Category Archives: Ringworm Types

Tinea Unguium

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What is Tinea Unguium

Tinea unguium, also called onychomycosis is a contagious fungal infection of the nail tissue which can affect both finger and toenails. It is a common disease affecting about 14% of the adult population and can be caused by dermatophytes (fungi living on the skin), nondermatophyte types of molds or yeasts.

Tinea Unguium symptoms

Epidemiology: tinea unguium is the most commonly found nail disease. It has a greater prevalence in older people and shows an increasing rate of incidence (also in younger people and children). Probably, the increased prevalence reflects the widespread usage of immunosuppresive drugs, usage of locker rooms and wearing of modern, tight shoes. Even though it can affect almost anyone, some are at greater danger of catching this type of infection. Predisposing factors include the HIV infection, diabetes (one third of diabetics is supposed to be affected) and poor peripheral circulation. Wearing artificial nails has also been implicated as a factor in the pathogenesis. It’s a bit more common in men and in people living in urban areas of the world.

Once the infection is acquired, it will not heal spontaneously and because of that, the incidence increases with age.

Commonly, the infection of the nails is preceded by tinea pedis (fungal infection of the skin on feet) from where the pathogens can easily invade the nail tissue and act as a reservoir for other kinds of tineas (on the body, groin, scalp etc.).

Tinea Unguium pictures

tinea unguium pictures

Photo Credit: http://www.treatmentforonychomycosis.com/

Aetiology: in most of the patients, the infection can be attributed to the next species of fungi: Trichophyton rubrum, Trichophyton interdigitale (these two are found in about 90% of the cases), Trichophyton tonsurans and Epidermophyton floccosum. Just about 10% of the toenail infections are caused by other organisms (nondermatophyte molds and yeasts) like: Acremonium, Aspergillus, Fusarium, Scopulariopsis brevicaulis and Scytalidium. About 30% of all the fingernails infections are caused by Candida spp.

Transmission: is similar to all the other ringworm tinea infections. The organisms can invade the nails after a direct contact with an infected individual or with items that contain infected particles of skin (common transmission between family members). Some species live in the environment and are not transmitted between humans.

Clinical manifestation of onychomycosis: about 80% of nail fungal infections occur on toe nails (especially the big toes).

There are four classic types of onychomycosis:

  • The distal lateral subungual onychomycosis: where a white patch is visible on the distal or lateral undersurface of the nail and the nail bed. If the infection is not treated, the nail becomes opaque, thickened, cracked and raised. It is the most common form of onychomycosis.
  • The white superficial onychomycosis: where on the proximal nail plate there is a white, chalk like plaque. This type is almost never seen on the fingernails, just on the toenails. It is sometimes misdiagnosed as keratin granulations (a reaction to nail polish). The distal lateral subungual and the white superficial type can coexist at the same time.
  • The proximal subungual onychomycosis: which occurs usually on the toenails and looks like a white spot. With time, the spot moves distally and can involve most of the undersurface of the nail. It is more commonly found in immuno compromised patients (patients with this type of disease should be screened for HIV).
  • The Candida onychomycosis: where Candida is the offending organism. Prior to the infection, usually there has been trauma or infection of the nails.

Differential diagnosis: tinea unguium can sometimes look a lot like psoriasis, eczema, Reiter syndrome, onycogryphosis, some congenital nail dystrophies, chemical or traumatic injuries to nails, lichen planus, yellow nail syndrome and Darier-White syndrome.

Diagnosis: with onychomicosis, clinical diagnosis (just by looking at the nails) is usually not enough. The doctor has to take a bit of the nail to examine it under a microscope or plant it into a medium to grow a fungal culture.

Treatment: of the nails infected with fungi is difficult because the organisms that cause the infection are inside the tissue and difficult to reach. In order for the nail to be truly healthy, a new one must completely replace the old one. The medications used in the treatment are anti fungals, which can be taken orally or applied topically.

  • Topical agents (available as lotions or lacquers) are usually just moderately effective. They have to be applied for a long time (about a year) and include ciclopirox nail paint amorolfine and efinaconazole. Even if topical therapy alone is not considered adequate, it might be an option in patients who cannot take systemic treatment.
  • Systemic agents include terbinafine, itraconazole and fluonazole. The indications for prescribing these type of drugs include affected fingernails, limited function of the infected part, pain, a greater potential for bacterial infections, physical and other disabilities.
  • Removing the diseased part of the infected nails is advised.

