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6th July 2023
Tinea Infections (Dermatophytoses)
This refers to a skin infection caused by dermatophytes and is one of the most common causes of superficial fungal infections. Dermatophytes are fungi that require keratin for growth and therefore infect the stratum corneum, nails and hair.
Risk factors include diabetes, immunodeficiency, occlusive clothing and crowded conditions. It is more likely in children and the elderly. Dermatophyte infections present as itchy, annular lesions with raised borders. Transmission is via contact with an infected person, contaminated objects or infected animal. The feature of the fungal infection depends on the site:
| Type | Site affected | Most common organisms | Additional notes |
|---|---|---|---|
| Tinea capitis | Scalp | M. canis | Annular patches with scale, broken hair shaft. Kerion: inflammatory tinea capitis that causes a painful, boggy plaque with associated pustules and scarring alopecia. |
| Tinea manuum | Hands | T. rubrum | Diffuse scaling with associated itch. Frequently affecting the palmar surface. Can form annular rashes and blisters. |
| Tinea unguium (onychomycosis) | Nails | T. rubrum
T. interdigitale |
Often involves the nail of the big toe or the little toe. Causes a white/yellow discolouration, thickening and crumbling. |
| Tinea cruris | Groin, natal cleft, adjacent thigh | T. rubrum
T. interdigitale E. floccosum |
Male predominance. RF: obesity, wet or restrictive clothing, warm climates. Itchy, erythematous with raised edges. Can be hyperpigmented. |
| Tinea pedis (athlete’s foot) | Feet | T. rubrum
T. interdigitale E. floccosum |
Most common tinea infection. Usually between the 4th and 5th toes. Male predominance. Skin is itchy, moist, fissured and erythematous. It can also be associated with hyperkeratosis and blisters. |
| Tinea incognita | – | – | Tinea infection that has been inappropriately treated with corticosteroids. This modifies its appearance – less scaly, margins are less raised and there is extension of the original infection. |
Table 5: Summary of tinea infection sites and common organisms
Tinea skin infection
Image Source: Wikimedia Commons (2012). Yeartinfection, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Yeartinfection.JPG (Accessed on: 10 March 2022).
Diagnosis can be established with skin scrapings, hair or nail clippings sent for microscopy and culture. First line management is with topical antifungals (e.g. terbinafine, clotrimazole, miconazole). Oral antifungals should be used in tinea capitis and severe or extensive disease. Oral terbinafine can cause hepatotoxicity so LFTs must be monitored.
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