Fungal skin infections

Acknowledgements

Developed in collaboration with the University of Auckland Goodfellow Unit in 2007.

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2009.  

Images have been sourced from the following:

  • Hon Assoc Prof Amanda Oakley
  • The Department of Dermatology, Health Waikato
  • Prof Raimo Suhonen (Finland)

 goodfellow unit logo

Tinea corporis CME

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Learning objectives

Clinical features

Tinea corporis presents as one or more round or oval erythematous scaly plaques that slowly enlarge. The appearance can be quite varied. The term ‘ringworm’ refers to the tendency for an annular raised edge and central healing. Any area can be involved including the face (tinea faciei).

Kerion is the name given to markedly inflammatory tinea, presenting as an elevated exudative, eroded or pustular nodule or plaque.

Tinea incognito refers to tinea mistaken for a dermatitis and treated with topical steroids. The plaques are poorly demarcated and less inflamed, and may have pustules rather than scale.

Diagnosis

Obtaining scrapings from the active edge of the lesion for mycology. If you can't obtain a scraping, it probably isn't a fungal infection.

Look for other sites of infection (scalp, feet, nails).

Consider other reasons for scaly plaques:

Consider other reasons for annular lesions:

Consider other reasons for eroded nodules:

Management

If tinea corporis persists despite topical imidazole creams, or is extensive, oral therapy is required for two to eight weeks, usually terbinafine or itraconazole. Oral azoles require specialist approval for PHARMAC subsidy. Griseofulvin may be more effective for M. canis infections but is no longer readily available in New Zealand.

Treatment should be continued until scaling has cleared up. If in doubt, repeat mycology and continue to observe.

Activity

Find out animal sources of dermatophyte infection. Are there specific clinical features that distinguish them?

Related information

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Skin lesion photography

Watch Dr Amanda Oakley presenting "Skin lesion photography" at The Australasian Skin Cancer Congress.

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