11/14/24, 10\:45 AM Ringworm (Tinea Infections)

Ringworm (Tinea Infections)

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Key points ⚡
Succinct notes to superpower your revision
Ringworm\: common super
dermatophytosis; more common in hot, humid environments.
Aetiology\: caused by dermatophytes (fungi). Common species include T . r u b r u m , T . i n t e r d i g i t a l e , T . t o n s u r a n s . Zoonotic
species include M . c a n i s , T . v e r r u c o s u m , T . e q u i n u m , T . e r i n a c e i .
Types\: Tinea capitis (scalp), tinea pedis (feet), tinea cruris (groin), tinea corporis (body).
Risk factors\: male sex, skin-skin contact, communal showers, inadequate drying of feet, previous tinea infections, diabetes
mellitus, hyperhidrosis, xerosis, ichthyosis.
Symptoms\: asymmetrical rash with circular erythematous patches, raised scaly edges, clearing centre (hypopigmentation).
Itching, social and infectious contacts, and contact with animals are important history elements.
Clinical
Tinea corporis\: circular erythematous patches with a scaly edge and hypopigmented centre.
Tinea capitis\: dry, scaly patches, brittle hair, hair loss, crusting.
Tinea pedis\: dry, cracked skin between toes, scaling rash.
Tinea ungium\: thickened, keratotic, brittle nails.
Tinea cruris\: annular plaques over groin folds.
Di
lupus erythematosus, erythema annulare centifugum.
Investigations\: clinical diagnosis; skin scraping for microscopy, culture, and sensitivity; Wood's lamp for hair
skin biopsy for atypical presentations.
Management\:
Topical therapy\:
Topical terbina
Econazole cream\: applied once or twice daily for 2 weeks.
Oral therapy\: for severe, multiple sites, recurrent, or resistant cases.
Oral terbina
Griseofulvin\: for scalp/hair/groin (4-6 weeks, up to 1 year).
Fluconazole or itraconazole\: last-line therapy.
Complications\: secondary bacterial infection (Staphylococcus aureus), disseminated infection in immunosuppressed
individuals, which can a
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Introduction

Ringworm is a common super
1
The infection is colloquially called “ringworm” because lesions are often circular-shaped. Despite this name, ringworm is
not a parasitic worm infection.
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Ringworm can also be referred to as tinea or dermatophytosis. Ringworm is more common in hot and humid
environments.
1

Aetiology

Ringworm (tinea) is caused by dermatophytes (a type of fungus).
Depending on the location, the condition can be referred to as\:
1,2,3
Tinea capitis (a
Tinea pedis (a
Tinea cruris (a
Tinea corporis (a
In the community, ringworm of the feet may be called “athlete’s foot”
, while ringworm of the groin may be called “jock itch”
.
Common species of dermatophyte include T . r u b r u m , T . i n t e r d i g i t a l e and T . t o n s u r a n s .
Zoonotic species such as M . c a n i s , T . v e r r u c o s u m , T . e q u i n u m and T . e r i n a c e i may be present in those that interact with
animals.
1

Risk factors

Ringworm is spread by skin-skin contact or contact with an infected surface.
Risk factors include\:
Male sex
Contact with an infected person
Frequent use of communal shower facilities
Not drying feet adequately (risk of tinea pedis)
The most at-risk groups include children attending daycare and early school and households of an infected person.
Medical risk factors are those primarily relating to an immunocompromised state or skin condition a
barrier, and include\:
1,2
Previous tinea infections
Diabetes mellitus
Hyperhidrosis
Xerosis (dry skin)
Ichthyosis

Clinical features

History

Typical symptoms of tinea corporis include\:
1,2,3
An asymmetrical rash consisting of solitary circular erythematous patches with a raised scaly leading edge and a
clearing centre (hypopigmentation within the ring) (Figure 1)
Itch
Other important areas to cover in the history include\:
1,2,3
Social history\: usually a
Infectious contacts\: either as a classmate, carer or household contact
Other risk factors\: frequent use of communal showers, pools or gyms, athletes
Contact with animals
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Clinical examination

