Dermatophyte infections are typically diagnosed clinically, although speciation via fungal culture and proof of mycological cure via serial fungal culture may aid patient care.
Confirm diagnosis of tinea unguium and tinea capitis prior to treatment.
Topical therapy is sufficient for most tinea infections.
Fungicidal topical allylamines demonstrate good cure rates with short duration of treatment.
Systemic therapy is preferred for tinea capitis, tinea barbae, tinea manuum, and onychomycosis.
Superficial fungal infection with varying presentation depending on site. Dermatophytes are fungal organisms that require keratin for growth. These fungi can cause superficial infections of the hair, skin, and nails. Dermatophytes are spread by direct contact from other people, animals, soil, and from fomites.
History and exam
- presence of risk factors
- history of skin, hair, or nail lesion
- skin discomfort
- scaling scalp lesions
- patchy alopecia
- erythematous, scaling skin lesions with central clearing
- erythematous, scaling rash with follicular pustules in beard or moustache
- erythematous, annular patches on face
- diffusely dry palmar surface with hyperkeratosis
- vesicles and scaling of hands
- erythematous, scaling lesions with raised border on thighs, together with pustules, vesicles, and maceration
- vesicles, pustules with or without bullae on the soles
- fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes
- chronically scaly, hyperkeratotic plantar skin with erythema of the soles, heels, and sides of the feet
- folliculitis with nodules
- thickened nail with subungual hyperkeratosis, onycholysis, and white-yellow to brown discoloration
- small, white speckled patches on the surface of the nail plate with crumbling nail
- absence of distal pulses
- black-dot alopecia
- milky white nail plate
- area of leukonychia in the proximal nail plate
- exposure to infected people, animals, or soil
- exposure to fomites, including hat, combs, hairbrushes, and upholstery
- chronic topical or oral corticosteroid use
- diabetes mellitus and other metabolic disorders
- occlusive clothing
- hot, humid weather
- frequenting public bathing areas while barefoot
- deformities of the feet
- recurrent trauma to the skin
- atopic dermatitis
- positive family history
- peripheral vascular disease
Antonella Tosti, MD
Professor of Clinical Dermatology
Dermatology and Cutaneous Surgery
University of Miami Health System
AT received honorarium and travel reimbursement from Valeant, PharmaDerm, and Polichem, and is on the speaker bureau for PharmaDerm.
Dr Antonella Tosti would like to gratefully acknowledge Dr Keira L. Barr and Dr Barry L. Hainer, the previous contributors to this topic. KLB declares that she has no competing interests. BLH is on the speaker bureaus for the vaccine programmes of Merck and Sanofi-Pasteur pharmaceutical companies.
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NS declares that she has no competing interests.
Christina M. Gelbard, MD
Department of Dermatology
Health Science Center of Houston
CMG declares that she has no competing interests.
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