Prognosis: as mentioned before, fungal infection of the nails will not go away if not treated. The pathogens will gradually spread to other toenails and skin areas (body, groin, hands). Because of the disease, the protective barrier of the skin is damaged and other organisms (like bacteria) can enter into the blood easily (happens frequently after a vein from the leg has been taken in a heart operation). Even after a successful course of treatment, the infection can often reoccur. Diabetic patients are at a significantly greater risk of having fungal nail infections and should be screened regularly.

Prevention: it is important to keep the feet dry and clean. The toenails should be regularly clipped and one should avoid walking bare feet in areas where the infection is possible (locker rooms,swimming, bathing areas). Shoes must allow the feet to breathe and mustn’t be too tight.

References

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Fitzpatrick, Thomas B and Freedberg, Irwin M, 2003, Fitzpatrick’s dermatology in general medicine. New York : McGraw-Hill, Medical Pub. Division.

Rook, Arthur and Burns, Tony, 2010, Rook’s textbook of dermatology. Chichester, West Sussex, UK : Wiley-Blackwell.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s color atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical.

http://www.medicinenet.com/script/main/art.asp?articlekey=5798

http://www.medicinenet.com/image-collection/ringworm_tinea_unguium_onychomycosis_picture/picture.htm

http://en.wikipedia.org/wiki/Onychomycosis

http://www.medscape.com/viewarticle/807034_3

 

What is Tinea versicolor

Tinea versicolor

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What is Tinea versicolor

Tinea versiolor (also called dermatomycosis furfuracea, pityriasis versicolor or tinea flava) is a common skin fungal infection that occurs usually on the chest and back.

Aetiology and epidemiology

it is caused by fungi from the species Malassezia (once called Pityrosporum). This organism is normally found on the skin of many different animals an humans (by some estimates it has been found on 18% of infants and 90-100% of the adults). It is present on the areas of the skin that show disease in and those that appear completely normal. Even though it may not cause any disease, it is thought to be associated many different skin conditions like: Pityrosporum folliculitis, confluent and reticulate papillomatosis, seborrheic dermatitis, and atopic dermatitis.

Malassezia is present worldwide and is more common in areas with high humidity and temperatures.

Tinea versicolor is a benign disease which is thought to be non contagious (because it already is present on the skin of people as part of the normal flora). The prevalence is not associated with race or sex and it is more common in people aged fifteen to twenty – four years.

Appearance: normally, the main compliant of the patients is the cosmetic effect of Malassezia – it causes small, round patches of skin discolouration. The affected skin can look hypo or hyperpigmentated (too light or too dark discolouration of the skin). The lesions are covered by very fine scales and are usually found on the trunk, back, abdomen and the proximal part of the limbs. Just sometimes, the affected skin can be mildly itchy.

Tinea versicolor Picture

Tinea versicolor

Photo Credit: https://www.dermquest.com/

Diagnosis

 because its distinctive look, the disease can often be diagnosed just by clinical examination. If the origin of the lesions is not so clear, the doctor might use a special lamp called Wood’s lamp that makes Malassezia glow or examine a small part of the skin under a microscope.

Tinea versicolor Cure

Treatment of the condition consists of:

  • Topical anti fungal medications: like ketoconazole or selenium sulphide shampoos.
  • Oral, systemic antifungal treatment: is the disease affects a very large area of the skin or if the topical treatment is not effective.

Prognosis

Tinea versicolor has a very good prognosis. It does not leave any marks or scars and the skin discolouration should disappear in about one to two months after the treatment has been initiated. However, recurrence is quite common and the treatment regimen frequently has to be repeated.

More to read,

http://www.mayoclinic.org/diseases-conditions/tinea-versicolor/basics/definition/con-20024674

http://www.patient.co.uk/health/pityriasis-versicolor-leaflet

http://www.nlm.nih.gov/medlineplus/ency/article/001465.htm

http://emedicine.medscape.com/article/1091575-clinical#showall

http://en.wikipedia.org/wiki/Tinea_versicolor

What is Tinea nigra

Tinea nigra

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What is Tinea nigra

Tinea nigra (also called superficial phaeohyphomycosis or tinea nigra palmaris et plantaris) is a uncommon infection of the skin usually caused by Hortaea werneckii (a species of fungi).

