Health

Tinea Corporis: Clinical Features and Effective Treatment in Children and Adults

Tinea corporis, commonly referred to as ringworm, is a superficial fungal infection of the skin caused by dermatophytes, typically Trichophyton species. It presents as a red, scaly, ring-like rash and is one of the most common dermatophytoses seen in primary care. Understanding how to recognise, diagnose, and treat tinea corporis is essential for UK health professionals, as prompt and effective treatment can prevent complications and reduce transmission within the community.

For a more comprehensive understanding of fungal skin conditions, check out Practitioner Development UK’s Understanding Common Fungal Skin Conditions in Primary Care.

Clinical Presentation

Tinea corporis typically presents as a round, erythematous lesion with a raised, scaly border and central clearing. The term “ringworm” comes from this characteristic appearance, though it has no association with actual worms. The lesions can be singular or multiple, often appearing on exposed areas of the body such as the arms, legs, and trunk. The edges of the lesions are usually more inflamed than the centre, giving them the typical ring-like look.

Patients commonly report itching, although the intensity can vary. In severe or untreated cases, lesions can expand or merge, leading to widespread infection. It’s important to differentiate tinea corporis from other common skin conditions like eczema, psoriasis, or pityriasis rosea, which can have similar presentations.

Diagnosis

Diagnosis of tinea corporis is primarily clinical, based on the characteristic appearance of the lesion. However, it’s important to confirm the diagnosis, especially in atypical cases. A skin scraping for potassium hydroxide (KOH) microscopy can help identify fungal elements, confirming the diagnosis. In cases where the clinical presentation or KOH results are inconclusive, fungal culture can be useful, although results take longer.

Differential Diagnosis

Several skin conditions can mimic tinea corporis, making a careful differential diagnosis essential:

Nummular eczema: This condition presents with circular lesions, but they lack the active, scaly borders seen in tinea.

Pityriasis rosea: While this also causes scaly, ring-like patches, its herald patch and subsequent distribution in a “Christmas tree” pattern can help distinguish it from tinea.

Psoriasis: Plaque psoriasis can sometimes resemble tinea corporis, but psoriatic lesions tend to be more uniform and often involve the scalp and nails.

Treatment

First-line treatment for tinea corporis involves topical antifungal agents. Imidazole derivatives such as clotrimazole or miconazole are effective, with treatment typically lasting 2-4 weeks. Terbinafine, a fungicidal agent, is often more effective for extensive or stubborn cases and requires only once-daily application.

For widespread or resistant infections, oral antifungal therapy may be necessary. Terbinafine and itraconazole are common options, but systemic treatment should be reserved for more severe cases or those not responding to topical therapies.

Key Points for Treatment:

Continue topical treatment for at least one week after the resolution of visible lesions to prevent recurrence.

Educate patients on hygiene, including washing bedding and clothing in hot water to prevent re-infection.

In cases of tinea corporis that affect multiple family members, treat all close contacts to prevent reinfection.

Patient Education and Prevention

Educating patients is vital in managing tinea corporis effectively. Encourage patients to avoid sharing personal items such as towels, clothing, or sports equipment, as these can transmit the infection. Advise on proper hygiene, including thorough washing and drying of the skin, particularly after sweating.

In children, tinea corporis often spreads through contact in communal environments such as schools, sports clubs, or swimming pools. Health professionals should emphasise the importance of treating affected children promptly and appropriately to minimise transmission to other children.

Conclusion

Tinea corporis is a common and manageable condition in primary care, provided it is promptly diagnosed and treated. By recognising its characteristic features, healthcare professionals can differentiate it from other skin conditions and apply appropriate treatments. Along with medication, patient education on hygiene and preventive measures is crucial to preventing recurrence and community spread.

For more insights on managing fungal skin conditions in primary care, consider reading Practitioner Development UK’s article Understanding Common Fungal Skin Conditions in Primary Care.

References:

Kim SM, Park HJ. Dermatophytosis: Clinical Features and Treatment. Clinical Dermatology. 2021; 39(6):998-1005.

Hay RJ, Asawanonda P. Epidemiology and Management of Dermatophyte Infections. Journal of Fungi. 2020; 6(4):283.