Dermatophytosis treatment guidelines
Dermatophytosis Tinea InfectionsAuthored byDr Colin Tidy, Reviewed by Dr Laurence Knott | Last edited 17 Mar 2021 | Meets Patients editorial guidelines This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Fungal Groin Infection (Tinea Cruris) article more useful, or one of our other health articles. Show
In this article
DermatophytosisTinea InfectionsIn this article
Introduction[1]Dermatophytosis (tinea) infections are fungal infections caused by dermatophytes - a group of fungi that invade and grow in dead keratin. Several species commonly invade human keratin and these belong to the Epidermophyton, Microsporum and Trichophyton genera. They tend to grow outwards on skin, producing a ring-like pattern - hence the term 'ringworm'. They are very common and affect different parts of the body. They can usually be successfully treated but success depends on the site of infection and on compliance with treatment. See the separate Tinea Capitis, Fungal Nail Infections, Pityriasis VersicolorandCandidiasis articles. Pathophysiology[2, 3]
EpidemiologyInfection is very common all over the world. Some types are more common than others, with tinea pedis being most common in adults and tinea capitis the most common in children. Onychomycosis is also extremely common. Presentation[2]History
Examination
Tinea corporisCorina G., Public domain, via Wikimedia Commons By Corina G., Public domain, via Wikimedia Commons
Differential diagnosis[7]Other annular rashes are often confused with tinea infections.Eczema and psoriasis are commonly confused with tinea. Pityriasis versicolor occurs all over the trunk while candida occurs as a flexural rash at extremes of age or in the immunocompromised, those with diabetes or patients on antibiotics. Treatment with topical steroids often causes confusion, making tinea less scaly and more erythematous. Steroid use also makes the 'active' edge and the inactive centre less distinct (tinea incognito). Clinically the diagnosis can be difficult but, if it is a possibility, take scrapings for mycology. Other fungal infections look nothing like tinea. Other conditions to consider include:
Investigations[10]
Associated diseasesDiabetes, immunocompromised states, atopy and Cushing's syndrome have all been associated with fungal infections. Management[4, 5, 7, 10]
ComplicationsThe main complication is secondary bacterial infection. Hair loss is a complication of tinea capitis. Pain and difficulty with shoes can result from onychomycosis. Scarring is uncommon but more likely in people with pigmented skin. Scarring usually fades with time. Skin protection such as using a moisturiser cream and sunscreen can be helpful. Extensive or severe scarring may need further treatment, such as using laser therapy. PrognosisExcellent with good compliance and subsequent precautions to avoid repeat infection. Prevention
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