### Date : 2024-06-23 18:47 ### Topic : Tinea (Dermatophytosis) #medicine #infectology ---- ### Tinea (Dermatophytosis, 백선) Overview **Tinea** (also known as ringworm or dermatophytosis) is a common fungal infection of the skin, hair, or nails. It is caused by dermatophytes, a group of fungi that thrive on keratin, the protein that makes up the outer layer of skin, hair, and nails. Tinea can affect various parts of the body, and it is typically named according to the area it infects. ### Types of Tinea 1. **Tinea Capitis (Scalp Ringworm):** - **Location:** Scalp and hair. - **Symptoms:** Scaly, itchy patches on the scalp, hair loss, and sometimes black dots where hair has broken off. Inflammatory types may cause swollen, tender patches (kerion). 2. **Tinea Corporis (Body Ringworm):** - **Location:** Body (arms, legs, trunk). - **Symptoms:** Circular, red, scaly patches with clear centers and raised borders, often resembling a ring. 3. **Tinea Cruris (Jock Itch):** - **Location:** Groin area. - **Symptoms:** Red, itchy rash in the groin, inner thighs, or buttocks, often with a well-defined edge. 4. **Tinea Pedis (Athlete's Foot):** - **Location:** Feet. - **Symptoms:** Itchy, scaly rash between the toes, which can spread to the soles and sides of the feet. May cause blisters and cracks. 5. **Tinea Unguium (Onychomycosis):** - **Location:** Nails. - **Symptoms:** Thickened, discolored, and brittle nails, often with white or yellow patches. 6. **Tinea Manuum:** - **Location:** Hands. - **Symptoms:** Similar to athlete's foot but affecting the hands, causing dry, scaly patches and sometimes redness and itching. 7. **Tinea Faciei:** - **Location:** Face. - **Symptoms:** Red, scaly patches on the face, which may itch and resemble other facial rashes. ### Pathophysiology Tinea infections occur when dermatophytes invade the keratinized tissues of the skin, hair, or nails. These fungi thrive in warm, moist environments and can be spread through direct contact with infected individuals, animals, or contaminated objects (such as towels, clothing, and floors). ### Diagnosis **Clinical Evaluation:** - **History and Physical Examination:** Assessment of the characteristic appearance of the lesions and location on the body. **Laboratory Tests:** - **KOH Preparation:** Scraping of the affected skin or nails is examined under a microscope after being treated with potassium hydroxide (KOH) to identify fungal elements. - **Fungal Culture:** Samples from the infected area are cultured to identify the specific dermatophyte species. - **Wood's Lamp Examination:** Certain species of dermatophytes fluoresce under ultraviolet light, aiding in diagnosis, particularly for tinea capitis. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 25 - **Occupation:** Fitness Trainer **Medical History:** - **Symptoms:** Itchy, red, circular patches with clear centers and raised, scaly borders on the trunk and arms. The rash appeared two weeks ago and has been gradually spreading. **Clinical Evaluation:** - **Physical Examination:** Multiple ring-like lesions with a well-defined edge on the trunk and arms, consistent with tinea corporis. **Laboratory Tests:** - **KOH Preparation:** Positive for dermatophyte hyphae. - **Diagnosis:** Based on clinical presentation and laboratory confirmation, Jee Hoon Ju is diagnosed with tinea corporis. ### Management 1. **Topical Antifungal Medications:** - **Clotrimazole, Miconazole, Terbinafine:** Applied directly to the affected area for mild to moderate cases. - **Application:** Typically applied twice daily for at least 2-4 weeks, continuing for one week after the lesions have cleared. 2. **Oral Antifungal Medications:** - **Terbinafine, Itraconazole, Fluconazole:** Used for more extensive or severe infections, or when topical treatment fails. - **Duration:** Usually prescribed for 2-6 weeks, depending on the severity and location of the infection. 3. **General Measures:** - **Hygiene:** Keeping the affected area clean and dry. - **Avoiding Spread:** Not sharing personal items such as towels, clothing, and grooming tools. - **Environmental Control:** Regularly cleaning and disinfecting floors, showers, and other surfaces to reduce fungal spores. 4. **Follow-Up:** - Monitoring the response to treatment and ensuring complete resolution of the infection. - Educating the patient on preventive measures to avoid recurrence. ### Prognosis - **Effective Treatment:** Most tinea infections respond well to antifungal treatment, with symptoms resolving within a few weeks. - **Recurrent Infections:** May occur if the underlying predisposing factors are not addressed, such as excessive sweating or exposure to infected individuals or animals. - **Chronic Cases:** Particularly in tinea unguium (nail infections), may require prolonged treatment and follow-up to ensure complete eradication. ### Conclusion Tinea infections are common fungal infections affecting various parts of the body. Prompt diagnosis and appropriate antifungal treatment are essential for effective management. Preventive measures, including good hygiene practices and avoiding shared personal items, are crucial to reduce the risk of infection and recurrence. With proper care, most individuals with tinea infections can achieve complete recovery.