eMedicine Specialties > Dermatology > Fungal Infections

Tinea Corporis

Author: Jack L Lesher Jr, MD, Chief, Professor, Department of Internal Medicine, Section of Dermatology, Medical College of Georgia
Contributor Information and Disclosures

Updated: Dec 2, 2009

Introduction

Background

Tinea corporis is a superficial dermatophyte infection characterized by either inflammatory or noninflammatory lesions on the glabrous skin (ie, skin regions except the scalp, groin, palms, and soles). Three anamorphic (asexual or imperfect) genera cause dermatophytoses: Trichophyton, Microsporum, and Epidermophyton. Dermatophytes may infect humans (anthropophilic), infect nonhuman mammals (zoophilic), or reside primarily in the soil (geophilic).

Pathophysiology

Dermatophytes preferentially inhabit the nonliving, cornified layers of the skin, hair, and nail, which is attractive for its warm, moist environment conducive to fungal proliferation. Fungi may release keratinases and other enzymes to invade deeper into the stratum corneum, although typically the depth of infection is limited to the epidermis and, at times, its appendages. They generally do not invade deeply, owing to nonspecific host defense mechanisms that can include the activation of serum inhibitory factor, complement, and polymorphonuclear leukocytes.

Following the incubation period of 1-3 weeks, dermatophytes invade peripherally in a centrifugal pattern. In response to the infection, the active border has an increased epidermal cell proliferation with resultant scaling. This creates a partial defense by way of shedding the infected skin and leaving new, healthy skin central to the advancing lesion. Elimination of dermatophytes is achieved by cell-mediated immunity.

Trichophyton rubrum is a common dermatophyte and, because of its cell wall, is resistant to eradication. This protective barrier contains mannan, which may inhibit cell-mediated immunity, hinder the proliferation of keratinocytes, and enhance the organism's resistance to the skin's natural defenses.

Frequency

International

Tinea corporis is a common infection more often seen in typically hot, humid climates. T rubrum is the most common infectious agent in the world and is the source of 47% of tinea corporis cases.¹ Trichophyton tonsurans is the most common dermatophyte to cause tinea capitis, and people with an anthropophilic tinea capitis infection are more likely to develop associated tinea corporis. Therefore, the prevalence of tinea corporis caused by T tonsurans is increasing. Microsporum canis is the third most common causative organism and associated with 14% of tinea corporis infections. A rare case of Microsporum fulvum skin infection (forearm) has recently been reported, identified by ITS sequencing and mass spectrometry.²

A 5-year study from Kuwait that included 2730 patients reported that fungal skin infections remain prevalent in that country, specifically the Capital area. In those patients with dermatophytes, 6 species were isolated. They included Trichophyton mentagrophytes (39%), M canis (16%), T rubrum (10%), Epidermophyton floccosum (6.2%), Trichophyton violaceum (2.4%), and Trichophyton verrucosum (0.4%).³

Mortality/Morbidity

Dermatophyte infections do not result in significant mortality, but they can greatly affect quality of life.

Sex

Tinea corporis occurs in both men and women. Women of childbearing age are more likely to develop tinea corporis as a result of their greater frequency of contact with infected children.

Age

Tinea corporis affects persons of all age groups, but prevalence is highest in preadolescents. Tinea corporis acquired from animals is more common in children. Tinea corporis secondary to tinea capitis typically occurs in children because tinea capitis is more common in this population.

Clinical

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.^4,5
  • 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.⁶
  • Tinea incognito is tinea corporis with an altered, nonclassic presentation due to corticosteroid treatment.⁷

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.

    [ CLOSE WINDOW ]

    

    Large, erythematous, scaly plaque.

  • Following central resolution, the lesion may become annular in shape, as is shown in the image below.
  • 
    

    

    Annular plaque.

    [ CLOSE WINDOW ]

    

    Annular plaque.

  • As a result of the inflammation, scale, crust, papules, vesicles, and even bullae can develop, especially in the advancing border.⁸
  • Rarely, tinea corporis can present as purpuric macules, called tinea corporis purpurica.⁹ One report describes 2 cases of tinea corporis purpurica resulting from self-inoculation with Trichophyton violaceum.¹⁰
  • 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.

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,^7,11 Trichophyton interdigitale, Trichophyton verrucosum,¹² Microsporum canis, and Microsporum gypseum⁶ 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.¹¹
• 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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