Typical clinical
1,2,3
Body (tinea corporis)\: asymmetrical rash that appears as solitary circular erythematous patches with a raised scaly
leading edge and hypopigmentation within the ring. (Figure 1).
Scalp (tinea capitis)\: often begins as a pimple that grows, creating dry, scaly, bald patches of skin. Associated with brittle
hair and hair loss at sites of infection. It can crust over and often be mistaken for dandru
Feet (tinea pedia)\: results in dry and cracked skin between the toes, with a scaling rash that can move proximally if not
treated.
Nails (tinea ungium)\: results in nail beds that are thickened, keratotic, dry, brittle and cracking
Groin (tinea cruris)\: appears as annular plaques over the groin folds
Figure 1. Typical annular lesion of tinea corporis.
5
Figure 2. Scale, pustules and patchy hair loss in tinea capitis.
6
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Figure 3. Tinea pedis.
7

Di

Ringworm can be mistaken for other dermatological conditions. Di
ringworm include\:
2
Discoid (nummular) eczema\: plaques tend to be con
plaques, steroid-responsive
Annular psoriasis\: lesion scale is silver, pitting of nails, family history of psoriasis
Pityriasis rosacea\: yeast infection, a patch of infection often preceded by a generalised rash
Pityriasis versicolour\: con
antifungals
Subacute cutaneous lupus erythematosus\: more common in females, distribution in photosensitive areas
Erythema annulare centifugum\: a trailing as opposed to a leading scale pattern to lesions

Investigations

Ringworm is a clinical diagnosis.
A skin scraping of the leading edge may be taken to con
initial anti-fungal treatment. Skin scrapings can be sent for microscopy, culture and sensitivities. Any topical therapy must
be removed before collecting scrapings. Hair and nail cuttings may also be used.
1
A Wood's lamp can examine hair as a
1
Treatment-resistant or atypical presentations may require a skin biopsy.

Management

Topical therapy

The
4
Topical terbina
scalp) or liquid (interdigital). Used once or twice daily for one to two weeks.
Econazole (or a similar azole) cream\: applied once or twice daily for two weeks.
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Oral therapy

Oral therapy is the next-line treatment option if the infection is severe, a
responding to topical treatment.
4
The
40 kgs, it is 125mg daily.
The length of treatment is dependent on the site of infection\:
Scalp\: four weeks
Fingernails\: six weeks
Toenails\: 12 weeks
Other body sites\: two weeks
The next option is griseofulvin (for tinea of the hair and scalp only) for 4-6 weeks and up to 1 year\:
Scalp/hair/groin\: 500mg daily
Feet/nails\: 1 g daily
The last line of therapy is oral

Complications

Complications most commonly arise in the immunosuppressed.
2,3
The most common complication is secondary bacterial co-infection with S t a p h y l o c o c c u s a u r e u s .
3,4
Those with untreated HIV/AIDS can experience a disseminated infection that can a
leading to serious cerebral complications and even death if treatment is not commenced in time.
3,4

References

Dermnet NZ. T i n e a c o r p o r i s . Available from [LINK]
Kovitwanichkanont, T., & Chong, A. H. (2019). Super
711.
The Royal Children's Hospital Melbourne. Ringworm. 2020. Available from [LINK]
AMH Online. Tinea. 2022. Available from\: [LINK]
DermNet. T y p i c a l a n n u l a r l e s i o n s o f R i n g w o r m . Licence\: [CC BY-NC-ND 3.0 NZ]
DermNet. T i n e a c a p i t i s . Licence\: [CC BY-NC-ND 3.0 NZ]
DermNet. T i n e a p e d i s . Licence\: [CC BY-NC-ND 3.0 NZ]

Reviewer

Dr Mark Graydon

Related notes

Acne vulgaris
Basal Cell Carcinoma (BCC)
Cellulitis
Cutaneous Squamous Cell Carcinoma (SCC)
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Erythema Multiforme

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Contents

Introduction
Aetiology
Risk factors
Cli i l f t
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