Dermatophyte (Tinea) Infections

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Dermatophyte (tinea) infections

Authors: Adam O Goldstein, MD, MPH, Beth G Goldstein, MD
Section Editors: Robert P Dellavalle, MD, PhD, MSPH, Moise L Levy, MD, Ted Rosen, MD
Deputy Editor: Abena O Ofori, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jul 2019. | This topic last updated: Dec 28, 2018.
INTRODUCTION
Dermatophyte infections are common worldwide, and dermatophytes are the prevailing causes of fungal
infection of the skin, hair, and nails [1-3]. These infections lead to a variety of clinical manifestations,
such as tinea pedis, tinea corporis, tinea cruris, Majocchi's granuloma, tinea capitis, and tinea unguium
(dermatophyte onychomycosis).
The clinical features, diagnosis, and treatment of dermatophyte infections of the skin will be reviewed
here. Dermatophyte infections of scalp hair (tinea capitis), beard hair (tinea barbae), and nails (tinea
unguium) are discussed in detail separately. (See "Tinea capitis" and "Infectious folliculitis", section on
'Fungal folliculitis' and "Onychomycosis: Epidemiology, clinical features, and diagnosis".)
GENERAL PRINCIPLES
Dermatophytes are filamentous fungi in the genera Trichophyton, Microsporum, and Epidermophyton.
Dermatophytes metabolize and subsist upon keratin in the skin, hair, and nails.
The major clinical subtypes of dermatophyte infections are:
● Tinea corporis – Infection of body surfaces other than the feet, groin, face, scalp hair, or beard hair
● Tinea pedis – Infection of the foot
● Tinea cruris – Infection of the groin
● Tinea capitis – Infection of scalp hair
● Tinea unguium (dermatophyte onychomycosis) – Infection of the nail
Additional terms used to describe less common presentations are tinea faciei (infection of the face),
tinea manuum (infection of the hand), and tinea barbae (infection of beard hair). (See 'Other clinical
variants' below.)
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Tinea corporis, tinea pedis, tinea cruris, tinea faciei, and tinea manuum infections are typically
superficial, involving only the epidermis. Occasionally, dermatophyte infections penetrate the hair follicle
and dermis causing a condition called Majocchi's granuloma. Tinea capitis and tinea barbae are
characterized by infection of terminal hairs.
A diagnosis of a cutaneous dermatophyte infection may be strongly suspected based upon the clinical
findings. However, testing to confirm the diagnosis is recommended because a variety of cutaneous
disorders may present with similar features. A potassium hydroxide (KOH) preparation is a rapid
method to confirm the diagnosis. Dermatophyte test medium or a fungal culture may also be used to
confirm the diagnosis. (See "Office-based dermatologic diagnostic procedures", section on 'Potassium
hydroxide preparation'.)
If a cutaneous dermatophyte infection is misdiagnosed and initially treated with a topical corticosteroid,
the appearance of the infection may be altered, making diagnosis more difficult (ie, tinea incognito).
Patients can develop diminished erythema and scale, loss of a well-defined border, exacerbation of
disease, or a deep-seated folliculitis (Majocchi's granuloma). (See 'Majocchi's granuloma' below.)
The simultaneous presence of more than one type of dermatophyte infection is common (eg, tinea pedis
and tinea cruris or tinea pedis and tinea unguium). Performance of a full skin examination including the
skin, hair, and nails aids in the detection of additional sites of infection. Occasionally, patients develop a
dermatophytid reaction, a secondary dermatitic reaction at a distant site that may reflect an immunologic
reaction to the infection. (See 'Dermatophytid (id) reactions' below.)
Topical or systemic antifungal drugs with antidermatophyte activity are effective therapies. Most
superficial cutaneous dermatophyte infections can be managed with topical therapy with agents such as
azoles, allylamines, butenafine, ciclopirox, and tolnaftate (table 1). Nystatin, an effective treatment for
Candida infections, is not effective for dermatophytes. Oral treatment with agents such as
terbinafine, itraconazole, fluconazole, and griseofulvin is used for extensive or refractory cutaneous
infections and infections extending into follicles or the dermis (eg, Majocchi's granuloma) or involving
nails. Patients should not be treated with oral ketoconazole because of risk for severe liver injury,
adrenal insufficiency, and drug interactions.
Although they can be effective and may accelerate resolution of the clinical manifestations of superficial
dermatophyte infections [4], use of combination antifungal and corticosteroid products that include
medium- or high-potency corticosteroids (eg, betamethasone-clotrimazole) is discouraged because
corticosteroid therapy is not necessary for achieving cure and use of a topical corticosteroid introduces
risk for topical corticosteroid-induced skin atrophy. Treatment failures have also been reported [5-7].
Immunosuppression may increase risk for dermatophyte infection and may contribute to the
development of extensive or persistent disease. The possibility of an underlying immune disorder
should be considered in patients with particularly severe or treatment-refractory disease.
TINEA PEDIS
Tinea pedis (also known as athlete's foot) is the most common dermatophyte infection. Tinea pedis may
manifest as an interdigital, hyperkeratotic, or vesiculobullous eruption, and rarely as an ulcerative skin
disorder. Interdigital tinea pedis is most common. Tinea pedis frequently is accompanied by tinea
unguium, tinea cruris, or tinea manuum.
Etiology — Tinea pedis usually occurs in adults and adolescents (particularly young men) and is rare
prior to puberty [8]. Common causes are Trichophyton rubrum, Trichophyton interdigitale (formerly
Trichophyton mentagrophytes), and Epidermophyton floccosum. Infection is usually acquired by means
of direct contact with the causative organism, as may occur by walking barefoot in locker rooms or
swimming pool facilities.
Clinical features — The three major clinical types of tinea pedis are:
● Interdigital tinea pedis – Interdigital tinea pedis manifests as pruritic, erythematous erosions or
scales between the toes, especially in the third and fourth digital interspaces (picture 1). Associated
interdigital fissures may cause pain.
● Hyperkeratotic (moccasin-type) tinea pedis – Hyperkeratotic tinea pedis is characterized by a

