, Younus DA, Abdullah SK, Alatraqchi AAF, Aldabbagh R, Denning DW. Fungal disease incidence and prevalence in Iraq - Preliminary estimates. J Mycol Med. 2024 Dec;34(4):101516.
[10] Lmimouni BE, Hennequin C, Penney ROS, Denning DW. Estimated Incidence and Prevalence of Serious Fungal Infections in Morocco. J Fungi (Basel). 2022 Apr 17;8(4):414.
[11] http://emedicine.medscape.com/article/1092976; [Medscape]
[12] http://emedicine.medscape.com/article/1091684; [Medscape]
[13] http://emedicine.medscape.com/article/1091351; [Medscape]
[14] http://emedicine.medscape.com/article/1091473; [Medscape]
[15] http://emedicine.medscape.com/article/1091806; [Medscape]