Tinea corporis

Introduction

Ringworm of the body.

Epidemiology

• transmission is by direct skin to skin contact
  • person to person or animal to person

Pathology

• superficial skin infection, generally limited to epidermis

Clinical manifestations

• well-defined, scaly, macular eruption
• frequently forms annular lesions
• expands in a centrifugal pattern
• erythematous border of small vesicles & scales
• may appear on any part of the body
• may be asymptomatic
• pruritus is common
• pruritic, peripheral annular, erythematous eruption with peripheral scaling, expanding outward as concentric rings
• pain, tenderness, erosions generally do not occur
• topical glucocorticoids may temporarily reduce inflammation & give the impression of improvement, but with rebound of symptoms with cessation of treatment

* Images

Laboratory

(see Tinea)

Differential diagnosis

• psoriasis
• nummular eczema
  • usually occur on the lower extremities
  • a scale or scaly eruption suggests Tinea corporis
• pityriasis rosea (herald patch)
  • single annular salmon-colored patch with peripheral rim of scale
  • lesions more ovoid than Tinea corporis
  • generally on trunk (Christmas tree pattern)
• secondary syphilis
• erythema migrans (Lyme disease)
  • axilla, inguinal region, popliteal fossa, belt line
  • erythema migrans not associated with scale

Management

• topical imidazole compound for 2-3 weeks
  • continue for 1 week after clinical cure
  • clotrimazole# (Lotrimin)
  • miconazole# (Monistat)
  • ketoconazole (Nizoral)
  • econazole (Spectazole)
  • sulconazole (Exelderm)
  • oxiconazole (Oxistat)
  • terconazole (Terazol)
  • butenafine* (Lotrimin Ultra)
• oral antifungals
  • extensive disease of lesions in beard
  • griseofulvin (ultramicrosize) 250-375 mg BID for 4 weeks
  • fluconazole 150 mg/week for 4 weeks
  • itraconazole 100-400 mg/day for 2-20 weeks (mean 6.3 weeks)
    • 400 mg/day results in higher cure rates & shorter treatment duration with a higher cost $$
    • relapse is common at all doses

* fungicidal

# fungistatic

More general terms

• Tinea