Tinea Infections

Content of This Page

1- Introduction

2- Causes

3- Symptoms

4- Types of Tinea Infections

5- Complications

6- Treatment

Introduction

Tinea infections, also known as dermatophytosis, are superficial fungal infections of the skin, hair, or nails caused by a group of fungi known as dermatophytes. These fungi thrive on keratin, a protein found in these tissues. Tinea infections are commonly named based on the part of the body affected, such as tinea capitis (scalp), tinea corporis (body), tinea pedis (feet), and tinea unguium (nails, also called onychomycosis).

Dermatophytes responsible for these infections belong to three genera: Trichophyton, Microsporum, and Epidermophyton. Transmission occurs through direct contact with infected individuals, animals, or contaminated surfaces (fomites), and is favored by warm, moist environments.

Tinea infections are common worldwide and can affect individuals of all ages, though some types are more prevalent in specific age groups or settings (e.g., tinea capitis in children, tinea pedis in athletes). Though usually not serious, they can cause itching, redness, scaling, and discomfort, and may lead to secondary bacterial infections if left untreated.

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Causes

  • Fungal Species (Dermatophytes):

    • Trichophyton (most common, especially T. rubrum, T. mentagrophytes)

    • Microsporum (e.g., M. canis)

    • Epidermophyton (e.g., E. floccosum)

  • Mode of Transmission:

    • Human-to-human contact (e.g., shared towels, close physical contact)

    • Animal-to-human contact (e.g., infected pets like cats and dogs)

    • Soil-to-human contact (rare; some species are geophilic)

    • Fomite transmission (contaminated surfaces, clothing, combs, shoes)

  • Risk Factors That Promote Infection:

    • Warm, humid environments

    • Excessive sweating (hyperhidrosis)

    • Poor hygiene

    • Wearing tight or occlusive clothing/shoes

    • Skin maceration or minor trauma

    • Immunosuppression (e.g., diabetes, HIV, steroid use)

Tinea Capitis © image from www.researchgate.net

Symptoms

-General Symptoms (common to all types):

  • Itching (pruritus)

  • Red, scaly patches

  • Circular or ring-shaped lesions with raised edges

  • Central clearing in many cases

  • Cracking, flaking, or peeling skin

  • Inflammation or irritation around the edges

-Location-Specific Symptoms:

  1. Tinea Capitis (scalp):

    • Scaly patches on the scalp

    • Hair loss in affected areas

    • Black dots from broken hairs

    • Painful, swollen lesions (kerion in severe cases)

    • Swollen lymph nodes in the neck

  2. Tinea Corporis (body):

    • Ring-shaped, red lesions on the trunk or limbs

    • Clearer center with a red, scaly, and raised border

    • Itching or mild burning

  3. Tinea Pedis (athlete’s foot):

    • Itching, burning, or stinging between the toes

    • Peeling, cracking, or flaking skin

    • Thickened skin on soles or sides of the feet

    • Possible blistering

  4. Tinea Cruris (jock itch):

    • Red, itchy rash in the groin and inner thigh area

    • Well-defined edges, often with scaling

    • May be painful or feel like burning

    • Usually spares the scrotum

  5. Tinea Unguium (onychomycosis – nails):

    • Thickened, discolored (white, yellow, or brown) nails

    • Brittle or crumbly texture

    • Nail distortion or separation from the nail bed

  6. Tinea Barbae (beard area):

    • Red, inflamed patches in areas with facial hair

    • Pustules or crusting

    • Hair loss in the affected area

    • Pain or swelling in severe infections

Types of Tinea Infections

  • Tinea Capitis

    • Affects the scalp and hair shafts

    • Common in children

    • Causes scaly patches, hair loss, and sometimes kerion formation

  • Tinea Corporis

    • Affects the skin of the trunk and limbs

    • Presents as ring-shaped lesions with central clearing and raised borders

    • Also called “ringworm of the body”

  • Tinea Cruris

    • Affects the groin, inner thighs, and buttocks

    • Also called “jock itch”

    • More common in males, especially in humid climates

  • Tinea Pedis

    • Affects the feet, especially between the toes

    • Also called “athlete’s foot”

    • Can present as interdigital, moccasin-type, or vesicular form

  • Tinea Manuum

    • Affects the palms of the hands

    • Often seen in individuals with tinea pedis (two feet, one hand syndrome)

  • Tinea Unguium (Onychomycosis)

    • Affects the nails (fingernails or toenails)

    • Causes thickened, discolored, brittle nails

  • Tinea Barbae

    • Affects the beard area of the face and neck

    • Usually occurs in adult men

    • Can cause pustules, swelling, and hair loss

  • Tinea Faciei

    • Affects the non-bearded areas of the face

    • May resemble tinea corporis but often less scaly and more inflamed

Complications

  1. Secondary Bacterial Infection

    • Scratching the itchy lesions can break the skin, allowing bacteria (e.g., Staphylococcus aureus) to enter and cause cellulitis, impetigo, or abscesses.

  2. Chronic or Recurrent Infection

    • Incomplete treatment, reinfection, or persistent risk factors (e.g., poor hygiene, immunosuppression) can lead to long-standing or frequently recurring infections.

  3. Kerion Formation (in Tinea Capitis)

    • A severe inflammatory reaction resulting in a painful, boggy mass with pus and hair loss

    • May result in permanent scarring and irreversible alopecia (hair loss)

  4. Nail Deformity (in Tinea Unguium)

    • Chronic infection of the nail can cause permanent changes in nail shape, thickness, or color

    • May affect function and appearance

  5. Spread to Other Body Areas or Individuals

    • The infection may extend to adjacent skin or spread to other people through direct contact or shared items

  6. Post-inflammatory Hyperpigmentation or Hypopigmentation

    • After healing, affected skin may remain discolored for a period, especially in individuals with darker skin tones

  7. Psychosocial Impact

    • Visible lesions (especially on the face, scalp, or nails) may lead to embarrassment, social anxiety, or decreased self-esteem

 

Treatment

1. Topical Antifungal Therapy

Used for mild to moderate, localized infections (e.g., tinea corporis, cruris, pedis):

  • Azoles:

    • Clotrimazole

    • Miconazole

    • Ketoconazole

    • Econazole

  • Allylamines:

    • Terbinafine (more effective than azoles)

    • Naftifine

    • Butenafine

  • Others:

    • Ciclopirox

    • Tolnaftate

Duration: Usually 2–4 weeks (continue 1 week after symptom resolution)

 

2. Oral Antifungal Therapy

Used for extensive, chronic, or refractory infections, or when hair or nails are involved:

  • Terbinafine

    • First-line for tinea unguium and capitis

    • Duration:

      • Skin: ~2 weeks

      • Nails: 6 weeks (fingernails), 12 weeks (toenails)

  • Griseofulvin

    • Especially used in tinea capitis in children

    • Long duration: 6–8 weeks or more

  • Itraconazole

    • Alternative for nail and skin infections

    • Can be used as pulse therapy for onychomycosis

  • Fluconazole

    • Also used for tinea and candidiasis

    • Weekly dosing possible for nails

3. Adjunctive Measures

  • Keep affected area clean and dry

  • Avoid tight clothing and occlusive footwear

  • Do not share personal items (e.g., towels, combs, shoes)

  • Treat household contacts or pets if source of infection

  • Use antifungal powders or sprays in recurrent tinea pedis

4. Treatment of Inflammatory or Secondary Infections

  • Topical corticosteroids: Only in combined antifungal/steroid creams for short-term use in highly inflamed cases

  • Antibiotics: If there’s a secondary bacterial infection

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