DERMATOPHYTE INFECTIONS (TINEA, RING WORM)

• Dermatophyte infections also known as Tinea are the most common fungal infections of the Skin, hair and Nails. Dermatophyte refers to Fungus that infects Keratinized tissue. Tineas are classified based on their location.
• Children and immune compromised individuals are more likely to contract tinea infections. However people of any age may suffer. The clinical Features of dermatophyte infection includes pruritis, scaling and erythema.

• Three species of dermatophytes implicated are; Trichophyton (affects skin, hair, nails), Microsporum ( Affects skin and hair ) , Epidermophyton ( Affects skin and nails )
• The most common causative pathogen of tinea is T.rubrum

• Tinea corporis(Ring worm) – Infection of the non hairy skin of trunk and limbs. Pruritic, round or annular, red scaling, well marginated patches and healing centers. It is distinguished from patches of eczema / psoriasis by history and presence of mycelium in scales
• Tinea cruris (ring worm of Groin , Jock’s Itch, Dhobi itch) :Most common in the Fungal infection of the inguinal area. Presents as pruritic, well defined red scaly patches that grows centrifugally. Similar to tinea corporis but often without central clearing and spares the scrotum. Seen asymmetrically on medial aspect of both thighs. If extensive, the possibility of host immunosuppression or HIV infection should be considered
• Tinea barbae – Ring worm of the beard and moustache. Also called T.sycosis, Barber’s itch
• Tinea faciei- Ring worm of the face. Annular, infiltrated and shiny due to absence of scales and photosensitivity is present
• Tinea pedis (Athelete foot) - Ringworm infection of feet.  Presents in the following ways; a)Interdigital type – Interdigital scaling and maceration with fissures is the most common form, b)Chronic hyperkeratotic type or Moccasin type – wide spread scaling extends onto the sides of the feet, c)Vesicular or bullous type , d) Acute ulcerative type
• Tinea manuum- Ringworm of the hands. Usually seen as a mild erythema with hyperkeratosis and scaling mainly over the palmar surfaces
• Tinea capitis - Ringworm of the scalp, occurs mainly in children. Clinical features include pink, scaling patches on the scalp skin and areas of hair loss due to breakage of hair shaft.
• Clinically it is two types – inflammatory and non inflammatory capitis. Inflammatory capitis heals with scarring alopecia. kerion is a severe form of T.capitis caused by zoophilic fungi, produces boggy painful inflammatory swelling studded with exudative follicular pustules, hair fallen off or easily plickable. Favus is caused by Trichophyton schoenleinii, mainly in Kashmir, active lesion will be concave sulphur yellow crust which heals with thin smooth atrophic scarring
• Tinea unguium (Onchomycosis) - Ringworm infection of the nail plate and the nail bed Clinical features include yellowish white discolouration of nail with subungual keratotic debris, usually starts from lateral end of nail plate distally. The nail becomes brittle, friable and thickened
• Tinea incognito- Ringworm infection modified by corticosteroids, systemic or topical prescribed for pre existing pathology or given mistakenly for the treatment of misdiagnosed tinea

Differential Diagnosis

• Impetigo, seborrhic dermatitis, Tinea Versicolor, Herald patch( Pityriasis rosea), cutaneous candidiasis, Erythrasma, Contact dermatitis , Psoriasis

• Usually clinical diagnosis
• KOH mount - Microscopic examination and identification of hyphae and spores in scales or hair. In nails, the presence of hyphae usually means dermatophyte infection, rarely saprophytic fungi infection
• Cellophane tape examination and staining with periodic acid schiff’s reagent

• Maintain good personal hygiene
• Frequent washing, drying of areas liable to excess sweating

Internal Medicines

• Nirgundyadi Kashaya
• Aragwadhadi Kashaya
• Patoladi gana Kashaya
• Chiravilwadi kashaya
• Krimighna vati
• Vilwadi gutika
• Doosheevishari gutika
• Haridra Khanda – reduce itching
• Aragwadarishtam
• Moolakarishta
• Madhusnuhi rasayana
• Sooranadi lehya

Procedures

• Nimbadi choorna / Eladi choorna – Lepa with Takra
• Vara choorna - kshalana
• Guggulumarichadi taila – Ext application
• Kimshukapatradi taila – Ext application
• Adithyapaka Taila – Ext application
• Gandhaka taila – Ext application
• Neeli taila – Ext application
• Rasothamadi lepa (in severe conditions)