Tinea corporis refers to any dermatophytosis of glabrous

skin except palms, soles, and the groin.

EPIDEMIOLOGY. Tinea corporis may be transmitted
directly from infected humans or animals, via fomites,
or it may occur via autoinoculation from reservoirs
of dermatophyte colonization on the feet.44 Children
are more likely to contract zoophilic pathogens, especially
M. canis, from dogs or cats. Occlusive clothing
and a humid climate are associated with more frequent
and severe eruptions.45 Wearing of occlusive clothing,
frequent skin-to-skin contact, and minor traumas
such as the mat burns competitive wrestling create an
environment in which dermatophytes flourish. “Tinea
corporis gladiatorum” is caused most commonly by T.
tonsurans, and it occurs most frequently on the head,
neck, and arms.46
ETIOLOGY. Although any dermatophyte may
cause tinea corporis, it is caused most commonly by
T. rubrum. T. rubrum is also the most likely candidate
in cases with concomitant follicular involvement.35
Epidermophyton floccosum, T. interdigitale (anthropophilic
and zoophilic strains), M. canis, and T. tonsurans
are also common pathogens.1 Tinea imbricata, caused
by T. concentricum, is limited geographically to areas
of the Far East, South Pacific, and South and Central
America.
CLINICAL FINDINGS. The classic presentation is
that of an annular (“ring-worm”-like; Fig. 188-9A) or
serpiginous plaque with scale across the entire active
erythematous border. The border, which may be vesicular,
advances centrifugally. The center of the plaque
is usually scaly but it may exhibit complete clearing.
Whereas concentric vesicular rings suggest tinea
incognito, often caused by T. rubrum, the erythematous
concentric rings of tinea imbricata demonstrate little to
no vesiculation. T. rubrum infections may also present
as large, confluent polycyclic (Fig. 188-9B) or psoriasiform
(Fig. 188-9C) plaques, especially in immunosuppressed
individuals.
Majocchi’s granuloma is a superficial and subcutaneous
dermatophytic infection involving deeper
portions of the hair follicles that presents as scaly follicular
papules and nodules that coalesce in an annular
arrangement (Fig. 188-10). It is caused most commonly
by T. rubrum, T. interdigitale, and M. canis. Majocchi’s
granuloma is observed on the legs in women who
become inoculated after shaving or who apply topical
corticosteroids to the involved area, which facilitates
infection. It is also observed increasingly among
immunocompromised patients.

Box 188-3 Differential Diagnosis

of Tinea Corporis
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
TINEA CORPORIS AND TINEA CRURIS
For isolated plaques on the glabrous skin, topical
allylamines, imidazoles, tolnaftate, butenafine, or
ciclopirox are effective. Most are applied twice daily
for 2–4 weeks. Oral antifungal agents are reserved for
widespread or more inflammatory eruptions. Comparative
studies in adults show that terbinafine 250
mg daily for 2–4 weeks, itraconazole 200 mg daily for
1 week, and fluconazole 150–300 mg weekly for 4–6
weeks are preferable over griseofulvin 500 mg daily
until cure is reached.73 Safe and effective regimens
for children include terbinafine 3–6 mg/kg/day for
2 weeks, itraconazole 5 mg/kg/day for 1 week, and
ultramicrosize griseofulvin 10–20 mg/ kg/day for up
to 2–4 weeks.