eMedicine Specialties > Emergency Medicine > Infectious Diseases

Tinea: Differential Diagnoses & Workup

Author: Rashid M Rashid, MD, PhD, Post-Graduate Year 2 and House Staff Resident, Department of Dermatology, MD Anderson Cancer Center, University of Texas and The Morzak Center
Coauthor(s): Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center; Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant 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 at Brooklyn
Contributor Information and Disclosures

Updated: May 12, 2009

Differential Diagnoses

Candidiasis
Erysipelas
Cellulitis
Impetigo
Dermatitis, Atopic
Psoriasis
Dermatitis, Contact
Vulvovaginitis

Other Problems to Be Considered

Alopecia areata
Atopic eczema 
Erythrasma
Intertrigo
 Seborrheic dermatitis

Workup

Laboratory Studies

  • Direct microscopic examination may be performed.
    • Skin scrapings, nail specimens, or plucked hairs are treated with potassium hydroxide and examined.
    • Hyphae can be visualized in skin and nails.
    • Spores within or around the hair shaft can be detected.
  • Fungal cultures can be performed for precise identification of the species.
  • Wood light (UV light) examination may be performed.
    • This examination is used mainly for the diagnosis of tinea capitis.
    • Hairs infected with Microsporum audouinii and M canis produce a brilliant yellow-green fluorescence. This is detailed in the Pathophysiology section above.
    • Trichophyton schoenleinii causes a dull green fluorescence.
  • Histology is not needed, but biopsy findings would show spongiosis, parakeratosis (that may alter with orthokeratosis), and a superficial inflammatory infiltrate. Neutrophils may be seen in the stratum corneum, which is a significant diagnostic clue. On occasion, septate branching hyphae are seen in the stratum corneum. Special fungal stains (eg, periodic acid-Schiff, Gomori methenamine silver) may be required.

More on Tinea

Overview: Tinea
Differential Diagnoses & Workup: Tinea
Treatment & Medication: Tinea
Follow-up: Tinea
Multimedia: Tinea
References
[ CLOSE WINDOW ]

References

  1. 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].

  2. 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].

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

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

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

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

  14. 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].

  15. 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].

  16. 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].

  17. 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].

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

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

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

  21. 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].

  22. 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].

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

  24. 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].

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

  26. 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].

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

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tinea, ringworm, ring worm, fungal infection, dermatophytes, dermatophytosis, Epidermophyton, Microsporum, Trichophyton, tinea capitis, tinea corporis, tinea manuum, tinea pedis, tinea cruris, tinea barbae, tinea faciale, tinea unguium, onychomycosis, Trichophyton rubrum, Trichophyton tonsurans, Trichophyton interdigitale, Trichophyton mentagrophytes, Microsporum canis, Epidermophyton floccosum

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Rashid M Rashid, MD, PhD, Post-Graduate Year 2 and House Staff Resident, Department of Dermatology, MD Anderson Cancer Center, University of Texas and The Morzak Center
Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant 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 at Brooklyn
Mark A Silverberg, MD, FACEP, MMB 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.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.