Tenis corporis

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Tenia corporis

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tinea corporis ringworm skin lesion

This clinical photograph displays a dermatological presentation of tinea corporis (ringworm) in a pediatric patient. The primary feature is an annular, erythematous plaque located on the trunk or proximal limb. The lesion is characterized by a well-demarcated, raised red border with evidence of mild scaling or vesiculation, indicating active peripheral growth. The center of the plaque shows partial clearing with a lighter pink hue, though it remains occupied by a few scattered inflammatory papules. Above the primary lesion, incidental linear hyperpigmented marks are visible, likely representing excoriations or minor superficial trauma. The image serves as a classic educational example of a fungal skin infection, specifically demonstrating the centrifugal spread and central clearing characteristic of Microsporum canis dermatophytosis.

Clinical photograph of a skin lesion on the upper back of a pediatric patient with a dark skin tone, consistent with Tinea corporis (ringworm). The image demonstrates a hypopigmented, well-circumscribed patch with an irregular, slightly raised, and scaly border. Centrally, the lesion shows characteristic clearing but maintains a whitish, fine-textured scaling. A linear extension of the scaling is visible, trailing away from the primary circular focus. This presentation illustrates a common superficial fungal infection (dermatophytosis) of the glabrous skin. The anatomical location is the posterior trunk near the right scapular region. The visual features are diagnostic of a fungal etiology, highlighting the annular morphology and peripheral scale distribution typically seen in localized tinea infections.

This clinical photograph displays a dermatological presentation of tinea corporis (zoonotic dermatophytosis) on the abdomen of an adult male. The primary feature is a well-circumscribed, annular, erythematous plaque approximately 4-5 cm in diameter. The lesion exhibits a classic 'ringworm' morphology with a slightly raised, scaly inflammatory border and a partially cleared central area containing subtle papular elements. Superior to the primary plaque is a secondary, smaller, raised erythematous papule with a central punctum or crust. The surrounding skin shows mild diffuse erythema and scattered smaller inflammatory macules. Hair follicles are visible throughout the affected and unaffected regions. This image serves as an educational example of fungal infection (likely Trichophyton mentagrophytes) transmitted from a pet (guinea pig) to a human host, emphasizing the visual diagnostic features of annular inflammatory skin lesions.

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Tinea Corporis

Tinea corporis is a dermatophyte infection of the glabrous skin of the trunk and extremities, excluding the scalp, beard, face, hands, feet, palms, soles, and groin. It is also called "ringworm" because of its characteristic annular appearance.

Etiology

Any dermatophyte can cause tinea corporis. The most common causative organisms are:

Genus	Species	Notes
Trichophyton	T. rubrum	Most common overall; may cause polycyclic/psoriasiform lesions
Trichophyton	T. mentagrophytes / T. interdigitale	Common; zoonotic strains from bamboo rats can cause epidemics
Trichophyton	T. indotineae	Emerging species, previously classified as T. mentagrophytes var. Vill
Trichophyton	T. tonsurans	"Tinea gladiatorum" in wrestlers
Microsporum	M. canis	Zoophilic; from dogs and cats, especially in children
Epidermophyton	E. floccosum	Less common

Tinea imbricata, caused by T. concentricum, produces concentric rings and is geographically limited to the Far East, South Pacific, and South/Central America.

Dermatology 2-Volume Set 5e, p. 1604; Andrews' Diseases of the Skin, p. 347

Epidemiology

Transmitted by direct contact with infected humans or animals, via fomites, or by autoinoculation (e.g., from tinea pedis reservoirs).
Children are more prone to zoophilic pathogens (M. canis) from pets.
Occlusive clothing and humid climates worsen frequency and severity.
Tinea gladiatorum: seen in wrestlers; caused mainly by T. tonsurans; affects head, neck, and arms due to skin-to-skin contact and mat burns.
Fitzpatrick's Dermatology, p. 2974

Clinical Features

The classic presentation is an annular (ringworm-like) plaque with:

A well-demarcated, raised, erythematous, scaly advancing border that spreads centrifugally
Central clearing (the hallmark that gives it the name "ringworm")
Scaling across the entire active border; the border may be vesicular

Variants:

Polycyclic plaques - multiple overlapping rings, especially in immunosuppressed patients (T. rubrum)
Psoriasiform - mimics psoriasis, also typically T. rubrum
Tinea incognita - atypical appearance with no raised border due to treatment with topical steroids or calcineurin inhibitors; may lack central clearing and look eczematous
Bullous tinea - vesicles and bullae, particularly on the feet
Majocchi granuloma - deeper follicular involvement; follicular papules and nodules in an annular arrangement; seen in women after shaving or after topical steroid use, and in immunocompromised patients; caused most often by T. rubrum

Widespread tinea corporis may be a presenting sign of HIV/AIDS or heavy topical steroid/calcineurin inhibitor use.

