Tinea corporis in Adult
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Synopsis
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.
Severe tinea capitis and corporis, Majocchi-like granulomas, deep ulcerated fungal infections, and fungal nail involvement occur in an inherited deficiency of CARD9 (caspase recruitment domain-containing protein 9), an inflammatory cascade-associated protein. The disorder is autosomal recessive and is most common in North African countries including Algeria, Morocco, and Tunisia. Infections usually begin in childhood and are caused by T rubrum and Trichophyton violaceum. Lymphadenopathy, high IgE antibody levels, and eosinophilia are common. The disorder may be fatal.
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.
Codes
ICD10CM:B35.4 – Tinea corporis
SNOMEDCT:
84849002 – Tinea corporis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Nummular dermatitis (round, scaly plaques)
- Granuloma annulare (ring-like lesions but nonscaly)
- Fixed drug eruption (round patches but nonscaly)
- Erythema annulare centrifugum
- Tinea versicolor (usually trunk and neck)
- Allergic contact dermatitis
- Irritant contact dermatitis
- Majocchi granuloma
- Psoriasis
- Lichen planus
- Lyme disease
- Erythrasma (in body folds)
- Pityriasis rosea
- Intertrigo
- Seborrheic dermatitis (the distribution of lesions is often a helpful clue in distinguishing this entity)
- Lichen simplex chronicus
- Ichthyosis vulgaris
- Scabies
- Sarcoidosis
- Small plaque parapsoriasis
- Pityriasis rubra pilaris
- Secondary syphilis
- Pellagra
- Mycosis fungoides (if an adult patient has persistent "eczema" that is not adequately responding to therapy, this entity should be ruled out with skin biopsies)
- Glucagonoma syndrome (necrolytic migratory erythema)
- Impetigo
- Subacute cutaneous lupus erythematosus
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Management Pearls
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Therapy
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References
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Last Reviewed:11/08/2016
Last Updated:03/24/2019
Last Updated:03/24/2019
Patient Information for Tinea corporis in Adult
Overview
Tinea infections are commonly called ringworm because some may form a ring-like pattern on affected areas of the body. Tinea corporis, also known as ringworm of the body, tinea circinata, or simply ringworm, is a fungal infection on the surface of the skin. Ringworm may be passed to humans from direct contact with infected people, infected animals, contaminated objects (such as towels or locker room floors), and the soil.There are several kinds of ringworm, including:
- The most common type, which appears as one or more rings on the skin. The edge of the ring is scaly or flaky.
- Majocchi granuloma, a deeper fungal infection of skin, hair, and hair follicles. It is most common in individuals who shave their legs.
- Tinea corporis gladiatorum, tinea corporis spread by skin-to-skin contact between wrestlers.
- Tinea imbricata, a form of tinea corporis seen in Central and South America, Asia, and the South Pacific.
Who’s At Risk
Ringworm may occur in people of all ages, races / ethnicities, and sexes.People who are more likely to develop ringworm include:
- Children.
- Pregnant people who come into contact with infected children.
- People who have another tinea infection elsewhere on their bodies, such as tinea capitis (ringworm of the scalp), tinea faciei (ringworm of the face), tinea barbae (ringworm of the beard area), tinea cruris (ringworm of the groin, also called jock itch), tinea pedis (ringworm of the feet, also called athlete's foot), or tinea unguium (ringworm of the fingernails or toenails).
- Athletes, especially those involved in contact sports.
- People in frequent contact with animals, especially cats, dogs, horses, and cattle.
- People with weakened immune systems.
- People who sweat heavily.
- People who live in warm, humid climates.
Signs & Symptoms
The most common locations for ringworm include the:- Neck.
- Arms.
- Legs.
- Trunk (chest, abdomen, and back).
Ringworm may cause itching or burning.
Self-Care Guidelines
If you suspect you have ringworm, you can try one of the following over-the-counter antifungal creams:- Terbinafine (eg, Lamisil)
- Clotrimazole (eg, Lotrimin)
- Miconazole (eg, Micatin)
Because people often have tinea infections on more than one body part, examine yourself for other ringworm infections, such as on the face, beard area, groin, and feet.
Have any household pets evaluated by a veterinarian to make sure they do not have a fungal infection. If the veterinarian discovers an infection, be sure to have the animal treated.
When to Seek Medical Care
If large areas of the body are affected or if the lesions do not improve after 1-2 weeks of applying an over-the-counter antifungal cream, see a medical professional for evaluation.Treatments
To confirm the diagnosis of ringworm, your medical professional may scrape some surface skin material (scales) onto a slide and examine them under a microscope. This procedure, called a KOH (potassium hydroxide) preparation, allows them to look for signs of a fungal infection.Once the diagnosis of ringworm has been confirmed, you will likely be started on treatment with an antifungal medication. Most infections can be treated with prescription-strength topical creams and lotions, including:
- Econazole (Spectazole).
- Oxiconazole (Oxistat).
- Ciclopirox (eg, Loprox).
- Ketoconazole (eg, Nizoral).
- Naftifine (Naftin).
- Butenafine (Lotrimin, Mentax).
- Luliconazole (Luzu).
- Terbinafine (Lamisil).
- Itraconazole (Sporanox).
- Fluconazole (Diflucan).
Tinea corporis in Adult
See also in: Cellulitis DDx