diffuse hyperkeratotic eruption involving the soles and medial and lateral surfaces of the feet,
resembling a "moccasin" distribution (picture 2). There is a variable degree of underlying erythema.
● Vesiculobullous (inflammatory) tinea pedis – Vesiculobullous tinea pedis is characterized by a

pruritic, sometimes painful, vesicular or bullous eruption with underlying erythema (picture 3). The
medial foot is often affected.
Infrequently, tinea pedis may manifest with interdigital erosions and ulcers (ulcerative tinea pedis)
(picture 4A-B). This presentation is usually associated with secondary bacterial infection.
Diagnosis — The diagnosis is confirmed with the detection of segmented hyphae in skin scrapings
from an affected area with a potassium hydroxide (KOH) preparation (picture 5A-B). In vesicobullous
tinea pedis, the roof of a vesicle can provide an adequate specimen. Dermatophyte test medium and
fungal culture are alternative diagnostic procedures. (See "Office-based dermatologic diagnostic
procedures", section on 'Potassium hydroxide preparation'.)
Patients who exhibit significant erosions, ulceration, or malodor in the affected area should have a Gram
stain and culture to evaluate for secondary bacterial infection.
Differential diagnosis — The differential diagnosis varies according to the clinical subtype:
● Interdigital tinea pedis

• Erythrasma (picture 6)
• Interdigital Candida infection (erosio interdigitalis blastomycetica) (picture 7)
● Hyperkeratotic (moccasin-type) tinea pedis

• Atopic dermatitis
• Chronic contact dermatitis (picture 8)
• Chronic palmoplantar (dyshidrotic) eczema (picture 9)
• Palmoplantar psoriasis (picture 10)

• Pitted keratolysis (picture 11)
• Juvenile plantar dermatosis (picture 12A-B)
• Keratolysis exfoliativa (see "Peeling skin syndrome", section on 'Keratolysis exfoliativa')
• Keratodermas
● Vesiculobullous (inflammatory) tinea pedis

• Acute palmoplantar (dyshidrotic) eczema (picture 13)
• Acute contact dermatitis
• Palmoplantar pustulosis (picture 14)
• Scabies (picture 15)
A positive KOH preparation demonstrating segmented hyphae distinguishes tinea pedis from nonfungal
diseases. Interdigital Candida infection will demonstrate budding yeasts, pseudohyphae, and septate
hyphae on a KOH preparation (picture 16A-B).
Treatment — Treatment is recommended to alleviate symptoms (pruritus), reduce risk for secondary
bacterial infection, and limit spread of the infection to other body sites or other individuals. Topical
antifungal therapy is the treatment of choice for most patients. Systemic antifungal agents are primarily
reserved for patients who fail topical therapy.
Topical drugs effective for tinea pedis include azoles, allylamines, butenafine, ciclopirox, tolnaftate, and
amorolfine (table 1). The cost of these agents varies widely. Amorolfine is not available in the United
States. A meta-analysis of randomized trials published prior to February 2005 supports efficacy of
topical therapy, finding strong evidence of superiority of topical antifungal agents (azoles, allylamines,
ciclopirox, tolnaftate, butenafine, and undecanoate) over placebo [9]. Allylamines may be slightly more
effective than azoles; a meta-analysis of data from 11 trials that compared topical allylamines with
topical azoles found slightly higher cure rates with allylamines (risk ratio of treatment failure 0.63, 95%
CI 0.42-0.94) [9].
Topical antifungal treatment is generally applied once or twice daily and continued for four weeks.
Shorter treatment courses may be effective; high cure rates have been obtained with terbinafine 1%
cream applied to interdigital tinea pedis for one week [10].
Patients requiring oral antifungal therapy are usually treated with terbinafine, itraconazole, or
fluconazole. Typical treatment regimens for adults include [11]:
● Terbinafine: 250 mg per day for two weeks

● Itraconazole: 200 mg twice daily for one week
● Fluconazole: 150 mg once weekly for two to six weeks
Griseofulvin can also treat tinea pedis but may be less effective than other oral antifungals and requires
a longer duration of therapy [11]. In a systematic review, terbinafine was found more effective than
griseofulvin, while the efficacy of terbinafine and itraconazole were similar [12]. Typical adult doses of
griseofulvin for tinea pedis are 1000 mg per day of griseofulvin microsize for four to eight weeks or 660
or 750 mg per day of griseofulvin ultramicrosize for four to eight weeks [11].
Dosing for children is weight-based with durations of treatment similar to adults. Typical pediatric doses
for oral therapy include:
● Terbinafine tablets:
• 10 to 20 kg: 62.5 mg per day

• 20 to 40 kg: 125 mg per day
• Above 40 kg: 250 mg per day
● Terbinafine granules:
• Less than 25 kg: 125 mg per day

