Tinea in Emergency Medicine in Emergency Medicine Clinical Presentation

  • Author: Rashid M Rashid, MD, PhD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 9, 2011
 

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.[6]
  • 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.
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Physical

At physical examination, the various types of tinea may have different findings, as follows:

  • Tinea capitis: The clinical appearance of fungal infection of the scalp varies depending on the type of hair invasion. Alopecia (hair loss), with hairs breaking at the scalp surface, usually is present.
  • Tinea corporis: Infection typically is on the exposed skin of the trunk and extremities. 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). 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: This is a fungal infection of the toe webs and plantar surface and often affects only one foot. Toe-web scaling, fissuring, and maceration; scaling of soles and lateral surfaces; erythema; vesicles; pustules; and bullae may be present.
  • Tinea manuum: This is a fungal infection of the palms and finger webs that usually occurs in association with tinea pedis. Usually, only one hand is involved. Scaling and erythema may be present.
  • Tinea cruris: It is a dermatophytic infection of the groin and pubic region. It is characterized by erythematous lesions with central clearing and raised borders. Tinea cruris often co-occurs with tinea pedis or tinea unguium.
  • Tinea barbae: The beard and neck area are affected. Erythema, scaling, and pustules are present.
  • Tinea unguium: Tinea unguium is also called onychomycosis; this is an infection of the nail. It is characterized by onycholysis (nail plate separation from nail bed) and thickened, discolored (white, yellow, brown, black), broken, and dystrophic nails.
  • Majocchi granuloma: This is a deep folliculitis-like infection. Majocchi granuloma is kerionlike, characterized by erythema and nodules.[7] Treatment may require a slightly higher dose; this infection is more chronic in nature than typical tinea hair-related infections.
  • Id reaction (ie, identity reaction): Id reaction is a fungus-free eruption that can resemble tinea. Is secondary to a tinea infection at another site, is due to cell-mediated immunity, and resolves with treatment of tinea.
  • Tinea imbricata as noted above.
  • 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.[8]
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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
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Contributor Information and Disclosures
Author

Rashid M Rashid, MD, PhD  Resident Physician, Department of Dermatology, University of Texas, Houston, MD Anderson Cancer Center, and Morzak Research Initiative

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew C Miller, MD  Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center (UPMC); Attending Physician, Department of Emergency Medicine, UPMC St Margaret's Hospital

Andrew C Miller, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Theodore J Gaeta, DO, MPH, FACEP  Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Satter EK. Tinea imbricata. Cutis. Apr 2009;83(4):188-91. [Medline].

  2. Zhu M, Li L, Wang J, Zhang C, Kang K, Zhang Q. Tinea Capitis in Southeastern China: A 16-Year Survey. Mycopathologia. Nov 21 2009;[Medline].

  3. Gupta AK, Sibbald RG, Lynde CW, et al. Onychomycosis in children: prevalence and treatment strategies. J Am Acad Dermatol. Mar 1997;36(3 Pt 1):395-402. [Medline].

  4. Mahe A, Prual A, Konate M, et al. Skin diseases of children in Mali: a public health problem. Trans R Soc Trop Med Hyg. Sep-Oct 1995;89(5):467-70. [Medline].

  5. Enweani IB, Ozan CC, Agbonlahor DE, et al. Dermatophytosis in schoolchildren in Ekpoma, Nigeria. Mycoses. Jul-Aug 1996;39(7-8):303-5. [Medline].

  6. Geddes ER, Rashid RM. Delusional tinea: a novel subtype of delusional parasitosis. Dermatol Online J. 2008;14(12):16. [Medline].

  7. Arenas R, Toussaint S, Isa-Isa R. Kerion and dermatophytic granuloma. Mycological and histopathological findings in 19 children with inflammatory tinea capitis of the scalp. Int J Dermatol. Mar 2006;45(3):215-9. [Medline].

  8. Del Boz J, Crespo V, Rivas-Ruiz F, de Troya M. Tinea incognito in children: 54 cases. Mycoses. Nov 26 2009;[Medline].

  9. Gorani A, Oriani A, Cambiaghi S. Seborrheic dermatitis-like tinea faciei. Pediatr Dermatol. May-Jun 2005;22(3):243-4. [Medline].

  10. Gupta AK, Sauder DN, Shear NH. Antifungal agents: an overview. Part I. J Am Acad Dermatol. May 1994;30(5 Pt 1):677-98; quiz 698-700. [Medline].

  11. Gupta AK, Sauder DN, Shear NH. Antifungal agents: an overview. Part II. J Am Acad Dermatol. Jun 1994;30(6):911-33; quiz 934-6. [Medline].

