History
About 2 weeks elapse from inoculation to subsequent clinically visible skin changes. Tinea pedis often follow activities that cause the feet to sweat.
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. [5] 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.
Tinea corporis can be seen in adults caring for children with tinea capitis.
Physical
At physical examination, the various types of tinea may have different findings, as follows:
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Tinea capitis: The clinical appearance of fungal infection of the scalp varies depending on the type of hair invasion. Patients typically present with scaling of the scalp or circumscribed alopecia with broken hair at the scalp.
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Tinea corporis: Infection is usually 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 (T 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.
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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.
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Tinea manuum: This is a fungal infection of the palms and finger webs that usually occurs in association with tinea pedis. Similarly, often only one hand is involved. Scaling and erythema may be present.
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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.
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Tinea barbae: The beard and neck area are affected. Erythema, scaling, and pustules are present.
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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.
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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. [6]
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Autoeczematization reactions: (also known as id reactions) are secondary dermatitic eruptions that occur in association with primary, often inflammatory, skin disorders. It is secondary to a tinea infection at another site. It is due to cell-mediated immunity and resolves with treatment of tinea.
Causes
The various tinea infections are caused chiefly by species of the genera Microsporum, Trichophyton, and Epidermophyton. Risk factors for tinea infection include the following:
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Moist conditions
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Communal baths
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Immunocompromised states (including the use of immunosuppressive drugs)
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Atopy
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Genetic predisposition
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Athletic activity that causes skin tears, abrasions, or trauma such as wrestling, judo, or soccer
Complications
Complications of tinea infection include the following:
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Bacterial superinfection
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Generalized invasive dermatophyte infection
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Wax model of kerionlike tinea barbae. Courtesy of the Museum of the Department of Dermatology, University of Medicine, Wroclaw, Poland.
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Tinea capitis; gray patch ringworm. 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 and are broken and shorter.
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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.
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Annular plaque (tinea corporis).
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Tinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle.
Tables
Species |
Natural habitat |
Incidence |
E floccosum |
Humans |
Common |
T rubrum |
Humans |
Very common |
T interdigitale |
Humans |
Very common |
T tonsurans |
Humans |
Common |
Trichophyton violaceum |
Humans |
Less common |
Trichophyton concentricum |
Humans |
Rare |
Trichophyton schoenleinii |
Humans |
Rare |
Trichophyton soudanense |
Humans |
Rare |
Microsporum audouinii |
Humans |
Less common |
Microsporum ferrugineum |
Humans |
Less common |
T mentagrophytes |
Mice, rodents |
Common |
Trichophyton equinum |
Horses |
Rare |
Trichophyton erinacei |
Hedgehogs |
Rare |
Trichophyton verrucosum |
Cattle |
Rare |
M canis |
Cats |
Common |
Microsporum gypseum |
Soil |
Common |
Microsporum nanum |
Soil/pigs |
Rare |
Microsporum cookei |
Soil |
Rare |
