Tinea symptoms can differ depending on the location on the body. It may include:

• redness with/without itching
• burning or stinging
• a rash that may form blisters or pustules
• raw, inflamed or scaly skin
• weeping or oozing areas of skin.

Tinea capitis

Tinea capitis appear as a small, raised pimple that spreads leaving fine, scaly patches of skin. Infected hairs can become brittle and break off causing small areas of temporary hair loss (as distinct from alopecia areata). This condition is most often seen in pre-adolescent children.

Tinea corporis

Tinea of the body occur on the trunk, arms or legs, and usually starts as flat, scaly spots before developing a raised red border that advances outwards in a circle. There may be vesicles and pustules. More unusually the lesions can appear as overlapping concentric circles (tinea imbricate) or even herpetiform subcorneal vesicles or pustules (bullous tinea corporis). The border may be scaly with raised edges and may blister, while the centre of the area often becomes more normal in appearance with fine scaling. Ringworm is often itchy.

Tinea pedis

Tinea between the toes is a common condition affecting the toe web. In its most common form, it occurs as red or white areas of scaling or cracking between the toes (most commonly between the small and fourth toes), skin may be macerated and erythematous. Erythema, vesicles and pustules can occur. The affected area usually itches and burns and the skin cracks may be painful.

Less common is ‘moccasin-type’ tinea pedis, which involves the sole of the foot and usually appears as dry, scaly patches or cracks in the skin. These may extend up onto the side of the foot in a moccasin-style pattern.

Tinea cruris

Tinea affecting the genitals, groin or upper thigh usually appears as a red rash with raised borders that may be scaly. It is often accompanied by itching and burning or tenderness. It often tolerated for some time before presentation.  Chafing (irritation of the skin by friction, for example, from close-fitting underwear) aggravate the problem. Usually occurs in men.

Tinea unguium

Tinea of the nail bed (onychomycosis) usually affects the toenail and can cause the nail itself to become discoloured and thickened. The nail may become brittle and crumble or lift away.

Tinea can be easily contracted through skin-to-skin contact with an infected person or animal, or through indirect contact with an object or surface that an infected person or animal has touched. Bathroom floors, bathmats, towels, showers and communal bathing, swimming and changing room areas are common sources of infection.

On contact with skin, the dermatophyte fungi spread to the surface layers of dead cells – they generally do not invade living skin cells. Symptoms result from the body’s allergic and inflammatory response to the infection, and they usually appear within four to 10 days.

Trichophyton, Microsporon and Epidermophyton species are responsible for this group of dermatophyte infections. Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum are the most common causes of dermatophyte infection in humans.Microsporon canis caught from dogs, cats or children causes tinea capitis in children and, uncommonly, other types of ringworm infection. Occasionally, a quite inflammatory ringworm can be caught from cattle (T. verrucosum) and horses (T. equinum).

In tenea infection, use imidazole cream twice-daily. Treatment is continued for 1-2 weeks after the skin has healed. Common antifungals include:

• • Clotrimazole
  • Econazole
  • Ketoconazole
  • Miconazole

Terbinafine cream daily can be considered as an alternative. Although more expensive, it usually requires only one week of treatment topically compared to at least four weeks with imidazoles. If this fails to clear, re-check mycology – if negative, reconsider analyze.

• Clotrimazole or miconazole is recommended topically for pregnant or breast-feeding women.
• Other antifungals available are:
  • Griseofulvin.
  • Salicylic acid.
  • Undecenoates.
  • Compound benzoic acid ointment – sometimes used for ringworm infections but less cosmetically acceptable than other options.
  • Tolnaftate – often a constituent of athlete’s foot treatments, sold over the counter

Agents containing a corticosteroid are not usually necessary. They may be used if there is a lot of skin inflammation. They should be used for a week only. Topical steroids alone should obviously not be used.

Advice on hygiene measures:

• • Continue school and sporting activities.
  • Cover feet in communal changing areas if these are involved.

Systemic agents are appropriate for tinea capitis and onychomycosis. Topical nail preparations such as amorolfine or tioconazole can be used in limited distal nail disease. Systemic agents should be used for extensive disease. They may also be used when topical treatments have failed or are inappropriate. Skin scrapings should be sent before starting oral treatment:

• • Terbinafine 250 mg daily for two weeks (up to six weeks).
  • Itraconazole 100 mg twice-daily for one week (high dose for one week or low dose for 30 days). Itraconazole can be given in a pulsed fashion and is preferred to terbinafine.

Contact a doctor if child has symptoms of a tinea infection. See a doctor if the infection becomes severe, long-lasting or if non-prescription treatments not worked, or if the skin is swollen, blistered, crusted or smells unpleasant. If nails are involved,may need a prescription course of antifungal tablets. See a doctor if the infection involves the scalp or beard.

• Oxford hand Book of medical Dermatology
• ABC Of Dermatology
• Clinical Dermatology
• Roxburgh’s common skin diseases
• Andrew’s Diseases of the skin