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Tinea nigra in Adult
Other Resources UpToDate PubMed

Tinea nigra in Adult

Contributors: Rajini Murthy MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Tinea nigra is a superficial fungal infection caused by Hortaea werneckii. Tinea nigra is uncommon in the United States, where it may be seen along the Gulf Coast. It is more commonly found in tropical regions of Central and South America, Africa, Southeast Asia, and Australia. It presents as one or more asymptomatic tan, brown, or black macules or patches, usually on the palm or sole. The palm is affected more frequently than the sole. Other areas of the body, such as the neck or trunk, can also be affected.

After contamination from an infected source (eg, soil, sand, waste, or wood), the mycosis infects the stratum corneum, resulting in a dark macule or patch as the fungal hyphae produce melanin. The incubation period is typically 10-15 days. 

The most frequently affected populations are children and adolescents (children are more prone to exposure to the fungus); however, persons of any age may be affected. 

Immunocompromised Patient Considerations
The fungus involved in causing infections of tinea nigra can lead to serious infections in immunocompromised patients. There is a risk of disseminated disease from superficial cutaneous fungal infections noted in transplant patients.

Codes

ICD10CM:
B36.1 – Tinea nigra

SNOMEDCT:
186289000 – Tinea nigra

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Single lesion:
  • Talon noir – Intracorneal hemorrhage, secondary to trauma.
  • Acral melanocytic nevus – Presents with furrow or fibrillar pattern on dermoscopy, which is not seen in tinea nigra.
  • Melanoma – Presents with irregular borders, color of different shades, expanding diameter; easily differentiated from tinea nigra using dermoscopy. No hyphae found on potassium hydroxide (KOH) scrapings.
  • Postinflammatory hyperpigmentation – Sequelae of inflammatory skin condition; evidence of inflammatory condition prior to hyperpigmentation.
  • Fixed drug eruption
    More than one lesion:
    • Acral nevi
    • Postinflammatory hyperpigmentation
    • Addison disease – Increased pigmentation resulting from increased levels of the pituitary hormones (melanocyte stimulating hormone [MSH] and adrenocorticotropic hormone [ACTH]) in Addison disease. Pigmentation usually occurs on the mucosa, elbows, knees, and dorsa rather than the plantar surface of hands.
    • Vitamin B12 deficiency
    • Laugier-Hunziker syndrome
    • Secondary syphilis – Pink, red, violaceous, or brown macules or thin papules, smooth or scaly, may be tender on palpation. Other features of secondary syphilis may accompany palmoplantar manifestations.

            Best Tests

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            Management Pearls

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            Therapy

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            References

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            Last Reviewed:03/20/2022
            Last Updated:04/06/2022
            Copyright © 2022 VisualDx®. All rights reserved.
            Tinea nigra in Adult
            A medical illustration showing key findings of Tinea nigra : Irregular configuration, Palm, Plantar foot
            Clinical image of Tinea nigra - imageId=2215789. Click to open in gallery.  caption: 'Dark brown macules and patches with a speckled appearance on the palm.'
            Dark brown macules and patches with a speckled appearance on the palm.
            Copyright © 2022 VisualDx®. All rights reserved.