• 25 to 35 kg: 187.5 mg per day
● Itraconazole: 3 to 5 mg/kg per day
● Fluconazole: 6 mg/kg once weekly
● Griseofulvin microsize 10 to 20 mg/kg per day or griseofulvin ultramicrosize 5 to 15 mg/kg per day
In our experience, patients with hyperkeratotic tinea pedis can benefit from combining antifungal
treatment with a topical keratolytic, such as salicylic acid. Burow's (1% aluminum acetate or 5%
aluminum subacetate) wet dressings, applied for 20 minutes two to three times per day, or placing
gauze or cotton between toes may be helpful as an adjunctive measure for patients with vesiculation or
maceration. Interventions that may help to reduce recurrences include use of desiccating foot powders,
treatment of shoes with antifungal powder, and avoidance of occlusive footwear.
TINEA CORPORIS
Tinea corporis is a cutaneous dermatophyte infection occurring in sites other than the feet, groin, face,
or hand.
Etiology — T. rubrum is the most common cause of tinea corporis. Other notable causes include
Trichophyton tonsurans, Microsporum canis, T. interdigitale (formerly T. mentagrophytes), Microsporum
gypseum, Trichophyton violaceum, and Microsporum audouinii. Acquisition of infection may occur by
direct skin contact with an infected individual or animal, contact with fomites, or from secondary spread
from other sites of dermatophyte infection (eg, scalp, feet, etc).
In particular, T. tonsurans tinea corporis in adults may result from contact with a child with tinea capitis,
which is often caused by this organism. M. canis tinea corporis is often acquired by contact with an
infected cat or dog. Tinea corporis can also occur in outbreaks among athletes who have skin-to-skin
contact, such as wrestlers (tinea corporis gladiatorum). T. tonsurans is a common cause of tinea
corporis gladiatorum [13].
Clinical features — Tinea corporis often begins as a pruritic, circular or oval, erythematous, scaling
patch or plaque that spreads centrifugally. Central clearing follows, while an active, advancing, raised
border remains. The result is an annular (ring-shaped) plaque from which the disease derives its
common name (ringworm) (picture 17A-C). Multiple plaques may coalesce (picture 18A-B). Pustules
occasionally appear (picture 19).
Tinea corporis contracted from infected animals, particularly kittens and puppies, is often intensely
inflammatory. Extensive tinea corporis should raise concern for an underlying immune disorder, such as
human immunodeficiency virus (HIV), or for diabetes.
Diagnosis — A potassium hydroxide (KOH) preparation will show the segmented hyphae characteristic
of dermatophyte infections (picture 5A-B). The highest yield is obtained from skin scrapings taken from
the active border of a plaque. A fungal culture is an alternative, albeit slower, method for diagnosis. (See
"Office-based dermatologic diagnostic procedures", section on 'Potassium hydroxide preparation'.)
Differential diagnosis — A wide variety of cutaneous disorders are included in the differential
diagnosis for tinea corporis. Examples of features that should raise consideration for alternative
diagnoses include extensive skin involvement, absence of scale, failure to respond to antifungal
therapy, and a negative KOH preparation.
Tinea corporis may be confused with other annular skin eruptions, especially subacute cutaneous lupus
erythematosus (SCLE), granuloma annulare, and erythema annulare centrifugum. SCLE can be
idiopathic or occur in association with systemic lupus erythematosus or drug exposure. SCLE often
manifests as annular or polycyclic erythematous scaly plaques on sun-exposed skin (picture 20).
Granuloma annulare is a benign inflammatory condition that classically presents with one or more
erythematous or violaceous annular plaques on the extremities (picture 21A-B). Unlike tinea corporis,
scale is absent. Erythema annulare centrifugum, an inflammatory skin disorder of unknown etiology,
exhibits annular erythematous plaques (picture 22A-B). A trailing rim of scale is often evident in the
superficial variant of this disorder. (See "Overview of cutaneous lupus erythematosus" and "Granuloma
annulare", section on 'Clinical features'.)
Other disorders, such as nummular eczema (picture 23), psoriasis, SCLE (picture 20), pityriasis rosea
(picture 24), and disciform erythrasma (picture 25), may also exhibit scaling plaques that resemble tinea
corporis. (See "Approach to the patient with annular skin lesions".)
Treatment — Tinea corporis usually responds well to topical antifungal drugs, such as azoles,
allylamines, butenafine, ciclopirox, and tolnaftate (table 1) [4,14]. Pooled data from randomized trials
supports the efficacy of two allylamines, terbinafine and naftifine, for tinea corporis and tinea cruris [4].
There are also data that suggest similar efficacy of topical allylamines and topical azoles [4]. Topical
nystatin is not effective for dermatophyte infections.
Topical antifungal treatment is generally administered once or twice per day for one to three weeks
(table 1). The endpoint of treatment is clinical resolution.
Systemic treatment is an alternative for patients with extensive skin involvement and patients who fail
topical therapy. Terbinafine and itraconazole are common treatments. Griseofulvin and fluconazole can
also be effective but may require longer courses of therapy. Randomized trials support the efficacy of
systemic therapy [15-18].
Reasonable regimens in adults include [19]:
● Terbinafine 250 mg per day for one to two weeks [20,21]
● Itraconazole 200 mg per day for one week
● Fluconazole 150 to 200 mg once weekly for two to four weeks
● Griseofulvin microsize 500 to 1000 mg per day or griseofulvin ultramicrosize 375 to 500 mg per day
for two to four weeks
Children are treated for similar durations. Reasonable pediatric doses for these drugs are:
● Terbinafine tablets:
• 10 to 20 kg: 62.5 mg per day