  12. Singal A, Pandhi D, Agrawal S, et al. Comparative efficacy of topical 1% butenafine and 1% clotrimazole in tinea cruris and tinea corporis: a randomized, double-blind trial. J Dermatolog Treat. 2005;16(5-6):331-5. [Medline].

  13. Ali S, Graham TA, Forgie SE. The assessment and management of tinea capitis in children. Pediatr Emerg Care. Sep 2007;23(9):662-5; quiz 666-8. [Medline].

  14. Avner S, Nir N, Henri T. Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis. J Dermatolog Treat. 2005;16(5-6):327-30. [Medline].

  15. Bahamdan K, Mahfouz AA, Tallab T, et al. Skin diseases among adolescent boys in Abha, Saudi Arabia. Int J Dermatol. Jun 1996;35(6):405-7. [Medline].

  16. Brodell RT, Elewski BE. Clinical pearl: systemic antifungal drugs and drug interactions. J Am Acad Dermatol. Aug 1995;33(2 Pt 1):259-60. [Medline].

  17. Degreef HJ, DeDoncker PR. Current therapy of dermatophytosis. J Am Acad Dermatol. Sep 1994;31(3 Pt 2):S25-30. [Medline].

  18. Derya A, Ilgen E, Metin E. Characteristics of sports-related dermatoses for different types of sports: a cross-sectional study. J Dermatol. Aug 2005;32(8):620-5. [Medline].

  19. Devliotou-Panagiotidou D, Koussidou-Eremondi T, Badillet G. Dermatophytosis in northern Greece during the decade 1981-1990. Mycoses. Mar-Apr 1995;38(3-4):151-7. [Medline].

  20. [Guideline] Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: tinea capitis and tinea barbae. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. Feb 1996;34(2 Pt 1):290-4. [Medline].

  21. [Guideline] Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. Feb 1996;34(2 Pt 1):282-6. [Medline].

  22. Elewski BE. Clinical diagnosis of common scalp disorders. J Investig Dermatol Symp Proc. Dec 2005;10(3):190-3. [Medline].

  23. Elewski BE. The dermatophytoses. Semin Cutan Med Surg. 1996;2:1043-55.

  24. Elewski BE. Tinea capitis: itraconazole in Trichophyton tonsurans infection. J Am Acad Dermatol. Jul 1994;31(1):65-7. [Medline].

  25. Gold DT, McClung B. Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med. Apr 2006;119(4 Suppl 1):S32-7. [Medline].

  26. Gupta AK, Adam P, Dlova N, et al. Therapeutic options for the treatment of tinea capitis caused by Trichophyton species: griseofulvin versus the new oral antifungal agents, terbinafine, itraconazole, and fluconazole. Pediatr Dermatol. Sep-Oct 2001;18(5):433-8. [Medline].

  27. Kemna ME, Elewski BE. A U.S. epidemiologic survey of superficial fungal diseases. J Am Acad Dermatol. Oct 1996;35(4):539-42. [Medline].

  28. Koumantaki-Mathioudaki E, Devliotou-Panagiotidou D, Rallis E, et al. Is itraconazole the treatment of choice in Microsporum canis tinea capitis?. Drugs Exp Clin Res. 2005;31 Suppl:11-5. [Medline].

  29. Möhrenschlager M, Seidl HP, Ring J, et al. Pediatric tinea capitis: recognition and management. Am J Clin Dermatol. 2005;6(4):203-13. [Medline].

  30. Roberts DT. Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br J Dermatol. Feb 1992;126 Suppl 39:23-7. [Medline].

  31. Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. Apr 1995;8(2):240-59. [Medline].

  32. Welsh O, Welsh E, Ocampo-Candiani J, et al. Dermatophytoses in monterrey, méxico. Mycoses. Mar 2006;49(2):119-23. [Medline].

 
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Wax model of kerionlike tinea barbae. Courtesy of the Museum of the Department of Dermatology, University of Medicine, Wroclaw, Poland.
Gray-patch ringworm (microsporosis) is an ectothrix infection or prepubertal tinea capitis seen here in an African American male child. Gray patch refers to the scaling with lack of inflammation, as noted in this patient. Hairs in the involved areas assume a characteristic dull, grayish, discolored appearance. Infected hairs are broken and shorter. Papular lesions around hair shafts spread and form typical patches of ring forms, as shown. Culture from the lesional hair grew Microsporum canis.
Typical lesions of kerion celsi on the vertex scalp of a young Chinese boy. Note numerous bright yellow purulent areas on skin surface, surrounded by adjacent edematous, erythematous, alopecic areas. Culture from the lesion grew Trichophyton mentagrophytes. Courtesy of Skin Diseases in Chinese by Yau-Chin Lu, MD. Permission granted by Medicine Today Publishing Co, Taipei, Taiwan, 1981.
Annular plaque (tinea corporis).
 
 
 
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