What is tinea (or a ringworm infection)?
What causes tinea?
Who gets tinea?
How do dermatophytes cause disease?
What are the common findings?
How is tinea diagnosed?
How is tinea treated?
What are the complications?
How is tinea prevented?
Leslie Capin, M.D.
Aurora/Parker Skin Care Center
Tinea, also referred to as ringworm, is a common fungal infection of the skin. Fungi are widespread in the environment. There are thousands of fungal species, but only approximately 200 species regularly infect humans, causing either superficial or deeper infections, and, occasionally, both.
The body area affected by the infection classifies tinea. "Tinea capitis" is a superficial fungal infection involving the scalp, while "tinea corporis" is a superficial fungal infection involving the trunk, limbs, and face. "Tinea manuum," or ringworm, is an infection of the hands, whereas "tinea pedis" is a fungal infection the feet. "Tinea unguium," or "onychomycosis," affects the nails.
Dermatophytes, a group of fungi, cause superficial fungal infections, also known as fungal dermatosis, dermatophytosis, ringworm, or tinea.
A dermatophyte infection of the scalp (tinea capitis) and of the general skin surface (tinea corporis) is very common during childhood. Because tinea capitis is no longer reportable to the Health Department, the true incidence is unknown. Probably, the highest incidence of tinea capitis occurs among children who are 1 to 10 years of age.
A dermatophyte infection of the hands (tinea manuum) and of the feet (tinea pedis) is more common in adulthood than in childhood. Tinea pedis is probably the most common dermatophytosis worldwide; up to 70% of the population has had this infection. Tinea pedis occurs in males and in females, and the incidence of the infection increases with age. Most cases of tinea pedis occur after puberty. Nail infection (tinea unguium) is unusual during the first two decades of life.
Tinea most commonly occurs in warm, humid, tropical climates. Certain risk factors may increase the likelihood of a person developing an infection. These predisposing risk factors include some systemic disorders and certain environmental and occupational sources. Systemic diseases that may predispose individuals to tinea infections include diabetes mellitus and those with compromised immune systems.
Environmental and occupational risk factors include animal contact, especially with kittens, puppies, and horses; contact sports; use of gymnasiums and swimming pools; and outdoor occupations.
Dermatophytes cause infection by invading keratin, which is a protein in the outermost layer of the skin, in the hair, and in the nails. Direct contact with infected animals, soil, or humans causes tinea.
Many patients with a mild tinea infection may have no symptoms. Symptoms include itching and burning, especially when the body, hands, or feet are involved. Patients also may complain of tenderness, swelling, and pain in the affected area. The more severe the infection, the worse the symptoms may become.
Tinea capitis appears as a combination of hair breakage and loss, redness, and scaling of the scalp. The extent of scalp redness and scaling varies from person to person. There can be minimal scaling and redness that resembles a mild form of dandruff, or there can be marked redness, swelling, puss formation, and hair loss.
Some patients have a strong reaction in their scalp to the dermatophyte, and may develop tenderness, pain, and swelling of the lymph nodes in their neck. Rarely, patients have an elevated white blood cell count. A long-term, severe case of tinea capitis that is not treated adequately may lead to permanent hair loss and scarring.
Tinea corporis is a dermatophyte infection of the general body surface. Physical examination reveals individual and grouped round patches of red, scaly skin. These round patches, or "rings," (hence the term, "ringworm") progressively enlarge and migrate outwards from the center of the ring to form expanding rings. As the ring expands, the center of the ring often becomes clear. Tinea corporis is similar in its appearance virtually anywhere on the body. Tinea faciei appears on the face, and tinea cruris is an infection that involves the upper thigh and groin area.
A tinea infection of the hands primarily involves the palms, with a dry scale often looking like small circular areas of scale. Occasionally, a tinea infection of the hands can have small blisters on the palms. For unknown reasons, a tinea infection of just one hand, in conjunction with an infection of both feet, is the most common pattern.
