Tineas

BODY PART AFFECTED

FEATURES

Tinea capitis

• Alopecia, scaly patches with hairs broken off when very short
• The lesion may sometimes be inflamed with multiple pustules (pockets of pus)
• Especially in children 4-14 years and immuno- suppressed

Tinea corporis (ringworm)

• Single or multiple plaques on hairless skin except, palm, sole and groin, especially the face, trunk or limbs.
• Well demarcated, scaly and raised border with relatively clear centre
• Pruritus

Tinea (or pityriasis) versicolor

• A chronic yeast infection caused by Malassezia furfur-  a normal flora.
• Well-defined round/oval patches on the chest, upper back, face and arms
• Pale or discolored spots on the skin, e.g., chest, back, face
• Not scaly, but peels off when scratched
• Rare in children, onset usually around puberty
• Treatment; topical application or shampoo; ketoconazole, clotrimazole, miconazole. In severe form, parental application may be used.
• NB: griseofulvin SHOULD NOT be used because p. versicolor is an yeast infection – not by dermatophyte hence not effective.

Nails (Onycho- mycosis)

• Thickened, discolored nails, can be white, yellow, green, or black
• Brittle nails that break easily

• White scaling usually between the 4th and 5th toes or between the 3rd and 4th toes on one foot only
• Scales, vesicles, cracks
• Burning or itching between toes and under foot especially when shoes and socks are removed
• May be secondary infection

Tinea capitis

• Oral griseofulvin 10 mg/kg/day as single dose once daily after meals for 6 weeks
• Do NOT treat with topical antifungal agents; they cannot get to the site of infection

Tinea corporis (ringworm)

• Apply Whitfield’s ointment (benzoic acid + salicylic acid) 12 hourly until 2 weeks after lesions clear
• Clotrimazole 1% cream twice a day
• Or miconazole 2% cream 12 hourly for 2-3 weeks

If topical treatment fails

• Griseofulvin 10 mg/kg for 3 weeks

HC2

HC2

HC3

HC3

Pityriasis versicolor

• Apply clotrimazole cream 12 hourly until lesions disappear
• Or miconazole 2% cream 12 hourly for 2-3 weeks

If topical treatment fails

• Fluconazole 300 mg once weekly for 2 weeks

NB Griseofulvin should not be used

Nails (Onychomycosis)

• Oral griseofulvin 10 mg/kg per day as single dose once daily after meals for 6-12 months

Tinea pedis (Athletes foot)

• Apply clotrimazole cream 12 hourly, continue for 14 days after the lesions have healed
• Or miconazole cream as above
• Apply powder (not necessarily medicated) to the feet rather than to the shoes
• For persistent or non-responsive infection, oral griseofulvin 10 mg/kg/day as single dose once daily after meals for 4-8 weeks

Note on griseofulvin:

• Double the dose in severe infections
• Take with fatty food
• Do NOT use for tinea versicolor (pityriasis)
• Advise female patient to not get pregnant while on treatment
• Men should avoid fathering children while on treatment