Here are classic clinical images:

Tinea corporis - annular erythematous plaque with raised border and central clearing

Tinea corporis on the upper back showing hypopigmented annular patch with scaly border

Tinea corporis (zoonotic) on the abdomen - classic ringworm morphology

Diagnosis

KOH preparation: Skin scrapings from the active border are examined under the microscope for branching hyphae. The most common artifact is "mosaic false hyphae" at junctions of normal keratinocytes. Cotton/synthetic fibers may also mimic hyphae.
Fungal culture: On Sabouraud dextrose agar; growth within 1-2 weeks; identifiable to genus/species level by colony morphology.
Skin biopsy: For chronic, refractory cases; may reveal tinea incognita.

Andrews' Diseases of the Skin, p. 347

Differential Diagnosis

Category	Conditions
Most likely	Erythema annulare centrifugum, nummular eczema, psoriasis, tinea versicolor, subacute cutaneous lupus erythematosus, cutaneous candidiasis
Consider	Contact dermatitis, atopic dermatitis, pityriasis rosea, seborrheic dermatitis
Rule out	Mycosis fungoides, parapsoriasis, secondary syphilis

These are distinguished by KOH examination and culture.

Fitzpatrick's Dermatology, p. 2974

Treatment

Topical Therapy (first-line for localized disease)

Used for isolated plaques on glabrous skin, without follicular involvement:

Class	Agents	Frequency	Duration
Allylamines	Terbinafine (Lamisil), Naftifine (Naftin), Butenafine (Mentax)	Once or twice daily	1-2 weeks (terbinafine can be 1 week)
Imidazoles	Clotrimazole, Miconazole, Econazole, Ketoconazole, Oxiconazole, Sulconazole	Once or twice daily	2-4 weeks
Other	Ciclopirox olamine, Tolnaftate	Twice daily	2-4 weeks

Most topical agents are effective; choice should be guided by cost-effectiveness.
Avoid combination products with potent corticosteroids (e.g., clotrimazole/betamethasone) - these cause widespread tinea and fungal folliculitis.

Systemic Therapy (for extensive or follicular disease)

Reserved for widespread eruptions, Majocchi granuloma, or tinea incognita:

Drug	Notes
Terbinafine	Preferred for Trichophyton spp.; shorter courses
Griseofulvin	Better for Microsporum spp.
Itraconazole	Effective for T. rubrum, T. tonsurans, T. mentagrophytes
Fluconazole	Also effective

Andrews' Diseases of the Skin, p. 347-348; Fitzpatrick's Dermatology, p. 2974

Special Forms Summary

Form	Key Feature
Tinea gladiatorum	Wrestlers; head, neck, arms; T. tonsurans
Tinea imbricata	Concentric rings; T. concentricum; geographically restricted
Tinea incognita	Atypical morphology from steroid/calcineurin inhibitor suppression
Majocchi granuloma	Deep follicular involvement; after shaving or steroid use
Bullous tinea	Vesicles/bullae; often on feet

Treatment

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Treatment of Tinea Corporis

The approach is determined by extent of disease and presence of follicular involvement.

Step 1 - Decide: Topical vs. Systemic

Scenario	Approach
Localized plaques, glabrous skin, no follicular involvement	Topical (first-line)
Widespread/extensive disease	Systemic oral
Follicular involvement (Majocchi granuloma)	Systemic oral (mandatory)
Tinea incognita	Stop topical steroids + systemic oral
Poor response after 2 weeks of topical therapy	Switch to systemic
Immunocompromised patients	Systemic oral

Topical Antifungals (Localized Disease)

Apply to the lesion and 1-2 cm beyond the active border. Continue for 2-4 weeks total, or 1 week beyond clinical resolution.

