Dermatophyte Skin Infections

(tinea corporis, tinea cruris, tinea pedis, tinea manum)

Comments from Expert Advisory Group

Definitions:

Tinea corporis - Infection of body surfaces (other than the feet, groin, face, scalp hair, or beard hair)

Tinea cruris - Infection of the groin

Tinea pedis - Infection of the foot

Tinea manum - Infection of the hand (usually unilateral; if bilateral, usually asymmetrical)

NB: Tinea incognito — inappropriate use of topical corticosteroids can lead to extensive spread of fungal infection, and a change in the morphology of lesions.

For guidance on when to perform skin scrapings, see section below treatment table.

Risk factors include:
  • Hot / humid environments
  • Wearing tight-fitting clothing
  • Obesity
  • Hyperhidrosis

Immunocompromised states may lead to severe, resistant or extensive disease.

Children with tinea pedis: consider referral to secondary care.

Self-care management strategies:
  • Wear loose-fitting clothes
  • Maintain good hygiene by washing affected skin areas daily
  • After washing dry thoroughly, especially in the skin folds
  • Avoid scratching affected skin, as this may spread infection to other sites
  • Do not share towels, and wash them frequently, to reduce the risk of transmission
  • For tinea pedis put on socks prior to underwear to reduce risk of fungal carriage to the groin

Wash clothes and bed linen frequently to eradicate fungal spores.

Image 1 Tinea corporis: Sharp red scaly margin of tinea corporis

Image source: Dermnet

 

 

 

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Image 2: Tinea corporis

Image source: Dermnet

 

 

 

 

 

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Image 3: Tinea cruris: Unilateral rash in the groin

Image source: Dermnet

 

 

 

 tinea-cruris-1

Image 4: Tinea cruris: Raised border and central clearing

Image source: Dermnet

 

 

 

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Image 5: Tinea pedis

Image source: Dermnet

 

 

 tinea-pedis1

Image 6: Tinea pedis

Image source: Dermnet

 

 

 

 tinea-pedis2

Treatment

  • Dermatophyte skin infections (tinea corporis, tinea cruris, tinea pedis, tinea manum) can often be cured with topical therapy alone
  • Systemic therapy is generally reserved for severe or refractory infection, or in immunocompromised patients
Dermatophyte skin infections (tinea corporis, tinea cruris, tinea pedis, tinea manum)
Drug Application frequency Duration Notes

Terbinafine 1% cream

 

Apply to the affected area every 12 hours

 

1-2 weeks

Tinea pedis – 2 weeks

Not recommended for children under 12 years as insufficient data on safety

 

OR

Clotrimazole 1% cream

 

 

Apply to the affected area  every 8 to 12 hours

 

 

4-6 weeks

 

 


First choice for tinea cruris and Candida skin infection.

To prevent relapse, treatment should be continued for at least two weeks after the disappearance of all signs of infection.

OR

Miconazole 2% cream

 

Apply to affected area every 12 hours

 

2 – 6 weeks

 
Continue for 7 – 10 days after lesions have healed.

When to take samples

Note: sensitivity is not 100% , approximately 1 in 3 samples will return a false negative result for fungal infection.

Take samples for fungi:

  • in severe or extensive skin fungal infections
  • skin infections refractory to initial treatment when the diagnosis is uncertain
Skin sampling instruction
  • Swabs are of little value for dermatophytes, unless there is insufficient material obtained by scraping
  • Wipe off any treatment creams before sampling
  • Keep any samples at room temperature. Do not refrigerate as dermatophytes are inhibited at low temperatures, and humidity facilitates the growth of contaminants
  • Samples should be collected into folded dark paper squares. Secure dark paper squares with a paper clip and place in a plastic bag, or use commercially available fungal packets
Skin scrapings
  • Scrape skin from the advancing edge of lesion; use a blunt scalpel blade or similar
  • 5mm2 of skin flakes are needed for microscopy and culture

 Safe Prescribing (visit the safe prescribing page)

 Reviewed December 2022

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