The involved fungus is not rare in Central and South America, Asia and Africa. As the fungus is not very common is the United states, patients have usually travelled elsewhere (especially to the Caribbean islands) prior to noticing the lesions on the skin.

Tinea nigra Picture

Tinea nigra picture

Photo Credit: http://www.ijmm.org/

Presentation: a lot of times, the pathogen does not cause any signs of the disease. When symptoms are present, they usually consist of dark brown or even black patches on the skin of the hands and feet (usually on the palmar and plantar side). The shape can vary from round to completely irregular and it may grow larger with time.

Diagnosis is frequently achieved with clinical examination alone. Rarely, microscopic examination of small skin scrapings or a fungal culture are performed. Because of its typical colour, melanoma should be ruled out.

Treatment: tinea nigra is an infection that responds well to topical anti fungal treatment in about two to four weeks. If treated appropriately, it does not reoccur.

http://emedicine.medscape.com/article/1092976-followup#showall

http://en.wikipedia.org/wiki/Tinea_nigra

What is Tinea corporis

 

Tinea corporis

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What is Tinea corporis

Tinea corporis also known as ringworm infection, tinea circinata or tinea glabrosa is a skin fungal infection that affects the skin of the trunk, arms, legs or neck but does not appear on the feet, hands, scalp or the groin area.

Epidemiology:

the transmission of the pathogens occurs by direct contact with an infected person or animal, by contact with an item that contains infected particles of skin or by spreading it from one’s feet that have been previously affected. In children, the most common way of getting the disease is by touching animals. Fungi affect both males and females and the prevalence peaks in the pre-adolescent children.

There are some environmental factors that predispose to the infection and are typical for fungi. They include worm, moist climates and wearing tight-fitting, occlusive clothing. Small injuries and frequent skin-to-skin contact favours the invasion of the pathogens. Such conditions are encountered in those who practice contact sports (wrestling for example) and are often called Tinea corporis gladiatorum. It occurs most commonly on the head, neck or arms.

What causes ringworm infection

Aetiology of the infection: the disease can, in fact, be caused by any dermatophyte (fungi that infect the skin) but is most commonly attributed to the next species: Trichophyton rubrum, Epidermophyton floccosum, Trichophyton interdigitale, Microsporum canis (found on cats and dogs), Trichophyton tonsurans and Trichophyton concentricum (this one, however, is limited to the Far East, the South Pacific and South and Central America).

How does Tinea corporis look

Usually, there is a circular patch with a red, scaly, a bit raised border. With time, the changes progress outwards and show a almost complete central clearing with some scaling. The ring-shaped lesion can be one or they might be multiple. The types of fungi which have been contracted from animals usually show a more pronounced immune response.

A very broadly spread disease can be the first sign of AIDS or it might follow the use of topical corticosteroids (anti – inflammatory drug).

Tinea corporis can be acute or chronic (mild disease which persist for a long time).

Differential diagnosis: ringworm infection can sometimes look a lot like nummular eczema, psoriasis, tinea versicolor, infection with candida, lupus erythematosus or different types of dermatitis (contact, atopic, seborrhoeic).

Diagnosis: beside its typical appearance, the doctor might have to scrape a bit the border of the lesion and examine the specimen under a microscope. In cases, where the diagnosis of ringworms is suspected but cannot be proven otherwise, the specimen can be put in a culture medium and in about a week or two, the organism should show signs of growth.

How to treat ringworm infections

Treatment: with localised disease, topical anti fungal drugs are usually effective enough. Typically, they have to be applied twice daily for about two to four weeks (but the regimen depends on the drug) and another seven days after the symptoms have disappeared. If the disease has spread to a larger area, if there is involvement of the hair follicles or if the infection does not respond to topical treatment, systemic anti-fungal agents have to be taken.

Other forms of tinea corporis:

  • Fungal folliculitis (infection of the hair follicles): also called Majocchi granuloma is a deeper form of tinea corporis which can resemble a carbuncle (localized skin infection from which pus can be passed) or kerion (a very nasty form of ringworm of the scalp). It’s usually caused by Trichophyton rubrum or Trichophyton mentagrophytes and shows up in places where hairs have been shaved. In patients with a compromised immune system (cancer, AIDS etc.), lesions appear to be even more deeply located and nodule-like. Orally taken medications are necessary in order to cure this type of infection.
  • Tinea incognito: is a term which describes a ringworm infection of the skin which has been previously treated with corticosteroids because it was mistaken for another dermatological disease. Because of this treatment, lesions do not appear as typical as always and a biopsy is sometimes in order. Systemic anti fungal treatment is usually indicated.