• 20 to 40 kg: 125 mg per day
● Terbinafine granules:
• Less than 25 kg: 125 mg per day

• 25 to 35 kg: 187.5 mg per day
● Itraconazole 3 to 5 mg/kg per day (up to 200 mg per day)
● Fluconazole 6 mg/kg once weekly
● Griseofulvin microsize 10 to 20 mg/kg per day or griseofulvin ultramicrosize 5 to 15 mg/kg per day
TINEA CRURIS
Tinea cruris (also known as jock itch) is a dermatophyte infection involving the crural fold.
Etiology — The most common cause is T. rubrum. Other frequent causes include E. floccosum and T.
interdigitale (formerly T. mentagrophytes).
Tinea cruris is far more common in men than women. Often, infection results from the spread of the
dermatophyte infection from concomitant tinea pedis. Predisposing factors include copious sweating,
obesity, diabetes, and immunodeficiency.
Clinical features — Tinea cruris often begins with an erythematous patch on the proximal medial thigh.
The infection spreads centrifugally, with partial central clearing and a slightly elevated, erythematous,
sharply demarcated border that may have tiny vesicles (picture 26A-B). Infection may spread to the
perineum and perianal areas, into the gluteal cleft, or onto the buttocks. In males, the scrotum is
typically spared.
Diagnosis — A potassium hydroxide (KOH) examination of scales scraped from tinea cruris will show
the segmented hyphae characteristic of dermatophyte infections (picture 5A-B). The highest yield is
obtained from skin scrapings taken from the active border. Dermatophyte test medium and fungal
cultures can also be used to confirm the diagnosis. (See "Office-based dermatologic diagnostic
procedures", section on 'Potassium hydroxide preparation'.)
Differential diagnosis — Other common skin disorders that may present with erythematous patches or
plaques in the inguinal region include inverse psoriasis (picture 27), erythrasma (picture 28), seborrheic
dermatitis (picture 29), and candidal intertrigo. A KOH preparation positive for hyphae rules out the first
three disorders.
A diagnosis of erythrasma is confirmed by the appearance of coral red fluorescence upon illumination
with a Wood's lamp (picture 30). Although not always present, the finding of seborrheic dermatitis or
psoriasis in other body locations is useful for identifying these conditions. (See "Erythrasma" and
"Seborrheic dermatitis in adolescents and adults" and "Epidemiology, clinical manifestations, and
diagnosis of psoriasis".)
Candidiasis is suggested by erythematous patches with satellite papules and pustules (picture 31).
Candidal pseudohyphae, hyphae, and yeast cells are seen on KOH preparation (picture 16A-B). In
contrast to tinea cruris, scrotal involvement is common in men with candidiasis of the crural folds. (See
"Intertrigo".)
Treatment — Treatment is similar to tinea corporis. Topical therapy with antifungal agents such as
azoles, allylamines, butenafine, ciclopirox, and tolnaftate is effective (table 1) [4,14]. Nystatin is not
effective for dermatophyte infections. Tinea cruris that is extensive or fails to resolve with topical therapy
can be treated with the oral antifungal regimens used for tinea corporis. (See 'Tinea corporis' above.)
Recurrence of tinea cruris is common. Concomitant tinea pedis should be treated to reduce risk for
recurrence. Treatment of onychomycosis may also reduce recurrences. Other interventions that may be
helpful include daily use of desiccant powders in the inguinal area and avoidance of tight-fitting clothing
and noncotton underwear.
MAJOCCHI'S GRANULOMA
Dermatophyte infections are usually limited to the epidermis. Majocchi's granuloma is an uncommon
condition in which the dermatophyte invades the dermis or subcutaneous tissue.
Etiology — T. rubrum is the most frequent etiologic agent, although other dermatophytes have been
implicated [22].
Majocchi's granuloma may be precipitated by trauma to the skin or occlusion of hair follicles, leading to
the disruption of hair follicles and passage of the dermatophyte into the dermis [23,24]. Shaving the legs
can be an inciting factor in women.
In immunosuppressed patients, the depression of cell-mediated immunity and the inflammatory

response may contribute to progression to Majocchi's granuloma [22,25-27]. In addition, topical
corticosteroid use on a superficial dermatophyte infection can lead to local immunosuppression and the
development of Majocchi's granuloma [28].
Clinical features — In immunocompetent patients, the clinical findings are typically characterized by a
localized area with erythematous, perifollicular papules or small nodules (picture 32A-C). Pustules may
also be present.
Immunocompromised patients may present similarly to immunocompetent patients or with

