SKIN DISEASES: Tinea (Ringworm, Roundworm)
fungal infections of the skin or nails mostly caused by species of the genera Microsporum, Trichophyton, Epidermophyton, characterized by ring-shaped, scaly, itching patches on the skin and generally classified by its location on the body.
The early belief was that the infection was due to a worm (in Latin Tinea is the name for a growing worm), which it is not, although the name has remained.
Tinea Barbae, Tinea Faciei
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Location: Tinea Faciei is the fungal infection limited to the glabrous area of the face including the upper lip and chin - in female and pediatric patients. In men the condition is called Tinea Barbae and includes the bearded areas of the face and neck, typically restricted to adult male animal handlers, dairy farmers and cattle ranchers. The causative agents vary according to geographic regions, Tinea mentagrophytes, Tinea verrucosum, Trichophyton rubrum and Trichophyton tonsurans.
Symptoms: Lesions may vary in type:
mild superficial form (looking like bacterial folliculitis) - with diffuse erythema, perifollicular papules and pustules, brittle, lusterless hair;
inflammatory, deep, boggy, purulent nodules (kerion) - involving chin, neck or maxillary area with upper lip sparing. Lesions are covered with crusts and have an abscess-like appearance, hairs become loose and brittle; kerions may be misdiagnosed as furuncles.
circinate, spreading form - has a spreading vesiculopustular border with central scaling.
Treatments: Tinea barbae is usually self-limited but may be treated with oral griseofulvin or oral azole antifungal agents such as fluconazole (Diflucan), griseofulvin, ketoconazole, itraconazole or terbinafine.
These agents are given as regular doses for 2 to 3 weeks until clinical resolution is achieved. Some patients may need either intralesional or a short course of oral corticosteroid. Systemic antibiotic treatment may be required in cases of bacterial superinfection.
Location: fungal infection of the scalp and hair that may either involve the hair of head, eyebrows and eyelashes, or be restricted to the skin alone (as in case when disease-causative agent is Trichopython rubrum).
Symptoms: There are three forms of this infection:
endothrix - infection with typical causative agent Trichopython tonsurans, presents as patchy alopecia and broken hair shafts, its alternative name is "Black dot" tinea capitis. This infection begins
by penetration of the hair, and the organism then grows up the interior main axis of the hair where it fragments into arthroconidia. The exception is form of the infection with causative agent Trichophyton schoenleinii,
forming an endothrix-style growth with channels within the hair shaft, but without the arthrocondia. Trichopython tonsurans does not fluoresce under black light;
favus (Tinea favosa) - later form of infection with the clinical presentation of scutula;
ectothrix - the infection caused by Microsporum canis produces diffuse, fine scaling. This infection begins as in endothrix, but then
extends back out through the outer wall of the hair forming a mass of arthroconidia both within and around the hair shaft.
Microsporum canis differs from Microsporum audouinii by perforating hair, hair or skin infected with Microsporum audouinii gives flourescence under Wood's ultraviolet light.
Treatments: preferred treatment for Tinea capitis is griseofulvin (Fulvicin, Grifulvin V, Grisactin, etc.), although itraconazole (Sporanox) and terbinafine (Lamisil) are also being studied for this purpose.
Tinea Corporis, Tinea Manuum, Tinea Cruris (Jock itch), Tinea Pedis (Atlete's Foot)
Location: Tinea corporis is a fungal infection involving the glabrous (relatively hairless) skin body surface.
Symptoms: Tinea pedis, Tinea manuum, and Tinea cruris are particular cases of Tinea corporis limited to the foot, hand, and groin, respectively.
Tinea pedis occurs in three patterns: interdigital infection - produces cracking and maceration in the interdigital spaces; plantar moccasin-type infection - produces irregular but sharply defined hyperkeratotic lesions; and itchy,
vesiculobullous infection - produces vesicular lesions. All the three types of lesions may occur in the same person.
Tinea manuum is a fungal infection of the hands, quite rare, its sympthoms are similar to the foot infection.
Tinea nigra - is a very rare infection, mainly affecting palmar surfaces(tinea nigra palmaris), but it also may occur on the soles(tinea nigra plantaris) and other surfaces of the skin, causing brown to black nonscaly macules (quantity and shape may vary -
lesions may be single or multiple, of rounded or irregular shape) with well-defined borders, resembling silver nitrate stains.
Tinea cruris, or "jock itch", produces pruritic, discolored rash on the groin, perianal and inner thigh areas.
Treatments: Treatment of the tinea corporis involves topical therapy in cases of non-inflammatory lesions; but in case of inflammatory lesions systemic therapy with griseofulvin, terbinafine, ketoconazole, itraconazole or fluconazole is recommended.
Tinea Unguium (Fungal nails, Onychomycosis)
Location: toenails and fingernails
Symptoms: Tinea unguium can present in one of the different forms, it may appear:
as a white or yellow opaque streak at one side of the nail (lateral onychomycosis);
as undernail scaling (subungual hyperkeratosis);
as flaky white patches and pits on the top of the nail plate (superficial white onychomycosis);
as yellow spots in the half-moon, or lunula (proximal onychomycosis);
as lifting of the end of the nail along with crumbling of the nail's free edge (distal onycholysis);
as complete destruction of the nail.
Treatments: onychomycosis of the toenails usually is more difficult to treat than the same infection affecting fingernails.
Onychomycosis that affects less than 80% of one or two nails may positively respond to topical antifungal medications but to be
successfully treated it usually requires an oral antifungal medication.
Tinea Versicolor (pityriasis versicolor, or Peter Elam's disease)
Location: back, underarm, upper arms, chest, and neck
Symptoms: Tinea versicolor presents as an eruption of discolored skin patches (dark-tan with a reddish cast), lesions have sharp borders and fine scales. These lesions may often appear white in contrast with hyperpigmented skin after exposure to intense sunlight. Most common in adolescent and young adult males
Treatments: Over-the-counter (OTC) antifungal remedies available to apply to the skin for the treatment of tinea versicolor include clotrimazole, miconazole, and selenium sulfide shampoo (e.g., Selsum Blue). Difficult to apply to large areas, however, this solutions makes it easy to miss spots.
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