Prognosis: cure rates for ringworm infection of the body are very good. Most of the times, topical treatment cures all the symptoms of the disease. If other parts of the body are infected (like nails or feet) they should be cured in order to prevent the tinea to reoccur.

How to avoid ringworms

Prevention: avoid sharing objects of personal hygiene (like towels, combs etc.), having close contact with infected people or animals, wash hands with hot water and soap after petting animals. All the pets should be checked for ringworms and treated if they have it.

References

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Fitzpatrick, Thomas B and Freedberg, Irwin M, 2003, Fitzpatrick’s dermatology in general medicine. New York : McGraw-Hill, Medical Pub. Division.

Rook, Arthur and Burns, Tony, 2010, Rook’s textbook of dermatology. Chichester, West Sussex, UK : Wiley-Blackwell.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s color atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical.

http://en.wikipedia.org/wiki/Tinea_corporis

http://www.merckmanuals.com/professional/dermatologic_disorders/fungal_skin_infections/tinea_corporis.html

http://www.dermnetnz.org/fungal/tinea-corporis.html

http://emedicine.medscape.com/article/1091473-followup#showall

 

What is Jock Itch

Tinea cruris

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Jock Itch Rash

Tinea Cruris (Fungal Groin Infection)

Tinea cruris also called jock itch, crotch itch, ringworm of the groin, gym itch or Tinea inguinalis is a disease caused by fungi which live on the skin. It affects the upper thigh, groin, the area of the genitalia and / or the skin of the perineum and around the anus. It appears to be the second most common infection of the skin caused by fungi.

Jock Itch pictures

Epidemiology

this infection is generally more common in men and is more frequently found in adults that in children. The routes of infection are similar to all other fungal infections caused by dermatophytes (commonly called ringworm infections). They include a direct contact with an infected person / item or a previously infected site on the body (from where, the pathogens have spread to the groin area by using an infected towel or with scratching). Most commonly, the original site of the infection includes feet (also called Tinea pedis).

Ringworm of the groin is more common in hot, humid climates and in people who emigrate from such places. The species most frequently implicated in Tinea cruris include Trichophyton rubrum, Epidermophyton floccosum, Trychophyton interdigitale and Trichophyton verrucosum.

This type of fungal infection can also be sexually transmitted and can cause epidemics in bathing facilities, dormitories or between soldiers. Affected patients may have been wearing tight-fitting garments for longer periods or have been suffering from diabetes or obesity.

Clinical presentation

It appears as a circular patch, which is easily distinguishable from the surroundings and has a raised, scaly border. Another possible clinical picture involves red, scaly changes with blisters and small bumps. Some species of fungi produce a central clearing of the plaque but others don’t. Jock itch is frequently found on both legs where it extends from the inguinal fold to the inner part of the thigh and backward towards the anus. The skin changes are often itchy, if bacteria join the infection they can even get painful. Commonly, the skin of the scrotum is affected, with some species invading the skin of the buttocks, skin of the lower back or abdomen.

Differential diagnosis

candidosis (occurs more commonly in women and classically does not present with a well demarcated border), pityriasis versicolor, erythrasma, inflammation between skin folds (common in the obese people), psoriasis, mycosis fungoides, atopic eczema, lichen simplex chronicus, contact dermatitis, Hailey–Hailey disease, Darier’s disease.

If topical corticosteroid have been used in the course of the disease, symptoms can be suppressed and the diagnosis difficult to determine.

Diagnosis

After a careful examination, the doctor might collect some scales of skin from the margin of the lesion and then examine them under a microscope. Biopsy is rarely performed.

Therapy

ringworm of the groin is typically treated with topical anti fungal medications (including Terbinafine, topical Clotrimazole and Miconasole). If the patient is unable to apply it regularly or if the infection has spread to a large area, orally taken systemic drugs might be subscribed. It is important for the patient to keep the affected part of the skin dry, clean and to change into dry clothes as soon as possible after getting wet. It is also advisable to put on socks before putting on underwear in order to refrain from spreading the infection.

Sometimes, anti fungal powders are used as a preventive measure. If obese, weight loss is strongly advised.

Prognosis

Prognosis is very good unless the subjected area is not kept dry – if not, recurrence is frequent.

