Tinea corporis

Tinea corporis is a dermatophyte infection of the skin of the trunk and extremities excluding the
hair, nails, palms, soles and groin. The infection is generally restricted to the stratum corneum
and most commonly occurs on exposed skin, but it can develop on any part of the body. While
tinea corporis is seen worldwide, it is most common in tropical regions. Any dermatophyte can
potentially cause tinea corporis, but T. rubrum is the most common pathogen worldwide,
followed by T. mentagrophytes (Table 76.7).

Table 76.7 -- Common dermatophytes that cause tinea corporis.
COMMON DERMATOPHYTES THAT CAUSE TINEA CORPORIS
Dermatophyte Clinical features
Anthropophilic
Trichophyton rubrum Commonly harbored by hair follicles; may produce concentric rings;
can recur; causative organism in Majocchi's granuloma and most
common cause of tinea corporis
T. tonsurans Commonly seen in adults who care for children with tinea capitis
caused by this organism
Epidermophyton
floccosum
Generally restricted to groin, feet; responsible for eczema marginatum
T. concentricum Responsible for tinea imbricata; infections typically chronic
T. mentagrophytes var.
interdigitale
Causes interdigital tinea pedis, tinea cruris and onychomycosis
Zoophilic
T. mentagrophytes var.
mentagrophytes
May be associated with dermatophytid reaction; causes inflammatory
tinea pedis and tinea barbae; associated with exposure to small
mammals
Microsporum canis Associated with pet exposure (cat or dog)
T. verrucosum May mimic bacterial furunculosis; associated with exposure to cattle
Geophilic
M. gypseum Frequently associated with outdoor/occupational exposure; lesions
may be inflammatory or bullous

Tinea corporis can result from human-to-human, animal-to-human or soil-to-human spread (see
Table 76.6). Domestic animals are an important factor in the transmission of organisms causing
tinea corporis, specifically the zoophilic species. Another important risk factor in acquiring tinea
corporis is having a personal history of, or close contact with, tinea capitis or tinea pedis. Other
factors that may predispose an individual to tinea corporis include occupational or recreational
exposure (e.g. military housing, gymnasiums, locker rooms, outdoor occupations, wrestling),
contact with contaminated clothing and furniture, and immunosuppression
[13]
.
There are various clinical presentations of tinea corporis, and they can mimic other dermatologic
conditions (Table 76.8). As with most dermatophyte infections, the extent of inflammation
depends on the causative pathogen and the immune response of the host. Also, because hair
follicles serve as reservoirs for infection, areas of the body with more hair follicles may display a
more pronounced inflammatory response.

Table 76.8 -- Differential diagnoses of dermatophyte infections.
DIFFERENTIAL DIAGNOSES OF DERMATOPHYTE INFECTIONS
Tinea corporis Tinea cruris Tinea faciei Tinea capitis Tinea pedis



Dermatitis

Nummula
r eczema

Atopic

Stasis

Contact

Seborrhei
c
(petaloid)


Pityriasis
versicolor


Pityriasis
rosea


Parapsoria
sis


Erythema
annulare
centrifugu
m


Cutaneous
candidiasis



Intertrigo

Seborrheic
dermatitis

Psoriasis



Erythrasma


Contact
dermatitis


Lichen simplex
chronicus


Parapsoriasis/m
ycosis
fungoides


HaileyHailey
disease


Langerhans cell
histiocytosis



Dermatitis

Seborrhei
c

Perioral

Contact


Acne
rosacea


Lupus
erythemat
osus


Acne
vulgaris


Annular
psoriasis
(children)


Seborrheic
dermatitis


Alopecia
areata


Trichotillo
mania



Psoriasis



If pustules:

Pyoderma

Folliculitis



If scarring:

Lichen
planus

Discoid
lupus
erythematos
us

Folliculitis
decalvans


Dermati
tis

Dyshidr
otic

Contact


Psoriasi
s

Vulgaris

Pustular


Juvenile
plantar
dermato
sis


Seconda
ry
syphilis


If
interdigi
tal:

Erythras
ma
DIFFERENTIAL DIAGNOSES OF DERMATOPHYTE INFECTIONS
Tinea corporis Tinea cruris Tinea faciei Tinea capitis Tinea pedis


Annular
psoriasis


Subacute
lupus
erythemat
osus


Granulom
a annulare



Impetigo

Central
centrifugal
cicatricial
alopecia

Bacteria
l
infectio
n, e.g.
GNR
GNR, Gram-negative rods.

The typical incubation period is 1 to 3 weeks. Infection spreads centrifugally from the point of
skin invasion, with central clearing of the fungus, typically resulting in annular lesions of varying
sizes (Fig. 76.4A). However, lesions may assume other shapes (e.g. arcuate, circinate, oval) (Fig.
76.4B). Most are scaly, although scale may be lessened or absent if topical corticosteroids have
been used (tinea incognito). Pustules within the active border is a finding suggestive of tinea

Fig. 76.4 Tinea corporis. A Annular lesion on the arm with active scaly border. B Widespread involvement of the back with
scalloped inferior border. C Pustules within multiple figurate lesions on the upper arm.


Clinical variants of tinea corporis include tinea profunda, Majocchi's granuloma and tinea
imbricata. Tinea profunda results from an excessive inflammatory response to a dermatophyte
(analogous to a kerion on the scalp). It may have a granulomatous or verrucous appearance and
be mistaken for cutaneous tuberculosis, a dimorphic fungal infection or squamous cell
carcinoma. Majocchi's granuloma, caused by T. rubrum, is characterized by perifollicular
pustules or granulomas (Fig. 76.5). This variant, commonly seen in women who have tinea pedis
or onychomycosis (caused by T. rubrum) and who also shave their legs, occurs when infected
hairs penetrate the wall of the follicle. The lesions may be extensive and possibly vegetating, and
also occur in the setting of immunosuppression.


Fig. 76.5 Majocchi's granuloma. Perifollicular inflammation and pustules on the buttocks due to Trichophyton rubrum.