Usually, tinea pedis is red and scaly between the toes and on the soles. The skin of the web spaces between the toes can become red, softened, and swollen. The redness and scaling can spread to the side of the foot. Blister formation is more common on the feet than with the other tinea infections.
A tinea infection of the nails (tinea unguium or onychomycosis) invades the nail plate, and causes the nail to lift, thicken, discolor, and become fragile.
An appointment should be made with a primary care provider or a dermatologist for diagnosis and treatment, if an individual experiences the following: hair loss, accompanied by redness and scaling of the scalp; patches of red, circular, scaly skin on the body, hands, or feet; blisters on the palms and soles; or nail changes.
The health care provider will sample a small piece of scale or blister, hair, or nail, and analyze it under the microscope for a fungal organism to establish the diagnosis. This test is called a potassium hydroxide preparation (KOH). Occasionally, the fungal branches and spores characteristic of the infection cannot be seen under the microscope, and a fungal culture will be sent to the laboratory to establish the correct diagnosis. It may take two to four weeks to obtain the fungal culture results.
Tinea infections are treated with topical or systemic oral antifungal medications, and, occasionally, both. Anytime the infection involves the hair or the nails, an oral antifungal medication must be used. When only the skin is involved, a topical antifungal medication is usually sufficient, if the infection does not cover a large body area.
If a large percentage of the body surface is involved, an oral and topical antifungal medication may be prescribed. Antifungal drugs have become increasingly effective in the treatment of tinea infections, especially the newer antifungal drugs on the market. Experience with most of the newer antifungal drugs is limited to patients over 12 years of age.
Griseofulvin was the first significant oral antifungal on the market used to treat tinea infections. It continues to be the preferred drug in the pediatric population because of its long history of effectiveness, its low cost, and its proven safety profile. Griseofulvin is used frequently to treat tinea capitis and tinea corporis in children. It also is used to treat tinea manuum and tinea pedis.
Common side effects of griseofulvin include headaches and gastrointestinal upset. Rarely, allergic rashes from griseofulvin occur. Griseofulvin may make a patient more sensitive to the sun, and the patient is at risk of developing a photosensitive rash or a sunburn.
Many very effective topical antifungal medications are available over the counter, and they can be used one to two times daily to clear infections (except tinea capitis and onychomycosis). Blistering skin eruptions on the palms and soles should be treated with cool compresses, such as Burrow's solution. Large blisters should be opened and drained for comfort.
The newer antifungal medications on the market, namely Itraconazole and Terbinafine, are very effective for nail infections. Your primary care provider will help you to decide which topical and/or oral antifungal medication is most appropriate for your child.
Tinea infections may lead to secondary bacterial infections, hair loss, and scarring. Occasionally, patients will have swollen lymph nodes that may persist
A cool, dry environment, as well as avoiding exposure to infected animals, soil, and humans, may help reduce infections. Good personal hygiene, thorough drying of the hands and feet, absorbent socks, and wearing breathable natural materials may help prevent infection. For patients that experience recurrent tinea pedis infections, light, ventilated footwear or sandals and a medicated foot powder may be helpful. Sprays or powders with antifungal activity applied into footwear also may help prevent reinfection. Treatment is usually permanent, although the infection may recur.
Buttaro, T., Trybulski, J., Bailey, P., Sandberg-Cook, J.: Primary Care: A Collaborative Practice, ed. 1, St. Louis, 1999, Mosby, Inc.
Hurwitz, S.: Clinical Pediatric Dermatology, ed. 2., Philadelphia, 1993, W.B. Saunders Company
Weston, W.L., Lane, A.T., and Morrelli, J.G.: Color Textbook of Pediatric Dermatology, ed. 2, St. Louis, 1996, Mosby, Inc.
About the Author
Dr. Capin received her medical education and completed her dermatology residency at the University of Colorado. A Fellow of the American Academy of Dermatology, she is board certified in Dermatology.