subcutaneous nodules and abscesses [28]. Rarely, systemic dissemination occurs [22,29].
Diagnosis — A presumptive diagnosis is made based on the patient's history and clinical findings and
is confirmed with a skin biopsy exhibiting fungal forms in the dermis [22]. Tissue culture can identify the
causative organism. A potassium hydroxide (KOH) preparation, which identifies fungal forms only within
the stratum corneum, may be negative [30].
Treatment — Topical antifungals are unlikely to penetrate deeply enough to effectively treat Majocchi's
granuloma. Treatment with an oral antifungal is recommended, and multiple treatment regimens have
been proposed, although no randomized trials or large case series are available.
Terbinafine 250 mg per day for two to four weeks has been used for the treatment of Majocchi's
granuloma in adults [31,32]. A case series of seven successfully treated patients, including one patient
receiving systemic immunosuppressants for chronic lymphocytic leukemia, led to the recommendation
of pulse therapy with itraconazole 200 mg twice daily for one week per month for two months [33].
Treatment regimens with griseofulvin and daily itraconazole have also been suggested [30].
Immunocompromised patients have been successfully treated with oral antifungals. Treatment by local
excision has been reported [34,35] but may not be necessary.
OTHER CLINICAL VARIANTS
Various other terms are used to describe additional clinical subtypes of dermatophyte infection.
Tinea faciei — Tinea faciei is a dermatophyte infection of facial skin devoid of terminal hairs. The
eruption may begin as small, scaly papules that evolve to form an annular plaque (picture 33) [8]. Tinea
faciei is managed similarly to tinea corporis. (See 'Tinea corporis' above.)
Tinea manuum — Tinea manuum is dermatophyte infection of the hand. Patients present with a
hyperkeratotic eruption on the palm or annular plaques similar to tinea corporis on the dorsal hand.
Tinea manuum commonly occurs in association with tinea pedis and is often unilateral (picture 34). This
clinical presentation is often referred to "two-feet, one hand syndrome." The approach to treatment is
similar to tinea pedis. (See 'Tinea pedis' above.)
Tinea capitis — Tinea capitis, dermatophyte infection of scalp hair, usually occurs in small children
(picture 35). Oral antifungal therapy is the treatment of choice. Tinea capitis is reviewed in detail
separately. (See "Tinea capitis".)
Tinea barbae — Tinea barbae is a dermatophyte infection involving beard hair in adolescent and adult
men (picture 36A-B). Oral antifungal therapy is necessary. Tinea barbae is reviewed separately. (See
"Infectious folliculitis", section on 'Fungal folliculitis'.)
Tinea imbricata — Tinea imbricata (also known as Tokelau ringworm) is a variant of tinea corporis
caused by Trichophyton concentricum. The disorder primarily occurs in the South Pacific Islands, South
Asia, and South America. Tinea imbricata is characterized by concentric, annular, scaly, erythematous
plaques (picture 37A-B). A potassium hydroxide (KOH) preparation demonstrates hyphae and fungal
culture confirms T. concentricum infection. The most effective treatments may be oral terbinafine and
griseofulvin [36]. Systemic therapy is often combined with a topical keratolytic agent.
DERMATOPHYTID (ID) REACTIONS
Autoeczematization reactions (also known as id reactions) are secondary dermatitic eruptions that occur
in association with primary, often inflammatory, skin disorders. The term dermatophytid reaction
describes this occurrence in relation to a dermatophyte infection. The pathogenesis may involve an
immunologic reaction to fungal antigens similar to a delayed-type hypersensitivity response [37].
Dermatophytid reactions can occur in patients with tinea pedis, tinea manuum, tinea cruris, tinea
corporis, or tinea capitis [37-39]. Patients typically present with pruritic, papulovesicular eruptions that
can be quite distant from the site of infection (picture 38A-B). In one series of 213 patients with tinea
pedis, 37 (17 percent) were diagnosed with dermatophytid reactions characterized by vesicular
eruptions on the hands [40]. A separate series of five children with dermatophytid reactions due to tinea
capitis found that in addition to involvement on the head and neck, trunk and extremity lesions were
common [37].
The management of dermatophytid reactions involves the successful treatment of the dermatophyte
infection; this may be compromised if the reaction is mistaken for a drug eruption related to antifungal
therapy. Topical corticosteroids and antipruritic agents are typically used for acute management. Rarely,
systemic glucocorticoids are needed.
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions around the
world are provided separately. (See "Society guideline links: Dermatophyte infections".)
INFORMATION FOR PATIENTS
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UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The
Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and
they answer the four or five key questions a patient might have about a given condition. These articles
are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond
the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles
are written at the 10th to 12th grade reading level and are best for patients who want in-depth information
and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-
mail these topics to your patients. (You can also locate patient education articles on a variety of subjects
by searching on "patient info" and the keyword(s) of interest.)
● Basics topics (see "Patient education: Ringworm, athlete's foot, and jock itch (The Basics)" and
"Patient education: Fungal nail infections (The Basics)")
● Beyond the Basics topics (see "Patient education: Ringworm (including athlete's foot and jock itch)
(Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
● Superficial fungal infections are most commonly caused by dermatophytes in the Trichophyton,
Epidermophyton, and Microsporum genera. These organisms metabolize keratin and cause a
range of pathologic clinical presentations, including tinea pedis, tinea corporis, tinea cruris,
Majocchi's granuloma, tinea capitis, and tinea unguium. (See 'General principles' above.)
● A diagnosis of a cutaneous dermatophyte infection may be strongly suspected based upon the
clinical findings. A potassium hydroxide (KOH) preparation should be used to confirm the diagnosis
(picture 5A). Failing to accurately diagnose a dermatophyte infection may lead to inappropriate
treatment with topical corticosteroids. (See 'General principles' above.)
● Most dermatophyte infections can be managed with topical treatments. For patients with limited
tinea pedis, tinea corporis, or tinea cruris, we recommend treatment with a topical antifungal drug
with antidermatophyte activity rather than systemic therapy (Grade 1A). Examples of effective
topical antifungal agents are azoles, allylamines, ciclopirox, butenafine, and tolnaftate. Oral
antifungal therapy is used for extensive infections or infections refractory to topical therapy. Nystatin
is not effective for dermatophyte infections. (See 'Tinea pedis' above and 'Tinea corporis' above and
'Tinea cruris' above.)
● Recurrences of tinea pedis and tinea cruris are common. For patients with tinea pedis, use of
desiccating foot powders, placement of antifungal powder in shoes, and avoidance of occlusive
footwear may help to reduce recurrences. Patients with tinea cruris may benefit from treatment of
concomitant tinea pedis or tinea unguium, use of desiccating powders in the groin, and avoidance
of occlusive clothing and noncotton underwear. (See 'Tinea pedis' above and 'Tinea cruris' above.)
● Majocchi's granuloma is caused by dermatophyte invasion into the dermal or subcutaneous tissue
via penetration of hair follicles. Inflammatory perifollicular papules, small nodules, or pustules are
typically seen. A KOH preparation may be negative. Oral antifungal therapy is indicated. (See
'Majocchi's granuloma' above.)
● Dermatophytid reactions are secondary dermatitic eruptions that may be precipitated by an