Class	Drug	Concentration	Frequency	Min Age
Allylamine	Terbinafine (Lamisil)	1% cream	Once daily	≥12 y
Allylamine	Naftifine (Naftin)	2% cream	Once daily	≥12 y
Benzylamine	Butenafine (Mentax)	1% cream	Once daily	≥12 y
Imidazole	Clotrimazole (Lotrimin)	1% cream/solution	Twice daily	All ages
Imidazole	Miconazole (Monistat)	2% cream	Twice daily	≥2 y
Imidazole	Econazole (Spectazole)	1% cream	Once or twice daily	All ages
Imidazole	Ketoconazole (Nizoral)	2% cream	Once daily	All ages
Imidazole	Oxiconazole (Oxistat)	1% cream	Once or twice daily	All ages
Imidazole	Luliconazole	1% cream	Once daily	≥2 y
Imidazole	Sulconazole (Exelderm)	1% cream/solution	Once or twice daily	Adults only
Other	Ciclopirox (Loprox)	0.77% cream	Twice daily	≥10 y
Other	Tolnaftate	1% cream/solution	Twice daily	All ages

Key points:

Allylamines and benzylamines may give a more sustained clinical cure compared to azoles.
Terbinafine course can be shortened to 1 week for tinea corporis.
Econazole and ciclopirox have additional antibacterial coverage - useful if bacterial superinfection is suspected.
Choice should be guided by cost-effectiveness and age appropriateness.
Goodman & Gilman's Pharmacological Basis of Therapeutics, p. 1506; Red Book 2021, p. 1169-1170

What NOT to Use

Combination topical antifungal + corticosteroid products (e.g., clotrimazole/betamethasone) are CONTRAINDICATED in tinea corporis.

They cause:

Widespread dissemination of tinea (tinea incognita)
Fungal folliculitis and Majocchi granuloma
Higher relapse rates
Increased cost and corticosteroid side effects

Oral ketoconazole is also no longer a first-line option due to risk of severe hepatotoxicity and QT prolongation (FDA black box warning).

Systemic (Oral) Antifungals (Widespread or Follicular Disease)

Confirm fungal etiology by KOH or culture before starting any oral agent. All oral agents may cause hepatotoxicity and should not be used in pregnancy or breastfeeding.

Drug	Notes	Species Preference
Terbinafine	Preferred for Trichophyton spp.; fewer drug interactions; short courses possible	Trichophyton > Microsporum
Itraconazole	Effective; significant P450 drug interactions; avoid in CHF/ventricular dysfunction	Broad spectrum
Fluconazole	Effective; approved in children ≥6 months for other indications; no FDA approval specifically for tinea corporis	Broad spectrum
Griseofulvin	Traditional option; better for Microsporum spp.; approved by FDA for dermatophyte skin/hair/nail infection; common side effects: GI distress, headache, urticaria	Microsporum > Trichophyton

Species-based oral drug selection:

Trichophyton spp. - prefer terbinafine (shorter courses)
Microsporum spp. - respond better to griseofulvin
Harrison's Principles of Internal Medicine 22e (2025), p. N/A; Andrews' Diseases of the Skin, p. 348; Goodman & Gilman's, p. 1506

Special Situations

Situation	Treatment
Majocchi granuloma	Oral antifungal mandatory (topical insufficient); terbinafine or itraconazole
Tinea incognita	Discontinue topical steroids/calcineurin inhibitors + systemic antifungal
Tinea gladiatorum	Oral terbinafine or griseofulvin; treat contacts; decontaminate mats
Immunocompromised patient	Systemic therapy preferred; longer courses
Recurrent tinea corporis	Treat concurrent onychomycosis (tinea unguium) and tinea pedis to reduce source

Monitoring & Follow-Up

Reassess at 2 weeks - if no significant improvement, reconsider diagnosis or switch to systemic therapy.
Topical therapy: continue for 1 week beyond clinical resolution to prevent relapse.
Oral agents: monitor liver function (hepatotoxicity risk for all oral antifungals).
Address predisposing factors: reduce moisture, avoid occlusive clothing, treat concurrent tinea at other sites.
Red Book 2021 (Committee on Infectious Diseases), p. 1170; Harrison's 22e, p. N/A

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