Tinea

Question 1

Define Tinea

Answer 1

Tinea = Fungal infection of the body and groin – dermatophyte fungi invade dead keratinous structures
Tinea corporis/ringworm = body
Tinea cruris = groin

Question 2

Aetiology of tinea

Answer 2

Body: Trichophytum rubrum, tricophyton interdigitale
Groin: autoinoculation from dermatophyte infection of the hands, feet, or nails caused by Trichophyton rubrum, Trichophyton interdigitale, or, more rarely, Epidermophyton floccosum.
Transmission: direct contact, zoophilic spread, indirect, contact with soil

Question 3

Risk factors for tinea

Answer 3

Hot, humid climates, high-temp. environments
Tight fitting clothing
Obesity
Hyperhidrosis
Immunocompromised

Question 4

Symptoms and signs of tinea

Answer 4

Ringed appearance, red or silver rash
Scaly, itchy skin
Single or multiple red or pink, flat or slightly raised annular (ring-shaped) patches of varying sizes that enlarge outwards
Typically active red, scaly advancing edge and a clear central area (central clearing)
Asymmetrical
Tinea capitis – scalp
Tinea pedis – feet

± kerion (severe inflamed ringworm patch)

Question 5

Differentials for tinea

Answer 5

Discoid eczema
Pityriasis rosea
Pityriasis versicolor
Psoriasis
Granuloma annulare
Erythema multiforme
Subacute cutaneous lupus
Intertrigo
Erythrasma
Flexural psoriasis

Question 6

Management for Tinea Faciei, Tinea Corporis, Tinea Cruris or Tinea Pedis

Answer 6

Clinical diagnosis
Take skin sample for fungal microscopy and culture if severe/extensive or diagnosis is uncertain

Hygiene advice

Mild → topical antifungals (e.g. topical terbinafine, clotrimazole, miconazole)
Moderate → hydrocortisone 1% cream, max 7 days
Severe → oral antifungals
- 1st line: oral terbinafine
- 2nd line: oral itraconazole, griseofulvin

Question 7

Management for tinea capitis

Answer 7

Clinical diagnosis
Take skin sample for fungal microscopy and culture if severe/extensive or diagnosis is uncertain

Hygiene advice

Oral antifungal (e.g. griseofulvin or terbinafine)

Question 8

What hygiene advice should be given for tinea

Answer 8

Wear loose-fitting cotton clothing
Wash affected areas of skin daily
Dry thoroughly after washing
Avoid scratching
Do not share towels
Wash clothes and bed lined frequently
No need for school exclusion

Question 9

Complications of tinea

Answer 9

Secondary bacterial infection
Majocchi granuloma: dermatophyte invades via hair follicle and penetrates into the dermis and SC skin
Fungal infection of hand (tinea manuum) due to scratching
Kerion: Inflammatory, painful, boggy scalp mass associated with untreated tinea capitis; may be treated with prednisolone. Can result in scarring alopecia.
Tinea incognito: inappropriate use of topical corticosteroids → extensive spread of fungal infection and change in morphology

Question 10

Management for scabies

Answer 10

permethrin (2x, OW full body treatments; wash off after 8-12 hours) + treat all household/close contacts

Question 11

Management for head lice

Answer 11

mx: malathion (2nd line for scabies; wash off after 24 hours)