Jock itch prevention

in order to properly treat jocks itch, it is essential to treat the almost always present fungal infection of the feet. In hotter areas, light clothing is preferred. If an infection is taking place, the patient should not share towels or any piece of clothing with others in order to refrain from spreading the pathogens. The underwear should be changed daily and the groin kept clean and dry.

Tinea manuum

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Tinea manuum

Tinea manuum or ringworm infection of the hands, is a fungal infection occurring on the skin of the hands. It is less common than the same infection affecting the feet and appears to be frequently misdiagnosed because its clinical presentation is similar to other dermatological diseases.

fungus on hands

Is tinea manuum contagious

Transmission:it can be acquired through contact with an infected person, soil, by touching an infected animal or by touching a previously infected part of your own body (like picking on infected feet, nails or groin area). Sometimes, the disease can start under rings or watches. Bad peripheral circulation in hands and excessive sweating can both play an important role in the development of the inflammation.

Aetiology: predominantly caused by Trichophyton rubrum, Trichophyton interdigitale or Epidermophyton floccosum. Less commonly diagnosed species include: Microsporum canis, Trichophyton verrucosum and Microsporum gypseum.

Tinea manuum symptoms

it presents with scaly, demarcated patches, which show signs of hyperkeratosis (thickening of the horny layers of the skin). Blisters and crops may be seen. The peripheral part of the lesion is well demarcated and the centre often appears to be clearing off. They are found on palms but can extend to the dorsum of the hand. Sometimes, hair follicles may be involved. The lesions are often found on just one hand (the dominant one more commonly) and are associated with Tinea pedis (fungal infection of feet) and Tinea cruris (fungal infection of the groin area). If the disease is chronic, nails are often affected.

Differential diagnosis: psoriasis, keratolysis exfoliativa, contact dermatitis, lichen simplex, atopic dermatitis. If topical corticosteroid creams have been used, diagnosis can be even more difficult to determine.

Diagnosis: scrapings of the skin or a fungal culture can aid in diagnosing this disease.

Course of the disease

The disease itself is chronic and does not heal spontaneously. Unless the usually concomitant nail infection is cleared, the hand infection will reoccur. Because the skin barrier is damaged, a new route for bacteria and possible infections is opened.

Treatment

For the disease to heal it is mandatory to eradicate the nail infections on both hands and feet and on the skin of feet and groin. Oral anti fungal therapy is advised and includes drugs like terbinafine, itraconasole and fluconasole (the prescribed regimen depends on the used medication).

Tinea pedis Or Athlete’s foot Or Jungle rot

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Athletes foot

Tinea pedis

Dermatophytic infection of the feet also called ringworm infection of the feet, Tinea pedis, athlete’s foot or jungle rot is a contagious fungal infection of the skin of the feet. It affects either the space between toes or the soles. Together with fungal infections of the hands, they are believed to be the most common dermatophytoses. The involved species of fungi include Trichophyton rubrum, Trichophyton interdigitale and Epidermophyton floccosum and a combined infection can sometimes be seen.

Tinea pedis - Athletes foot

Jungle rot - Fungus on feet

Epidemiology frequently affects older children and young adults and is most commonly found in those aged twenty to fifty years. It is more commonly found in males than females. As all of the fungal skin infections, it is more frequently found in hot, humid climates. Predisposing factors include wearing tight footwear and having a condition called hypertrichosis (an abnormal amount of body hair). Because of widespread wearing of modern, tight shoes and world travelling, these infections have a very high incidence. They are also commonly acquired by walking bare-feet in pool and shower areas and can be transmitted between members of the same household. If fungi are present and infect another part of the body, it is possible for them to spread to the feet.

Tinea pedis symptoms

Redness, scaling, formation of large blisters and occasional peeling is seen. Often, a fungal infection of the toenails precedes it. If a bacterial infection follows it, the skin lesion is itchy, painful and emits a foul smell. There are four different clinical pictures associated with Tinea pedis (combination of them is possible):

  • The interdigital type: is most commonly found between the forth and fifth toe and can spread to other parts of the feet. It can be dry and scaly or macerated (by definition softening by soaking in liquid). Excessive perspiration is commonly found. This is the most common form of all.
  • The moccasin type: is most commonly located on heels, soles and the lateral borders of the feet. It can affect both feet. The skin is red, with small superficial elevations called papulae on the margin, finely scaly and hyperkeratotic (excessive thickening of the horny layer of the skin).
  • The inflammatory/ bullous type: blisters filled with clear fluid are present on the sole, the instep. Pus indicates that bacteria have also infected the damaged skin.
  • The ulcerative type: is observed when the interdigital infection has extended to the plantar or lateral part of the foot. Frequently, bacterial inflammation of the skin,the lymph nodi and fever are associated with this form.

