Tinea (Superficial Fungal Infection) - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Tinea is also called dermatophytosis or “ringworm”. It is a fungal infection of the skin where the fungus infects the most superficial layer of the skin, hair and nails. Since “worms” do not actually cause tinea, the term “ringworm” is an inaccurate name for the condition. The term is often used because the rash appears in the shape of a ring. Tinea is one of the most common skin infections seen by dermatologists worldwide.[1] Up to 25% of the people may be affected by tinea.[1] Tinea infections are not serious, but can be uncomfortable because of itching and burning. Western medical approaches focus on treatment with antifungals and

Treatment Philosophy

Typical tinea infections of the skin can be treated with topical antifungal medications that can be prescribed or purchased over-the-counter. Usually these medications are creams, but also include powders for feet or shampoos for the hair. Oral anti-fungal medications are often needed when the hair (tinea capitis) or nails (tinea unguium) are infected or when infections are severe or not improving with topical anti-fungal medications. Once treatment is completed, it is very important to limit risk factors for developing a subsequent infection.

Symptoms

Each type of tinea infection can have a very different appearance. For example, tinea corporis looks like a pink scaly circle with a clearer center. The edge of the ring is scaly and enlarges as the infection progresses. Tinea cruris shows up as a red, moist rash in the groin folds. Sometimes the affected skin can begin to ooze or form a blister.[2] Occasionally, tinea infections can get into the hair follicles and deeper layers of the skin to form bumps. This is a condition called Majocchi’s granuloma.[3] Hair loss from the scalp can happen in tinea capitis as can a large scalp lump with scaling. Infected nails can become thickened, turn yellow/gray and crack.[4]

Here are several forms of tinea:

Tinea infections are named according to the location of the body that the fungus infects[4]:

  • Tinea capitis: fungal infection of the scalp hair
  • Tinea faciei: fungal infection of the face
  • Tinea barbae: fungal infection of the beard
  • Tinea corporis: fungal infection of the body surfaces other than the face, groin, scalp hair, beard hair or feet
  • Tinea manuum: fungal infection of the hand
  • Tinea pedis: fungal infection of the feet; also known as athlete’s foot
  • Tinea unguium: fungal infection of the finger or nails; also known as “nail fungus”
  • Tinea cruris: fungal infection of the groin; also known as “jock itch”
  • Majocchi’s granuloma: tinea infection in the hair follicles that lead to inflamed, red, and itchy bumps

Causes

Several different species of fungi can cause tinea. The most common are Trichophyton, Microsporum and Epidermophyton.[4] Fungi thrive in moist and warm skin, which explains why they are more common in the groin and feet. Tinea also live on objects in warm and moist environments such as decks of swimming pools, sauna rooms, and locker rooms. They can also live in the hair shafts and nails. Skin friction may also increase the risk of passing tinea from person to person, which may explain why wrestlers and contact sport athletes are at higher risk of getting tinea infections.[5,6] Tinea also infects animals and at times the infection can transmit between humans and animals.[7]

 

Risk Factors

Your body

  • Weakened Immune System: People who have weakened immune system such as those who have diabetes, HIV, or taking medication that suppresses the immune system are more likely to get tinea infections.[8,9]

Lifestyle

  • Friction: Frequent skin friction causes small breakage in the skin barrier and allows fungi to enter the skin and cause an infection.[5,6,10]

Products 

  • Topical Steroid Use: Tinea infections can be misdiagnosed as eczema or other skin diseases. Topical steroids {insert link} can temporarily decrease skin inflammation. However, topical steroids decrease the ability of the skin’s immune system to fight off the tinea infection, and may eventually worsen the tinea infection.[11]

Environment

 

  • Moisture and Heat: People who live in warm tropical climates are at higher risk of getting tinea infections.[4]

Treatments

Medications

  • Topical Anti-fungal Medications: Most tinea infections of the upper skin layers can be treated with topical anti-fungal medications. Antifungal powders can be used on the feet and groin areas to reduce moisture and treat tinea infection at the same time.[12,13]
  • Oral Anti-fungal Medications: When tinea infects the nails and hair, treatment with oral anti-fungal medications may be needed.[14] Medications that are typically used in the oral treatment include terbinafine, itraconazole, griseofulvin, and fluconazole.