immunologic response to dermatophyte infection. Management of dermatophytid reactions involves
treatment of the associated dermatophyte infection. Topical corticosteroids and antipruritic agents
may be beneficial for symptom relief. (See 'Dermatophytid (id) reactions' above.)
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Mycoses 2008; 51 Suppl 4:2.
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Mycopathologia 2008; 166:335.
3. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol 2010; 28:197.
4. El-Gohary M, van Zuuren EJ, Fedorowicz Z, et al. Topical antifungal treatments for tinea cruris and
tinea corporis. Cochrane Database Syst Rev 2014; :CD009992.
5. Alston SJ, Cohen BA, Braun M. Persistent and recurrent tinea corporis in children treated with
combination antifungal/ corticosteroid agents. Pediatrics 2003; 111:201.
6. Greenberg HL, Shwayder TA, Bieszk N, Fivenson DP. Clotrimazole/betamethasone diproprionate:

a review of costs and complications in the treatment of common cutaneous fungal infections.
Pediatr Dermatol 2002; 19:78.
7. Rosen T, Elewski BE. Failure of clotrimazole-betamethasone dipropionate cream in treatment of

Microsporum canis infections. J Am Acad Dermatol 1995; 32:1050.
8. Hawkins DM, Smidt AC. Superficial fungal infections in children. Pediatr Clin North Am 2014;
61:443.
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Cochrane Database Syst Rev 2007; :CD001434.
10. Korting HC, Tietz HJ, Bräutigam M, et al. One week terbinafine 1% cream (Lamisil) once daily is
effective in the treatment of interdigital tinea pedis: a vehicle controlled study. LAS-INT-06 Study
Group. Med Mycol 2001; 39:335.
11. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia 2008;
166:353.
12. Bell-Syer SE, Khan SM, Torgerson DJ. Oral treatments for fungal infections of the skin of the foot.
Cochrane Database Syst Rev 2012; 10:CD003584.
13. Adams BB. Tinea corporis gladiatorum. J Am Acad Dermatol 2002; 47:286.
14. van Zuuren EJ, Fedorowicz Z, El-Gohary M. Evidence-based topical treatments for tinea cruris
and tinea corporis: a summary of a Cochrane systematic review. Br J Dermatol 2015; 172:616.
15. Bourlond A, Lachapelle JM, Aussems J, et al. Double-blind comparison of itraconazole with
griseofulvin in the treatment of tinea corporis and tinea cruris. Int J Dermatol 1989; 28:410.
16. Cole GW, Stricklin G. A comparison of a new oral antifungal, terbinafine, with griseofulvin as
therapy for tinea corporis. Arch Dermatol 1989; 125:1537.
17. Panagiotidou D, Kousidou T, Chaidemenos G, et al. A comparison of itraconazole and griseofulvin