Differential diagnosis: includes several different dermatological diseases like psoriasis, eczematous dermatitis, bullous impetigo, allergic contact dermatitis and dyshidrotic eczema.

Diagnosis

Most of the times, diagnosing Tinea pedis is possible just by looking at the lesion. If the presentation is somehow misleading, the doctor may perform small scrapings of the affected skin and examine them under a microscope, use a special lamp called Wood’s lamp which makes some species of fungi glow (although species that cause athlete’s foot usually do not) or try to grow the pathogens in a special medium.

Treatment

Tinea pedis is treated with anti fungal drugs which can be taken orally or applied topically (in form of a cream, powder, gel or spray). With the moccasin type, the topical medication has to be applied to the bottom and sides of the feet, with the interdigital type to the affected part plus the soles (because often the infection spreads). The moccasin type is based on the plantar surface of the feet where the skin is thick. Sometimes, urea based creams have to be applied together with topical anti fungals in order to soften it.

Patients with extensive hyperkeratotic or vesicular infections, those with accompanying infection of the nails, patients with diabetes, a compromised immune system (cancer, transplant patients) or disease of the peripheral vessels have to take oral anti fungal medications.

Complications

Because Tinea pedis can be quite itchy, scratching it can cause a bacterial infection of the already damaged skin. By touching the site of the inflammation, the pathogens can also spread to other parts of the body and cause the infection. The disease can extend to nails or cause a specific reaction called ‘id reaction’ where blisters can appear in distant parts of the body (by treating the feet it will usually go away).

Course and prognosis of the infection

This disease is commonly chronic in nature and repeats itself. If the patient has issues with veins in his legs, the pathogens can enter into more deeply lying tissues. Often, Tinea pedis will reoccur because patients do not stick to the prescribed therapy.

Prevention

  • use comfortable shoes that breathe
  • keep feet dry
  • change socks regularly
  • wear sandals when walking in public pools or shower areas
  • keep nails short and clean
  • keep all bathroom surfaces clean and disinfected
  • do not share shoes or towels with others.

Tinea faciei – Ringworm on face

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Face Fungus

Definition

Tinea facei (also called ringworm of the face) is a fungal infection of the face area (excluded the moustache and beard areas of men – called tinea of the barb). It is a condition which is commonly misdiagnosed (more than any other ringworm infections) and wrongly attributed to other diseases (lupus for example).
Tinea faciei pictures
Face Fungus

Cause

The inflammation is usually caused either by Trichophyton rubrum, Trichophyton mentagrophytes of Microsporum canis – all species of fungi.

Tinea faciei is a fairly common disease, which occurs worldwide. However, fungi that cause it like warmer, moister climates so it is more frequent in tropical areas.

Although all ages can be affected by Tinea faciei, two groups of patients show increased incidence: children who come in contact with animals more often (also possible in neonates) and those aged between twenty to forty years.

Pathogenesis: the infectious agents can spread to the skin by direct contact with an external, infected source (a pet mouse for example) or by spreading from another part of the body which is already affected. Sometimes, Tinea faciei can be seen in people practising wrestling.

Symptoms

Most of the patients show round lesions. The scaling (present in less that two thirds of cases), red, elevated periphery of the skin changes points in the direction of a fungal infection. Commonly, patients complain of itching, burning sensations which get worse after being exposed to the sun. The lesions can affect any area of the facial skin and are usually not symmetric to both sides. The most commonly affected parts of the face are as follows: cheeks, nose, area around the eyes, the chin and the forehead. If the patient has previously been using corticosteroid creams (a type of anti inflammatory drug), involvement of hair follicles can be seen. Sometimes, lesions of the facial skin can appear at the same time as the ones on the body or scalp.

Diagnosis

The doctor may perform some small scrapings from the lesion to microscopically determine the involved pathogen. Sometimes a small piece of skin has to be taken to further clarify the origin of the disease. If corticosteroids have been used, cessation of therapy of a few days can make symptoms more prominent and therefore the diagnosis easier.