Lifestyle changes

There are a few tips for keeping the skin less likely to get a fungal infection:[15]

  • Keep your skin dry and clean.
  • Clip fingernails and toe nails short and keep them clean.
  • Avoid walking barefoot, especially in public, damp areas like locker rooms, sauna rooms, and pools.
  • Avoid touching animals with bald spots, because those may be areas with tinea infection.
  • Avoid sharing clothing, shoes, towels and sheets.
  • Dry wet feet and hands with a towel, because moisture and heat can easily build up between the fingers and toes.
  • Wash hands with soap and water after petting animals.
  • After playing contact sports, shower immediately. Do not share sports gear or helmets.
  • Change your socks and undergarment at least once daily.
  • If there is frequently infections of the feet, put on socks before underwear to lessen the chance of spreading the infection to the groin area.
  1. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008; 51 Suppl 4:2-15; PMID: 18783559 Link to research.
  2. Meykadeh N, Waltermann K, Schaller M, et al. Bullous ulcerating tinea. J Eur Acad Dermatol Venereol. 2009; 23(7):846-847; PMID: 19207638 Link to research.
  3. Smith KJ, Neafie RC, Skelton HG, 3rd, et al. Majocchi's granuloma. J Cutan Pathol. 1991; 18(1):28-35; PMID: 2022763 Link to research.
  4. Jean Bolognia JJ, Julie Schaffer. Third Edition, Volume 2. Elsevier Publishing. Dermatology. PMID:
  5. Wilson EK, Deweber K, Berry JW, et al. Cutaneous infections in wrestlers. Sports Health. 2013; 5(5):423-437; PMID: 24427413 Link to research.
  6. Bassiri-Jahromi S, Sadeghi G, Paskiaee FA. Evaluation of the association of superficial dermatophytosis and athletic activities with special reference to its prevention and control. Int J Dermatol. 2010; 49(10):1159-1164; PMID: 20636349 Link to research.
  7. Tan JS. Human zoonotic infections transmitted by dogs and cats. Arch Intern Med. 1997; 157(17):1933-1943; PMID: 9308505 Link to research.
  8. Ramos ESM, Lima CM, Schechtman RC, et al. Superficial mycoses in immunodepressed patients (AIDS). Clin Dermatol. 2010; 28(2):217-225; PMID: 20347666 Link to research.
  9. Nenoff P, Kruger C, Ginter-Hanselmayer G, et al. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014; 12(3):188-209; quiz 210, 188-211; quiz 212; PMID: 24533779 Link to research.
  10. Pecci M, Comeau D, Chawla V. Skin conditions in the athlete. Am J Sports Med. 2009; 37(2):406-418; PMID: 18988923 Link to research.
  11. Solomon BA, Glass AT, Rabbin PE. Tinea incognito and "over-the-counter" potent topical steroids. Cutis. 1996; 58(4):295-296; PMID: 8894430 Link to research.
  12. El-Gohary M, van Zuuren EJ, Fedorowicz Z, et al. Topical antifungal treatments for tinea cruris and tinea corporis. Cochrane Database Syst Rev. 2014; 8:CD009992; PMID: 25090020 Link to research.
  13. Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev. 2007;10.1002/14651858.CD001434.pub2(3):CD001434; PMID: 17636672 Link to research.
  14. Bell-Syer SE, Khan SM, Torgerson DJ. Oral treatments for fungal infections of the skin of the foot. Cochrane Database Syst Rev. 2012; 10:CD003584; PMID: 23076898 Link to research.
  15. Goldstein AO, Goldstein BG. Patient information: Ringworm (including athlete's foot and jock itch) (Beyond the Basics) Last updated Feb 19, 2014. Update.com.