in the treatment of tinea corporis and tinea cruris: a double-blind study. J Int Med Res 1992;
20:392.
18. Faergemann J, Mörk NJ, Haglund A, Odegård T. A multicentre (double-blind) comparative study to
assess the safety and efficacy of fluconazole and griseofulvin in the treatment of tinea corporis
and tinea cruris. Br J Dermatol 1997; 136:575.
19. Elewski BE, Hughey LC, Sobera JO. Fungal diseases. In: Dermatology, 3rd ed, Bolognia JL, Joriz
zo JL, Schaffer JV (Eds), Elsevier Limited, Philadelphia; London 2012. Vol 2, p.1251.
20. Voravutinon V. Oral treatment of tinea corporis and tinea cruris with terbinafine and griseofulvin: a
randomized double blind comparative study. J Med Assoc Thai 1993; 76:388.
21. Farag A, Taha M, Halim S. One-week therapy with oral terbinafine in cases of tinea cruris/corporis.
Br J Dermatol 1994; 131:684.
22. Smith KJ, Neafie RC, Skelton HG 3rd, et al. Majocchi's granuloma. J Cutan Pathol 1991; 18:28.
23. Gill M, Sachdeva B, Gill PS, et al. Majocchi's granuloma of the face in an immunocompetent
patient. J Dermatol 2007; 34:702.
24. Cho HR, Lee MH, Haw CR. Majocchi's granuloma of the scrotum. Mycoses 2007; 50:520.
25. Tse KC, Yeung CK, Tang S, et al. Majocchi's granuloma and posttransplant lymphoproliferative
disease in a renal transplant recipient. Am J Kidney Dis 2001; 38:E38.
26. Kim ST, Baek JW, Kim TK, et al. Majocchi's granuloma in a woman with iatrogenic Cushing's
syndrome. J Dermatol 2008; 35:789.
27. Akiba H, Motoki Y, Satoh M, et al. Recalcitrant trichophytic granuloma associated with NK-cell
deficiency in a SLE patient treated with corticosteroid. Eur J Dermatol 2001; 11:58.
28. Ilkit M, Durdu M, Karakaş M. Majocchi's granuloma: a symptom complex caused by fungal
pathogens. Med Mycol 2012; 50:449.
29. Novick NL, Tapia L, Bottone EJ. Invasive trichophyton rubrum infection in an immunocompromised
host. Case report and review of the literature. Am J Med 1987; 82:321.
30. Feng WW, Chen HC, Chen HC. Majocchi's granuloma in a 3-year-old boy. Pediatr Infect Dis J
2006; 25:658.
31. Gupta AK, Prussick R, Sibbald RG, Knowles SR. Terbinafine in the treatment of Majocchi's
granuloma. Int J Dermatol 1995; 34:489.
32. McMichael A, Sanchez DG, Kelly P. Folliculitis and the follicular occlusion tetrad. In: Dermatology,
2nd ed, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Elsevier Limited, St. Louis 2008.
33. Gupta AK, Groen K, Woestenborghs R, De Doncker P. Itraconazole pulse therapy is effective in
the treatment of Majocchi's granuloma: a clinical and pharmacokinetic evaluation and implications
for possible effectiveness in tinea capitis. Clin Exp Dermatol 1998; 23:103.
34. Burg M, Jaekel D, Kiss E, Kliem V. Majocchi's granuloma after kidney transplantation. Exp Clin
Transplant 2006; 4:518.
35. Liao YH, Chu SH, Hsiao GH, et al. Majocchi's granuloma caused by Trichophyton tonsurans in a
cardiac transplant recipient. Br J Dermatol 1999; 140:1194.
36. Bonifaz A, Vázquez-González D. Tinea imbricata in the Americas. Curr Opin Infect Dis 2011;
24:106.
37. Cheng N, Rucker Wright D, Cohen BA. Dermatophytid in tinea capitis: rarely reported common
phenomenon with clinical implications. Pediatrics 2011; 128:e453.
38. Romano C, Rubegni P, Ghilardi A, Fimiani M. A case of bullous tinea pedis with dermatophytid
reaction caused by Trichophyton violaceum. Mycoses 2006; 49:249.
39. Al Aboud K, Al Hawsawi K, Alfadley A. Tinea incognito on the hand causing a facial dermatophytid
reaction. Acta Derm Venereol 2003; 83:59.
40. Veien NK, Hattel T, Laurberg G. Plantar Trichophyton rubrum infections may cause
dermatophytids on the hands. Acta Derm Venereol 1994; 74:403.
Topic 4030 Version 35.0
GRAPHICS
Topical antifungal agents
Drug Dose How supplied*
Azoles ¶
Clotrimazole Δ Twice per day Cream 1%
Ointment 1%
Solution 1%
Econazole Once per day (twice per day for candidiasis) Cream 1%
Foam 1%
◊
Efinaconazole Once per day Solution 10%
Ketoconazole Once per day (shampoo is usually one use) Cream 2%
Shampoo 2% (1% shampoo is available over-

the-counter)
Gel 2%
Foam 2%
Luliconazole Once per day Cream 1%

Δ
Miconazole Twice per day Cream 2%
Ointment 2%
Solution 2%
Lotion 2%
Powder 2%
Aerosol solution 2%
Aerosol powder 2%
Oxiconazole Once to twice per day Cream 1%
Lotion 1%
Sertaconazole Twice per day Cream 2%
Sulconazole Once or twice per day Cream 1%
Solution 1%
Allylamines §
Naftifine Once per day (cream), twice per day (gel) Cream 1%
Cream 2%
Gel 1%
Gel 2%
Δ
Terbinafine Once to twice per day Cream 1%
Gel 1%
Spray solution 1%
Benzylamine §
Butenafine Δ Once per day (twice per day for tinea pedis) Cream 1%
Polyene: Treats Candida infections only
Nystatin Two to three times per day Cream 100,000 units/gram
Ointment 100,000 units/gram
Powder 100,000 units/gram
Other
Ciclopirox ¥ Twice per day Cream 0.77%
Gel 0.77%
Suspension 0.77%
Shampoo 1%
Solution 8%
Δ‡
Tolnaftate Twice per day Cream 1%
Powder 1%
Aerosol:
Liquid 1%
Powder 1%
Solution 1%
* Preparations available in United States and some other countries.

¶ Azoles have activity against dermatophytes, tinea versicolor, and Candida. Sulconazole, oxiconazole, and luliconazole may be
less effective for Candida infection than other azoles.
Δ Available in over-the-counter (nonprescription) preparations in the United States and some other countries.
◊ Indicated for onychomycosis.
§ Can treat Candida in addition to dermatophytes and tinea versicolor but may be less effective than azoles and ciclopirox for
Candida infection.
¥ Treats dermatophytes, tinea versicolor, and Candida.
‡ Does not treat Candida; less effective than other options for dermatophytes.
Prepared with data from: US Food & Drug Administration (FDA) approved product information. US National Library of Medicine.
(Available online at: http://dailymed.nlm.nih.gov/dailymed/about.cfm).
Graphic 76148 Version 11.0
Tinea pedis with interdigital maceration
Erythema and white, macerated skin between the toes in a patient with tinea pedis.
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights reserved.
Hyperkeratotic (moccasin-type) tinea pedis
Diffuse scale on the plantar surface and side of the foot.
Bullous tinea pedis
Vesicles and bullae on the plantar skin of a patient with tinea pedis.
Ulcerative tinea pedis
Extensive erosions in a patient with tinea pedis.
Ulcerative tinea pedis
Erosions and ulceration on the distal plantar foot.
Potassium hydroxide (KOH) preparation from dermatophyte infection
Multiple septate hyphae on a background of squamous cells in a potassium hydroxide (KOH) preparation taken from the site
of a dermatophyte infection.
Courtesy of Beth G Goldstein, MD.
Dermatophyte potassium hydroxide preparation
Septate hyphae are visible on a background of squamous cells in this potassium

