Tinea

Background

• Fungal infection caused by dermatophytes that feed on keratin

Tinea Types

• Tinea capitis (head)
• Tinea corporis (body)
• Tinea pedis (foot)
• Tinea cruris (groin)

Tinea Corporis

Tinea Capitis

Clinical Features

Tinea cruris

• Scaly, with variable pruritus
• Corporis: ring appearance with central clearing
• Capitis: patchy alopecia

Differential Diagnosis

• Pityriasis rosea
• Lichen planus
• Psoriasis
• Eczema
• Contact dermatitis

Evaluation

• Clinical diagnosis with Wood's lamp
• Kerion
  • Painful, itchy, eczematous
  • Hair loss
  • Fever, malaise
  • Lymphadenopathy

Management

Coverage for Trichophyton and Epidermophyton and all treatment should be at lease 1 week past resolution of lesions

Topical Therapy

Applies to Tinea corporis, pedis, cruris, and manus

Must use a topical therapy for 7-10days beyond resolution of lesions

• Topical antifungal treatment for all except tinea capitis
• Terbinafine 1% BID x2-3weeks or
• Clotrimazole 1% BID x2-3weeks or
• Ketoconazole 1% BID x2-3weeks

Capitis

• Griseofulvin 500mg-1000mg PO once daily (20-25mg/kg/d)
  • Usually requires 8wk of treatment
• Terbinafine for 2-4 weeks is as effective of 6-8 weeks of griseofulvin
  • 62.5mg/day in children <20kg
  • 125mg/day in children 20-40kg
  • 250mg/day in children >40kg
• Selenium sulfide or ketoconazole shampoos are adjunct treatment
• Children can return to school during treatment

Kerion

• Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks
• Cephalexin 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
• Ketoconazole shampoo, isolated towels decrease spread to household members

Tinea corporis

First line should be topical therapy. For refractory cases or severe bullous disease the below anti-fungals are all equivalent options.

• Fluconazole 150mg (6mg/kg) PO once a week x 2 weeks or
• Itraconazole 200mg (5mg/kg) PO daily q12hrs for 1 week or
• Griseofulvin 500-1000mg (20mg/kg) PO daily for 2-4 weeks

Disposition

• Discharge

See Also

• Rashes
• Dermatophytosis