Tinea corporis - Cellulitis DDx
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Synopsis
Tinea corporis is also commonly (and incorrectly) known as "ringworm." It represents a skin infection by a dermatophyte species of fungus, namely of the genera Trichophyton, Microsporum, or Epidermophyton. Different species of dermatophytes may be anthropophilic (humans are the primary host) or zoophilic (animal host), and this may, in turn, influence the inflammatory response engendered.
Tinea corporis usually appears as annular, erythematous, scaling plaques. Fungal organisms are transmitted to humans by direct contact (with animals or with humans, such as in tinea corporis gladiatorum, common in wrestlers), or through fomites. Tinea corporis is more prevalent in warm, humid climates and may also result from the spread of infection from other body sites.
Tinea corporis may be itchy, especially in the case of Trichophyton rubrum infections, in which case, secondary lichenification from scratching may obscure its annular configuration. It may also be minimally pruritic or asymptomatic. It may be a superficial infection or it may affect follicular structures. When tinea infects the follicle, the condition may appear as a fungal folliculitis, or it may appear otherwise more deeply situated. Follicular infection is known as Majocchi granuloma.
When a dermatophyte infection occurs in the scalp, it is known as tinea capitis. When on the face, it is known as tinea faciei; in the beard area, it is known as tinea barbae; in the inguinal folds, it is known as tinea cruris; on the feet, it is known as tinea pedis; and when it involves the hands (primarily the palms), it is known as tinea manuum.
Tinea imbricata is a distinct form of tinea corporis caused by Trichophyton concentricum, which is prevalent in tropical locales such as Central and South America, the South Pacific, and Southeast Asia.
In the immunocompromised patient, infection can be quite similar to that in immunocompetent patients, with superficial scaly plaques, pruritus, and lesions displaying the classic annular, advancing, scaling border. However, infections without pruritus or classic features are seen. Disseminated tinea corporis may be seen in patients with immunosuppression, diabetes, Cushing syndrome, malignancy, and old age. Dermatophyte infections are frequently seen in untreated AIDS and solid organ transplant patients. Renal transplant patients are at even higher risk for tinea corporis.
Tinea indecisiva (tinea pseudoimbricata) is tinea corporis that mimics tinea imbricata. These cases are not caused by Trichophyton concentricum but rather by other Trichophyton or Microsporum species. There is usually underlying immunosuppression in patients with tinea indecisiva.
Scaling is a more prominent feature in tinea corporis than in cases of cellulitis. Lesions may also demonstrate a central clearing.
Tinea corporis usually appears as annular, erythematous, scaling plaques. Fungal organisms are transmitted to humans by direct contact (with animals or with humans, such as in tinea corporis gladiatorum, common in wrestlers), or through fomites. Tinea corporis is more prevalent in warm, humid climates and may also result from the spread of infection from other body sites.
Tinea corporis may be itchy, especially in the case of Trichophyton rubrum infections, in which case, secondary lichenification from scratching may obscure its annular configuration. It may also be minimally pruritic or asymptomatic. It may be a superficial infection or it may affect follicular structures. When tinea infects the follicle, the condition may appear as a fungal folliculitis, or it may appear otherwise more deeply situated. Follicular infection is known as Majocchi granuloma.
When a dermatophyte infection occurs in the scalp, it is known as tinea capitis. When on the face, it is known as tinea faciei; in the beard area, it is known as tinea barbae; in the inguinal folds, it is known as tinea cruris; on the feet, it is known as tinea pedis; and when it involves the hands (primarily the palms), it is known as tinea manuum.
Tinea imbricata is a distinct form of tinea corporis caused by Trichophyton concentricum, which is prevalent in tropical locales such as Central and South America, the South Pacific, and Southeast Asia.
In the immunocompromised patient, infection can be quite similar to that in immunocompetent patients, with superficial scaly plaques, pruritus, and lesions displaying the classic annular, advancing, scaling border. However, infections without pruritus or classic features are seen. Disseminated tinea corporis may be seen in patients with immunosuppression, diabetes, Cushing syndrome, malignancy, and old age. Dermatophyte infections are frequently seen in untreated AIDS and solid organ transplant patients. Renal transplant patients are at even higher risk for tinea corporis.
Tinea indecisiva (tinea pseudoimbricata) is tinea corporis that mimics tinea imbricata. These cases are not caused by Trichophyton concentricum but rather by other Trichophyton or Microsporum species. There is usually underlying immunosuppression in patients with tinea indecisiva.
Scaling is a more prominent feature in tinea corporis than in cases of cellulitis. Lesions may also demonstrate a central clearing.
Codes
ICD10CM:
B35.4 – Tinea corporis
SNOMEDCT:
84849002 – Tinea corporis
B35.4 – Tinea corporis
SNOMEDCT:
84849002 – Tinea corporis
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Last Updated:03/19/2019
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Tinea corporis - Cellulitis DDx
See also in: Overview