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Dermatophyte infections

Last updated: December 29, 2020

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Dermatophyte infections, also known as tinea, are the most common fungal infections of the skin, hair, and nails. The term “dermatophyte” refers to fungal species that infect keratinized tissue, and includes members of the Trichophyton, Microsporum, and Epidermophyton genera. Tinea are classified based on their location (e.g., tinea pedis occurs on the feet and tinea capitis on the scalp). Children and immunocompromised individuals are more likely to contract tinea infections, especially tinea capitis. However, people of all ages may suffer from tinea pedis or tinea unguium. The clinical features of dermatophyte infection include pruritus, scaling, and erythema. The best initial test for the diagnosis of dermatophyte infection is potassium hydroxide (KOH) preparation, which allows segmented hyphae to be seen on microscopy. Generally, the treatment for dermatophyte infections is topical antifungals. Oral antifungals (e.g., terbinafine, griseofulvin) are always used in tinea capitis and are also used for severe, refractory cases of other kinds of tinea. Concomitant tinea infections in household members or pets should be treated as well.

Tinea versicolor, despite its name, is not caused by dermatophytes and is discussed in another article.

General [1]

Diagnosis of dermatophyte infections

Treatment of dermatophyte infections [4]

Because topical treatments are unable to penetrate the hair shaft, systemic therapy with oral antifungals such as griseofulvin or terbinafine is necessary in tinea capitis.

To prevent tinea infections from spreading, contaminated objects should not be shared (e.g., shoes, combs). Other members of the household and pets who are infected should also receive treatment!

Tinea pedis (athlete's foot)/tinea manuum

Tinea corporis (ringworm)

  • Definition: dermatophyte infection affecting a location other than feet, scalp, nails, and groin; mostly the arms and upper body.
  • Predisposing factors
    • Contact with infected individuals or animals
    • Moist environments (e.g., public swimming pools)
  • Pathogen: most commonly T. rubrum
  • Clinical presentation [6]
  • Diagnosis and treatment: See “Overview” section above.

Tinea capitis

Favus

  • Definition
    • Chronic infection caused by T. schoenleinii
    • Severe form of tinea capitis
  • Epidemiology: more common in Africa, the Middle East, and the Mediterranean
  • Clinical presentation: formation of yellow, malodorous crust with subsequent scarring alopecia
  • Treatment

Tinea unguium (onychomycosis)

The successful treatment of onychomycosis involves not only the elimination of sources of infection, but also the promotion of personal hygiene, the disinfection of footwear, and the elimination of predisposing factors.

Tinea cruris (jock itch)


References:[5][6][7][7][8]

The differential diagnoses listed here are not exhaustive.

  1. Goldstein AO, Goldstein BG. Dermatophyte (tinea) infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/dermatophyte-tinea-infections?source=search_result&search=tinea%20infections&selectedTitle=1~142#H300483.Last updated: November 23, 2015. Accessed: February 20, 2017.
  2. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  3. Marks JG Jr, Miller JJ . Lookingbill and Marks' Principles of Dermatology. Saunders Elsevier ; 2013
  4. Goldstein AO. Onychomycosis: Epidemiology, Clinical Features, and Diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/onychomycosis-epidemiology-clinical-features-and-diagnosis.Last updated: June 26, 2017. Accessed: May 14, 2018.
  5. Richard Guerrant David Walker Peter Weller. Tropical Infectious Diseases: Principles, Pathogens, & Practice. Saunders ; 2011
  6. Hainer BL. Dermatophyte infections.. Am Fam Physician. 2003; 67 (1): p.101-8.
  7. Evanthia Tambosis, Christopher Lim. A Comparison of the Contrast Stains, Chicago Blue, Chlorazole Black, and Parker Ink, for the Rapid Diagnosis of Skin and Nail Infections. International Journal of Dermatology. 2012 .
  8. Jaya Garg, Ragini Tilak, Atul Garg, Pradyot Prakash, Anil Kumar Gulati, and Gopal Nath. Rapid detection of dermatophytes from skin and hair. Ads BMC research notes. 2009 .
  9. Goldstein AO, Bhatia N. Onychomycosis: Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/onychomycosis-management.Last updated: February 14, 2017. Accessed: March 29, 2017.
  10. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2015
  11. Le T, Bhushan V. First Aid for the USMLE Step 1 2015. McGraw-Hill Education ; 2014
  12. Lesher JL Jr. Tinea Corporis. Tinea Corporis. New York, NY: WebMD. http://emedicine.medscape.com/article/1091473. Updated: August 8, 2016. Accessed: March 29, 2017.
  13. Robbins CM. Tinea Pedis. Tinea Pedis. New York, NY: WebMD. http://emedicine.medscape.com/article/1091684. Updated: August 5, 2016. Accessed: March 29, 2017.
  14. Handler MZ. Tinea Capitis. Tinea Capitis. New York, NY: WebMD. http://emedicine.medscape.com/article/1091351. Updated: May 13, 2016. Accessed: March 29, 2017.