Tinea corporis (fungal infection)

Superficial trichophytosis of the body.

Superficial dermatophyte infection of the smooth, non-terminal hair-bearing skin of the trunk and extremities. The scalp, beard region, groin, hands, feet, and nails are classified as separate forms of tinea.

A common superficial mycosis worldwide. Children are affected more frequently than adults. Contributing factors include heat, moisture, occlusive clothing, contact with animals, contact sports, immunosuppression, and topical corticosteroids.

• Classic tinea corporis.
• Tinea corporis gladiatorum.
• Tinea incognito.
• Tinea imbricata.
• Majocchi granuloma.
• Deep dermatophytosis.

The most common causative agents are Trichophyton rubrum, the T. interdigitale/T. mentagrophytes complex, Microsporum canis, and Epidermophyton floccosum.

Tinea corporis gladiatorum is usually caused by Trichophyton tonsurans.

Zoophilic infections are frequently transmitted by cats, dogs, guinea pigs, or other animals and often have a more inflammatory course.

Trichophyton indotineae is becoming increasingly relevant, often presenting with chronic, extensive, and terbinafine-refractory courses.

Typical findings include sharply demarcated, erythematous papules or plaques with prominent scaling at the margins, central atrophy, and an active, slightly elevated border. Pruritus is common.

In extensive cases, polycyclic or map-like patterns develop.

Zoophilic pathogens can cause pustular, highly inflammatory, or nodular lesions.

In Majocchi’s granuloma, perifollicular papules, pustules, or nodules predominate.

Tinea incognito that has been pretreated with steroids may appear with indistinct borders and an eczematous appearance.

Clinical presentation.

Mycological identification of the pathogen from the active margin: KOH mount and culture.

In cases of atypical, deep, or treatment-resistant courses: PCR and/or biopsy with PAS staining.

Dermatoscopy may be helpful.

Wood’s light has no routine diagnostic value for tinea corporis.

In principle, possible on the entire integument except for the scalp, beard region, groin, hands, feet, and nails.

The trunk, neck, arms, and legs are frequently affected.

Contact with animals?
Contact sports?
Affected household members?
Topical corticosteroids or combination creams?
Immunosuppression?
Recurrences or treatment failure?

Hyperkeratosis, parakeratosis, variable acanthosis, and superficial perivascular infiltrate.

Fungal hyphae in the stratum corneum on PAS or silver staining.

In Majocchi granuloma, perifollicular and dermal granulomas with fungal elements are found in the follicles and dermis.

Chronicity, spread via autoinoculation, and tinea incognito following steroid use.

Zoophilic pathogens can cause severe inflammation.

Follicular involvement may progress to a Majocchi granuloma.

In cases of severe immunosuppression, deep or invasive dermatophytoses are possible.

Have pets examined by a veterinarian if zoophilic tinea is suspected.

Examine close contacts as well if they have symptoms.

Do not use topical steroid-antifungal combinations without a confirmed indication.

In sports: Skin inspection, mat hygiene, and no sharing of contaminated textiles.

With adequate treatment, the prognosis is good.

Localized infections usually respond quickly to topical therapy.

Recurrences are possible, particularly with insufficient treatment duration, a persistent reservoir, steroid use, immunosuppression, or resistant pathogens.

General measures

If a zoophilic dermatophyte is detected, animals with relevant contact should be examined and treated if necessary.

In recurrent cases, household contacts should be considered.

Topical therapy

Localized tinea corporis is primarily treated topically.

Suitable topical preparations in Switzerland include, for example, terbinafine-containing topical agents such as Lamisil Cream 1%, clotrimazole-containing preparations such as Canesten Cream, ketoconazole-containing creams such as Nizoral Cream 2%, econazole-containing preparations such as Pevaryl Cream 1%, and ciclopirox-containing creams such as Mycoster Cream. 

In Germany, options include terbinafine-containing creams such as Lamisil Cream, Terbiderm Cream, or Terbinafin AbZ Cream; clotrimazole-containing creams such as Canesten Cream; ketoconazole-containing creams such as Nizoral 2% Cream; econazole-containing preparations such as Epi-Pevaryl 1% Cream; ciclopirox-containing topical preparations, and amorolfine-containing creams such as Loceryl Cream. 

In Austria, terbinafine-containing creams such as Lamisil 1% cream, clotrimazole-containing preparations such as Canesten Clotrimazole cream, ketoconazole-containing creams such as Fungoral 2% cream, and econazole-containing preparations such as Pevaryl cream are available. 

Topical therapy usually lasts 2–4 weeks and should generally be continued for an additional 1–2 weeks beyond clinical resolution.
 

Systemic therapy

Systemic therapy is indicated for multiple, extensive, deep, chronic, recurrent, immunosuppressed, or topically refractory cases, as well as for Majocchi’s granuloma.

Itraconazole 200 mg orally once daily for 1–2 weeks.
Alternatively: Fluconazole 150–200 mg orally once weekly for 2–4 weeks.
Alternatively: Terbinafine 250 mg orally once daily for 2–4 weeks.
Alternatively: Griseofulvin by mouth for 2–4 weeks; not commercially available in Switzerland.

For Trichophyton indotineae, terbinafine is often unreliable; itraconazole is preferred in these cases, usually for a longer duration.

A general combination of topical and systemic therapy is not mandatory in all cases, but may be appropriate with systemic treatment.

During pregnancy, nystatin is not effective against dermatophytes and is therefore not a treatment option for tinea corporis.

1. Barac A, Peralbo E, Verma A, et al. Dermatophytes: Update on Clinical Epidemiology and Treatment. Mycopathologia. 2024. PMID: 39567411.
2. Hill RC, Kaffenberger JA, Elston DM. Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance. J Am Acad Dermatol. 2024. PMID: 38494575.
3. Khurana A, Sardana K, Rudramurthy SM. Clinico-mycological and therapeutic updates on cutaneous dermatophytic infections in the era of Trichophyton indotineae. J Am Acad Dermatol. 2024. PMID: 38574764.
4. Nenoff P, Klonowski E, Uhrlass S, et al. Dermatomycoses: topical and systemic antifungal treatment. Dermatologie (Heidelb). 2024. PMID: 38874607.
5. Gupta AK, Venkataraman M, Talukder M. The emergence of Trichophyton indotineae: Implications for clinical practice. Int J Dermatol. 2023. PMID: 35867962.
6. Leung AKC, Lam JM, Leong KF, Hon KL. Tinea corporis: an updated review. Drugs Context. 2020. PMID: 32742295.
7. Caplan AS, Gold JAW, Smith DJ, Ely JW. Diagnosis and Management of Tinea Infections. Am Fam Physician. 2025. PMID: 41118183.
8. Zalewski A, Goldust M, Szepietowski JC. Tinea Gladiatorum: Epidemiology, Clinical Aspects, and Management. J Clin Med. 2022. PMID: 35887830.
9. Babba ZI, Shehu MY, Ukonu BA, Ibekwe PU. Dermoscopic Features seen in Tinea Capitis, Tinea Corporis, and Tinea Cruris. West Afr J Med. 2023. PMID: 37245212.
10. Müller VL, Kreuter A, Uhrlass S, Nenoff P. Trichophyton mentagrophytes genotype VII increasingly causes anogenital infections. Dermatologie (Heidelb). 2024. PMID: 38189829.