Tinea Corporis Clinical Presentation

  • Author: Jack L Lesher Jr, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

History

Symptoms, contact history, recent travel, and international residence are relevant clues in the history of a person with tinea corporis.

  • Infected patients may have variable symptoms.
    • Patients can be asymptomatic.
    • A pruritic, annular plaque is characteristic of a symptomatic infection. Patients occasionally can experience a burning sensation.
    • HIV-positive or immunocompromised patients may develop severe pruritus or pain.
  • Tinea corporis may result from contact with infected humans, animals, or inanimate objects. The history may include occupational (eg, farm worker, zookeeper, laboratory worker, veterinarian), environmental (eg, gardening, contact with animals), or recreational (eg, contact sports, contact with sports facilities) exposure.
  • A few clinical variants are described, with distinct presentations.
    • Majocchi granuloma, typically caused by T rubrum, is a fungal infection in hair, hair follicles, and, often, the surrounding dermis, with an associated granulomatous reaction. Majocchi granuloma often occurs in females who shave their legs.
    • Tinea corporis gladiatorum is a dermatophyte infection spread by skin-to-skin contact between wrestlers.[7, 8]
    • Tinea imbricata is a form of tinea corporis found mainly in Southeast Asia, the South Pacific, Central America, and South America. It is caused by Trichophyton concentricum.[9]
    • Tinea incognito is tinea corporis with an altered, nonclassic presentation due to corticosteroid treatment.[10]
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Physical

  • Tinea corporis can manifest in a variety of ways.
    • Typically, the lesion begins as an erythematous, scaly plaque that may rapidly worsen and enlarge, as shown in the image below.Large, erythematous, scaly plaque. Large, erythematous, scaly plaque.
    • Following central resolution, the lesion may become annular in shape, as is shown in the image below.Annular plaque. Annular plaque.
    • As a result of the inflammation, scale, crust, papules, vesicles, and even bullae can develop, especially in the advancing border.[11]
    • Rarely, tinea corporis can present as purpuric macules, called tinea corporis purpurica.[12] One report describes 2 cases of tinea corporis purpurica resulting from self-inoculation with Trichophyton violaceum.[13]
    • Infections due to zoophilic or geophilic dermatophytes may produce a more intense inflammatory response than those caused by anthropophilic microbes.
    • HIV-infected or immunocompromised patients often have atypical presentations including deep abscesses or a disseminated skin infection.
  • Majocchi granuloma manifests as perifollicular, granulomatous nodules typically in a distinct location, which is the lower two thirds of the leg in females.
  • Tinea corporis gladiatorum often manifests on the head, neck, and arms, which is a distribution consistent with the areas of skin-to-skin contact in wrestling.
  • Tinea imbricata is recognized clinically by its distinct scaly plaques arranged in concentric rings.
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Causes

  • Tinea corporis can be caused by a variety of dermatophytes, although prevalence and patient history are very helpful in identifying the most likely organism.
    • Internationally, the most common cause is T rubrum.
    • T tonsurans, Trichophyton mentagrophytes,[10, 14] Trichophyton interdigitale, Trichophyton verrucosum,[15] Microsporum canis, and Microsporum gypseum[9] are also known to produce infection.
    • Tinea imbricata is caused by Trichophyton concentricum.
  • Dermatophytoses may be acquired from different sources, such as people, animals, or soil.
    • Infected humans are the most common source of tinea corporis in the United States.
    • Contact with contaminated household pets, farm animals, and fomites (eg hair brushes, towels) can spread infection.
    • T verrucosum causes 98% of dermatophyte infections in cattle and is showing increasing prevalence of infection in human contacts.
    • T mentagrophytes is spread by rabbits, guinea pigs, and small rodents.[14]
    • Infection with M gypseum, a geophilic organism, can mimic tinea imbricata in presentation.
  • Because fungal arthroconidia can survive in the environment, recurrent outbreaks may occur.
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Contributor Information and Disclosures
Author

Jack L Lesher Jr, MD  Chief, Professor, Department of Internal Medicine, Section of Dermatology, Medical College of Georgia

Jack L Lesher Jr, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, Medical Association of Georgia, Society for Investigative Dermatology, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William James, MD, and previous authors Mary Elizabeth Rushing Lott, MD, and Gwendolyn Zember, MD, to the development and writing of this article.

References

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  10. Sanchez-Castellanos ME, Mayorga-Rodriguez JA, Sandoval-Tress C, Hernandez-Torres M. Tinea incognito due to Trichophyton mentagrophytes. Mycoses. Jan 2007;50(1):85-7. [Medline].

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  14. Shiraki Y, Hiruma M, Matsuba Y, et al. A case of tinea corporis caused by Arthroderma benhamiae (teleomorph of Tinea mentagrophytes) in a pet shop employee. J Am Acad Dermatol. Jul 2006;55(1):153-4. [Medline].

  15. Placzek M, van den Heuvel ME, Flaig MJ, Korting HC. Perniosis-like tinea corporis caused by Trichophyton verrucosum in cold-exposed individuals. Mycoses. Nov 2006;49(6):476-9. [Medline].

  16. Seyfarth F, Ziemer M, Gräser Y, Elsner P, Hipler UC. Widespread tinea corporis caused by Trichophyton rubrum with non-typical cultural characteristics--diagnosis via PCR. Mycoses. 2007;50 Suppl 2:26-30. [Medline].

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Annular plaque.
Large, erythematous, scaly plaque.
 
 
 
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