Dermatophytosis - Causes, Picture, Symptoms and Treatment of Ring Worm Dermatophytosis

Dermatophytes are fungi that infect skin, hair, and nails and include members of the genera Trichophyton, Microsporum, and Epidermophyton. Infection of the foot (tinea pedis) is most common and is often chronic; it is characterized by variable erythema and edema, scaling, pruritus, and occasionally vesiculation. Involvement may be widespread or localized, but almost invariably the web space between the fourth and fifth toes is affected.

Symptoms of Dermatophytosis

Infection of the nails (tinea unguium) occurs in many patients with tinea pedis and is characterized by opacified, thickened nails and subungual debris. The groin is the next most commonly involved area (tinea cruris), with males affected much more often than females.

It presents as a scaling erythematous eruption that spares the scrotum. Microscopic examination of either untreated tinea pedis or tinea cruris scale after digestion with KOH preparation will generally demonstrate hyphae.

Dermatophyte infection of the scalp (tinea capitis) has returned in epidemic proportions, particularly affecting inner city children. The predominant organism is T. tonsurans. This organism can produce an inflammatory or relatively noninflammatory infection that may present with either well-defined or irregular, diffuse areas of mild scaling and hair loss.

Tinea corporis, or infection on non-hair-bearing skin, may have a variable appearance, depending on the extent of the associated inflammatory reaction. It may have the typical annular appearance of "ringworm" or appear as deep inflammatory nodules (on the scalp known as a kerion) or granulomas. KOH examination of scale or hair from patients with tinea capitis or inflammatory tinea corporis often does not reveal hyphae, and diagnosis may require culture or biopsy.

Treatment of Dermatophytosis

Both topical and systemic therapies may be used to treat dermatophyte infection. Treatment depends on the site involved and the type of infection. Topical therapy is generally effective for uncomplicated tinea corporis, tinea cruris, and limited tinea pedis. It is not effective as monotherapy for tinea capitis or tinea unguium. Topical imidazoles (miconazole, ketoconazole, econazole, clotrimazole, oxiconazole, and sulconazole), triazoles (terconazole), and allylamines (terbinafine and naftifine) may all be effective topical therapies for dermatophyte infections. Haloprogin, undecylic acid, ciclopirox-olamine, and tolnaftate are also effective, but nystatin is not active against dermatophytes. Treatment should continue until the patient is clear of infection by clinical examination and culture. Tinea pedis often requires longer treatment courses and is associated with a high relapse rate.

Medicine and drugs for Dermatophytosis

Griseofulvin is the drug of choice for dermatophyte infections requiring systemic therapy. A daily dose of 500 mg of microsized or 350 mg of ultramicrosized griseofulvin administered with a fatty meal is an adequate dose for most dermatophyte infections. The duration of therapy may be as short as 2 weeks for uncomplicated tinea corporis but may be as long as 6 to 12 months for nail infections. The most common side effects of griseofulvin are gastrointestinal distress and headache. Dermatophyte infection of hair-bearing areas (e.g., tinea capitis) requires systemic antifungal therapy.

The usual adult dose of griseofulvin is 1 g of microsized or 0.5 g of ultramicrosized given daily, and treatment should be continued for 6 to 8 weeks. Children should be treated with 15 to 20 mg/kg as a single daily dose given with a fatty meal. The adjunctive use of topical antifungal agents in addition to systemic therapy may be useful, but topical therapy alone is not adequate. Markedly inflammatory tinea capitis may result in scarring and hair loss, and systemic or topical glucocorticoids may be helpful in preventing this sequela. Recent studies in children have also suggested that both itraconazole (3 to 5 mg/kg for 6 to 10 weeks) and terbinafine (125 mg/d for 6 weeks) may be effective treatments for tinea capitis.

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