13-34: Dermatophyte Infections

J. Matthew Hardin

Clinical Summary

Tinea corporis includes all dermatophyte infections excluding the scalp, face, hands, feet, and groin. The dermatophytosis is pruritic and consists of a well-circumscribed scaly plaque with a slightly elevated border and central clearing. This annular configuration is most commonly found on the trunk and neck. Skin scrapings examined with a KOH preparation demonstrate hyphae.

FIGURE 13.91

Tinea Corporis, Ringworm. A well-defined, annular, pruritic plaque with a raised, scaly border and central clearing. KOH preparation is positive. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

In a patient with tinea corporis or ringworm, there is an area of normal skin, surrounded by raised, red, scaly borders.

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Tinea faciale (dermatophyte infection of the facial skin) commonly appears as a well-circumscribed scaling and erythematous patch. Tinea manuum (hands) presents with long-term scaling of the palms. Tinea cruris, or “jock itch,” is a pruritic dermatophytosis of the intertriginous areas, usually, but not always, sparing the penis and scrotum. The scaly, erythematous plaque spreads peripherally with well-defined borders. Tinea pedis, or “athlete’s foot,” consists of erythema and scaling of the sole and interdigital spaces, frequently with maceration, vesiculation, and fissure formation. The toenails may also be affected (tinea unguium). Tinea capitis (scalp) presents as a pruritic, erythematous, scaly plaque. This may develop into a delayed-type hypersensitivity reaction, where the initial erythematous, scaly plaque becomes boggy with inflamed, purulent nodules and plaques (kerion). The hair follicle is frequently destroyed by the inflammatory process in a kerion, leading to a scarring alopecia.

FIGURE 13.92

Tinea Faciale. Note the sharply marginated, annular plaques with central clearing. KOH preparation is positive. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

In a patient with tinea faciale there are areas of normal skin, surrounded by raised, red, scaly borders over the left half of the face.

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FIGURE 13.93

Tinea Manuum and Tinea Pedis. The involvement of both the hands and feet are common. (Photo contributor: James J. Nordlund, MD.)

In a patient with tinea manuum and tinea pedis there are multiple, white, scaly lesions scattered over the hands and feet.

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FIGURE 13.94

Tinea Cruris. Erythematous plaque with accentuated and well-defined border. The scale may not be appreciated in this anatomic site. (Photo contributor: James J. Nordlund, MD.)