She has been in practice at the Aurora/Parker Skin Care Center for twelve years, and recently opened CARA MIA Medical Day Spa in Parker, Colorado. She enjoys teaching, and often has students with her during office hours.
She is experienced in medical and surgical dermatology, as well as cosmetic dermatology. She is often asked to participate in conferences, and speaks internationally.
Copyright 2012 Leslie Capin, M.D., All Rights Reserved
The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.
If you think that you are having a medical emergency,
call 911 or the number for the local emergency ambulance service NOW!
And when in doubt, call your doctor NOW
or go to the closest emergency department.
By using this website, you accept the information provided herein "AS IS." Neither RemedyConnect nor the providers of the information contained herein will have any liability to you arising out of your use of the information contained herein or make any express or implied warranty regarding the accuracy, content, completeness, reliability, or efficacy of the information contained within this website.
RemedyConnect, Inc. has created this privacy statement in order to demonstrate our firm commitment to your privacy. The following discloses our information gathering and dissemination practices for this website: http://www.remedyconnect.com.
Acquisition of Information through PMD
We do not acquire any more information about website visitors than is required by law or is otherwise necessary to provide a high level of service efficiently and securely. Our site's registration form requires users to give us contact information (e.g., their name and e-mail address) and demographic information (e.g., children's birth months, but not birth dates). We use customer contact information from the registration form to (1) send the user pertinent medical and parenting information and (2) allow your local health provider lists of who is registering on that provider's site as a parent/guardian, staff member, doctor, or visitor. Users may opt-out of receiving future mailings; see the choice/opt-out section below.
We use your IP address to help diagnose problems with our server and to administer our Website. Your IP address is used to help identify you and to gather broad demographic information.
Demographic and profile data is also collected at our site. We may use this data to tailor the visitor's experience at our site, showing them content that we think they might be interested in, and displaying the content according to their preferences.
Our site may use order forms to allow users to request information, products, and services.
Your Doctor's Right to Privacy
We will respect your doctor's right to privacy. A doctor typically does not give his/her e-mail address to the parents/guardians of patients. We will not provide the e-mail addresses of doctor(s) in the local practice to users of their site without the doctor(s)' permission. Their site is restricted to use by whomever they wish, and they may deny access to their site to one or more prior users. In unusual cases, doctors may change their private site's access code and arrange for us to e-mail the new access code to approved users.
This site contains links to other sites. RemedyConnect.com is not responsible for the privacy practices or the content of such Websites. See Disclaimers.
Disclosure to Third Parties
We will provide individually-identifiable information about website users to third parties only if we are compelled to do so by order of a duly-empowered governmental authority, we have the express permission of the visitor, or it is necessary to process transactions and provide you services from our affiliates: Live Agent Answering Service, Digital Answering Service, Medical Answering Service and Pediatric Answering Service.
Privacy and Our Business Partners
This site may make chat rooms, forums, message boards, and/or news groups available to its users. Please remember that any information that is disclosed in these areas becomes public information and you should exercise caution when deciding to disclose your personal information.
This site has security measures in place to protect the loss, misuse and alteration of the information under our control. For further information regarding our security, please contact us at firstname.lastname@example.org. If you have any concerns regarding the security of information, please do not provide any information to RemedyConnect, Inc. until you are comfortable with our security measures.
You may correct or update your User Registration information at any time, by visiting the User Registration section and providing your personal password that you set at registration. If need be, please email us at email@example.com.
Our site provides users the opportunity to opt-out of receiving e-mail communications from our partners or us, except communications approved by your doctor's practice office. To so opt-out, please email us at firstname.lastname@example.org. To be removed as a user, please email us at the same address. If need be, you may mail requests to us at RemedyConnect, Inc.
Contacting the Website
If you have any questions about this privacy statement, the practices of this site, or your dealings with this Website, you can contact us by email at email@example.com or by mail at our address above.