Tinea corporis is a localized inflammatory skin condition due to fungal colonization of the superficial epidermis. The most commonly implicated species is Trichophyton. Fungal organisms are transmitted to children by direct contact with those infected or through fomites. Majocchi granuloma is caused by organisms invading the hair follicle or shaft of hairs on skin other than the scalp with a secondary granulomatous perifolliculitis. Varying location presentations include tinea capitis (scalp), tinea faciei (face), tinea pedis (feet), tinea manuum (hands), and tinea cruris (crural folds).
Disseminated tinea may be seen in patients with immunosuppression, diabetes, Cushing syndrome, and malignancy. Majocchi-like granulomas, deep ulcerated fungal infections, severe tinea capitis and corporis, and fungal nail involvement are characteristic of 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. The infections usually begin in childhood and are caused by Trichophyton rubrum and Trichophyton violaceum. Lymphadenopathy, high IgE antibody levels, and eosinophilia are common, and the disorder can be fatal.
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. This form has been reported in children as well.
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.
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 as ringworm, is a fungal infection on the surface of the skin. Ringworm may be passed to humans by direct contact with infected people, infected animals (such as kittens or puppies), contaminated objects (such as towels and 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.
Tinea corporis gladiatorum, a name given to ringworm spread by skin-to-skin contact between wrestlers.
Tinea imbricata, a form of ringworm 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.
Ringworm is most commonly seen in children.
Other people who are more likely to develop ringworm include:
Pregnant individuals 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, or jock itch), tinea pedis (ringworm of the feet, or 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:
Trunk (chest, abdomen, and back).
Ringworm appears as a ring-shaped plaque (a raised area of skin larger than a thumbnail) with a distinct scaly border. Lesions can range in size from 1 cm to 10 cm. In lighter skin colors, the border can be pink or red, whereas in darker skin colors, the border can be dark red, purple, brown, or grayish. The central area may appear as normal skin; in other words, there is no skin color change in the center. The border of the affected skin may contain papules (small firm bumps), vesicles (small fluid-filled blisters), or scabs.
Ringworm may cause itching or burning.
If you suspect your child has ringworm, you can try one of the following over-the-counter antifungal creams or lotions:
Terbinafine (eg, Lamisil)
Clotrimazole (eg, Lotrimin)
Miconazole (eg, Micatin)
Apply the cream to each lesion and to the normal-appearing skin 2 cm beyond the border of the affected skin for at least 2 weeks until the lesions completely clear. Because ringworm is very contagious, have your child avoid contact sports until lesions have been treated for a minimum of 48 hours. Do not allow your child to share towels, clothing, and other personal items with others until the lesions are healed.
Because people often have tinea infections on more than one body part, examine your child for other ringworm infections, such as on the face, 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 over-the-counter antifungal creams, see your child's medical professional for an evaluation.
To confirm the diagnosis of ringworm, your child's 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 fungal infection.
Once the diagnosis of ringworm has been confirmed, your child will likely be started on treatment with an antifungal medication. Most infections can be treated with topical creams and lotions, including:
Ciclopirox (eg, Loprox).
Ketoconazole (eg, Nizoral).
Butenafine (Lotrimin, Mentax).
Sometimes more extensive infections or those not improving with topical antifungal medications may require 3-4 weeks of treatment with oral antifungals, including: