Tinea corporis (mycosis)

Trichophytia corporis superficialis.

Superficial infection with dermatophytes.

• Children > adults.
• Immunosuppression is a predisposing factor.

• Exciter:
  • T. rubrum, T. mentagrophytes, Epidermophyton floccosum.
  • Tinea corporis gladiatores is mostly caused by T. tonsurans.
• Transmission often occurs through cats, hamsters or other pets.

• Initially follicularly bound pustules, which in the course of time become progressive in size and become erythematous, sharply demarcated, marginally accentuated, pruritic, scaly plaques and asbcending nodules. In severe dissemination, land-map-like figures develop.
• Especially in immunosuppressed patients, necrosis may also occur.
• Chronic tinea corporis is often persistent in body folds.
• Majocchi granuloma --> Tinea corporis involving the hair follicles and producing pustules and nodules.
• More common: Tinea imbricata, originates in Asia and produces small brownish-red ringworm.

• Anamnesis (animal contact?, contact with another person who has similiar symptoms?)
• Clinical appearance
• Detection of pathogens (recovery of scales: then native preparation and culture)
• Biopsy with PAS staining
• Wood light (discrete fluorescence).

• Possible on the entire integument.

• Spontaneous healing possible.
• Often, especially without therapy, highly chronic course.

General measures

• If zoophilic dermatophytes are detected, all animals with which there has been contact should be examined.
• Examination of other persons in the household.
• Therapy should be administered with both topical and systemic antifungal agents!

Topical therapy

• Clotrimazole cream
• Terbinafine cream
• Ketoconazole cream
• Amorolfin cream
• Econazole cream
• Ciclopirox cream
• Pregnancy: Only nystatin is approved

Supportive shampoos

• Shampoo containing ketoconazole: leave on for 5- 10 minutes. Repeat on the 2 following days.
• Ciclopirox-containing shampoo: leave on for 5- 10 minutes. Repeat on the 2 following days.

Systemic therapy

• Itraconazole p.o. 200 mg 1x/day for 1 week
• Alternatively: fluconazole p.o. 150-200 mg 1x/week for 2-4 weeks
• Alternative: Terbinafine p.o. 250 mg 1x tgl. for 2 weeks.
• Alternatively: Griseofulvin p.o. 500 mg 2x tgl. (not commercially available in Switzerland) for 2-4 weeks.
• Children: Although only griseofulvin is approved for children, we rather recommend the use of itraconazole with regard to the data.
• Therapy should be continued for about 1 month beyond clinical healing --> ↓ recurrences.

1. Voravutinon V. Oral treatment of tinea corporis and tinea cruris with terbinafine and griseofulvin: a randomized double blind comparative study. J Med Assoc Thai 1993;76:388-93.
2. Farag A, Taha M, Halim S. One-week therapy with oral terbinafine in cases of tinea cruris/corporis. Br J Dermatol 1994;131:684-6.