Differential diagnosis

The disease can be frequently mistaken for seborrhoeic dermatitis, contact dermatitis, the rash seen in Lyme disease, lupus, photo-toxic eruptions, rosacea and skin infections with Candida.

Tinea faciei treatment

if involvement of hair follicles (called fungal folliculitis) is present, or if the infection is widely spread, oral anti fungal treatment is advised. If there is no observed folliculitis, then topical therapy will usually suffice.

Prognosis

The prognosis with this type of infection is usually good and it should respond to treatment in about four to six weeks.

References

Ali, Asra, 2007, Dermatology. New York : McGraw-Hill Medical Pub. Division.

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Burns, Tony and Rook, Graham Arthur, 2010, Rook’s textbook of dermatology. Oxford [u.a.] : Wiley-Blackwell.

Fitzpatrick, Thomas B and Wolff, Klaus, 2008, Fitzpatrick’s dermatology in general medicine. New York [u.a.] : McGraw-Hill.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s colour atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical

Emedicine.medscape.com, 2015, Tinea Faciei. [online]. 2015. [Accessed 13 January 2015]. Available from: http://emedicine.medscape.com/article/1118316-overview

Tinea barbae

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Tinea barbae ringworm affects the facial hair (like the beard area)

Tinea barbae is a condition also known as Tinea sycosis or barber’s itch. Because of the specificity of the involved areas and structures (beard and moustache areas with invasion of hairs) it is a disease of adult males. It is not a very common infection, mostly affecting people working in the agriculture field (more common if working in contact with farm animals – cattle, horses or dogs may be the source). The shift of prevalence towards farmers and ranchers occurred after hygiene in barbers shops improved and the transmission by infected razors decreased. On general, Tinea barbae can be caused by fungi which have adopted to animal or human hosts (in Latin they are called zoophilic and antropophilic species respectively).

Tinea barbae ringworm also known as Tinea sycosis or barber's itch

Usually two types of clinical presentation are recognised:

  • the first type, where deep, nodular, suppurative (suppuration means the formation or discharge of pus) lesions are seen. This type develops slowly, with nodular thickening of the involved skin and swelling that reminds of kerion (a severe ringworm infection of the scalp). The most common causative pathogens are Trichophyton mentagrophytes and Trichophyton verrucosum – both types of fungi. The affected skin is visibly inflamed, the present swellings diffuse. The hairs may be absent or very loose, from the remaining follicular openings pus might be expressed. Usually the lesions are confined to one part of the face or neck skin.

tinea barbae pictures

  • the second type, where more superficial, crusted and partially bald patches with folliculitis (inflammation of a hair follicle) can be observed. The inflammation usually appears to be milder in nature and the affected hairs can sometimes be extracted with ease. If loss of hairs is present, it usually reverses with therapy. The involved pathogens include Trichophyton violaceum and Trichophyton rubrum, just rarely Epidermophyton floccosum.

In most of the cases the lesion is present on one side of the face or neck and involves the beard area (rarely moustache area and upper lip). The area appears to be itchy, tender and painful.

Diagnosis of Tinea barbae

the diagnosing process starts with the mandatory clinical inspection which in most cases suggests the underlying fungal infection. It is confirmed by microscopically examining the hairs extracted from the affected part of the skin (treated with potassium hydroxide) or by performing a skin biopsy. In some cases the doctor can make an attempt to grow a fungal culture (plant the extracted hair or a piece of skin in the appropriate medium), although this is rarely performed.

Differential diagnosis of Tinea barbae: when barber’s itch is suspected, two conditions with a fairly similar presentation must be kept in mind:

  • Inflammation of the hair follicles caused by bacteria called Staphylococci (in Tinea barbae there is usually no involvement of the upper lip and the lesions appear to be confined to one side)
  • Herpetic infections (lesions seen with herpes virus appear to be umbilicated – have a central depression)
  • Acne vulgaris, rosacea, contact dermatitis, perioral dermatitis or candidal folliculitis

Treatment of Tinea barbae

Although some forms of Tinea can be cured with topical agents this is not one of those cases. The infection show tendencies of spontaneous healing but can, however, persist for months. With barber’s itch systemic, orally taken anti fungals must be prescribed by a doctor and local creams serve merely as part of an adjunctive (joined) therapy.

References

Ali, Asra, 2007, Dermatology. New York : McGraw-Hill Medical Pub. Division.

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Burns, Tony and Rook, Graham Arthur, 2010, Rook’s textbook of dermatology. Oxford [u.a.] : Wiley-Blackwell.

Fitzpatrick, Thomas B and Wolff, Klaus, 2008, Fitzpatrick’s dermatology in general medicine. New York [u.a.] : McGraw-Hill.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s colour atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical.

Ringworm in babies

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baby ringworm

Ringworms in children and babies

ringworm babies contagious Ringworms are a class of infectious diseases caused by fungi. Despite their name they are not related to worms or parasites of any kind. These pathogens can affect people of any age, but are more common in children older that two years (also possible in younger babies but quite rarely). These common infections are not dangerous by nature.

Ringworm in babies

The child or baby can get infected with ringworms by having contacts with an infected person, animal (pets like dogs or cats), by picking it up from floors, soil or by coming into contact with an object which contains pathogens (towels, combs, different pieces of clothing).

 

Symptoms

Ringworm infection in children are usually quite specific. Usually they present as a scaly patch which can be found almost anywhere on the body (scalp, face, body, hands, legs). The patch grows with time and it’s usually round in shape, red coloured with a smooth, sometimes clear centre. The border is composed of scales, small blisters and bumps. If the lesion is located on the head, there might be scaly areas with missing or broken – off hair. This condition can be mistaken for another one called cradle cap (greasy, scaly patches that sometimes appears on the head of a baby) or for other, rash causing diseases (like psoriasis, eczema, seborrhoea or contact dermatitis). Sometimes the lesion on the skin is one and sometimes there are multiple.

If the child’s organism responds to the ringworm infection with a vivid immune response, a condition called kerion might follow. It is characterised by a swollen, moist area of inflammation with pus filled bumps (called pustules).

Diagnosing ringworm in babies

when the doctor inspects the child for possible ringworm infection he might be able to diagnose it just by looking at the lesion. If the diagnosis is not as straightforward, he might use a special lamp called Wood’s lamp or perform a small scraping of the diseased skin which will get examined under a microscope.

Treatment of ringworms in babies

when a ringworm is suspected in a child, an appointment with the doctor is to be scheduled. The prescribed treatment depends on the site, where the inflammation is taking place. If the lesions are located on the body of the baby, topical anti fungal creams will usually be enough (for example clotrimasole cream used twice daily). In most of the cases, in a couple of weeks the infection should go away (about three to four). After there are no more visible signs of the disease, the cream should be used for another seven days to prevent possible relapses. Some children might be sensitive or even allergic to prescribed creams. In that case, the paediatrician has to be consulted. In most of the cases, topical medications will suffice, only sometimes oral anti fungals will be recommended (when the infection is located on the scalp of the baby).

How to prevent ringworm in babies – Precautions

  • Sometimes the changes on the child’s skin can be itchy. When scratched, dirt and bacteria can get in the already damaged skin and cause a bacterial infection. It is therefore very important to keep the child s nails short and clean.
  • The clothes and the bedding have to be thoroughly washed to prevent a reinfection.
  • If the child is in daycare or school, consult with his teacher and/or doctor on whenever you should keep him at home to prevent from spreading the disease to others.
  • After applying anti fungal creams, the parent have to wash their hands with soap and hot water
  • Pets should be taken to the vet for a check – up (they can show symptoms or not)
  • If the baby has Tinea capitis (ringworm located on the scalp), all the household members are advised to use anti fungal shampoos for an appropriate amount of time
  • Children should use appropriate footwear when walking around pool areas and avoid sharing personal care objects like combs, towels etc.
  • The affected child should wear light, cotton made garments which breathe in order to stay dry.

References

Askdrsears.com, 2015, [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.askdrsears.com/topics/health-concerns/skin-care/ringworm

BabyCenter, 2015, Ringworm | BabyCenter. [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.babycenter.com/0_ringworm_10902.bc?page=2

conditions, Baillnesses, 2015, Ringworm. BabyCentre [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.babycentre.co.uk/a548378/ringworm

HealthyChildren.org, 2015, Ringworm. [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Ringworm.aspx

Melbourne, The, 2015, Kids Health Info : Ringworm. Rch.org.au [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.rch.org.au/kidsinfo/fact_sheets/Ringworm/

TheBump.com, 2015, Ringworm in Babies. [online]. 2015. [Accessed 13 January 2015]. Available from: http://pregnant.thebump.com/new-mom-new-dad/baby-symptoms-conditions/articles/ringworm-baby.aspx