hydroxide preparation taken from a lesion of tinea corporis. Potassium hydroxide
preparations from tinea pedis and tinea cruris have a similar appearance.
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights

reserved.
Erythrasma
Interdigital scale and maceration on the foot.
Candidal intertrigo of the finger web
Erosio interdigitalis blastomycetica (interdigital candidal infection) in a bartender

whose hands were constantly wet. In the acute phase, erosio interdigitalis
blastomycetica may have a more macerated appearance.
Reproduced with permission from: Habif T. Clinical Dermatology: A Color Guide to

Diagnosis and Therapy, 4th ed, Mosby, New York 2004. Copyright © 2004 Elsevier.
Allergic contact dermatitis
Erythematous, scaly plaques on the dorsum of the feet of a patient with shoe allergic
contact dermatitis.
Reproduced with permission from: Stedman's Medical Dictionary. Copyright © 2008 Lippincott
Williams & Wilkins.
Dyshidrotic foot eczema
Desquamation following vesicle desiccation in a patient with plantar dyshidrotic eczema.
Palmoplantar psoriasis
Erythematous, scaly plaques with fissures on the palms and soles.
Pitted keratolysis
This 20-year-old female with plantar hyperhidrosis exhibited

asymptomatic cribriform pits on her soles. The feet were malodorous.
Copyright © Shahbaz A Janjua, MD, Dermatlas; http://www.dermatlas.org.
Juvenile plantar dermatosis
Shiny-appearing plantar skin with accentuation of the skin folds and fissures in a
teenager with juvenile plantar dermatosis.

reserved.
Juvenile plantar dermatosis 2
Shiny and cracked appearance of the plantar skin in a child with juvenile plantar
dermatosis.

reserved.
Dyshidrotic eczema
Multiple small vesicles and postinflammatory hyperpigmentation on the foot.
Palmoplantar pustulosis
Pustules within an erythematous, scaly plaque on the foot.
Scabies
Erythematous and hyperpigmented papules and crusts on the foot of a child

with scabies.

reserved.
Candida albicans
Potassium hydroxide preparation of candida infection.
Reproduced with permission from: Goodheart, HP. Goodheart's Photoguide of

Common Skin Disorders, 2nd ed, Lippincott Williams & Wilkins, Philadelphia 2003.
Copyright © 2003 Lippincott Williams & Wilkins.
Candida albicans
Pseudohyphae of Candida with budding yeasts in a potassium hydroxide

preparation. Pseudohyphae are chains of elongated yeast cells that fail to detach
after budding.
Reproduced with permission from: Goodheart HP. Goodheart's Photoguide of

Tinea corporis
Annular, scaly plaques.
Tinea corporis
Annular plaque with scale on the extremity.
Tinea corporis
An inflammatory, annular plaque with peripheral scale is present.
Tinea corporis
Multiple annular, erythematous plaques with peripheral scale are present.
Tinea corporis
Multiple round, erythematous plaques of variable size, some with signs of central
resolution, on the leg of a patient with tinea corporis.
Tinea corporis
Annular, erythematous plaque with pustules.
Subacute cutaneous lupus erythematosus
Erythematous, annular plaques with scale.

reserved.
Granuloma annulare
This child with granuloma annulare has a nonscaly, erythematous, annular

plaque.
Reproduced with permission from: Goodheart HP, MD. Goodheart's Photoguide of

Common Skin Disorders, 2nd Edition, Lippincott Williams & Wilkins, Philadelphia
2003. Copyright © 2003 Lippincott Williams & Wilkins.
Granuloma annulare
This granuloma annulare lesion is an erythematous, nonscaly, annular plaque.

Common Skin Disorders, 2nd Edition, Lippincott Williams & Wilkins, Philadelphia
2003. Copyright © 2003 Lippincott Williams & Wilkins.
Superficial erythema annulare centrifugum
Annular, erythematous plaques with "trailing scale" are classic features of

superficial erythema annulare centrifugum.

reserved.
Superficial erythema annulare centrifugum
Erythematous, annular plaques with "trailing scale" are classic features of

superficial erythema annulare centrifugum.

reserved.
Nummular eczema
A plaque of nummular eczema with erythema, vesiculation, and crusting.
Pityriasis rosea
Erythematous plaques with trailing collarettes of scale.
Disciform erythrasma
Tinea cruris
Tinea cruris infection caused by Trichophyton rubrum involving the crural fold
and medial aspect of the right thigh.
Courtesy of John T Crissey, MD.
Tinea cruris
Erythematous and scaly plaque with ring-like, raised borders in the groin, characteristic
of tinea cruris.
Inverse psoriasis
Shiny, erythematous plaques within skin folds.
Erythrasma
Red-brown plaques of erythrasma in the groin.
Reproduced with permission from John L Aeling, MD.
Seborrheic dermatitis
Erythematous patch in the inguinal crease.
Erythrasma under light from a Wood's lamp
Examination with a Wood's lamp reveals coral red fluorescence on the inner
thighs of this patient with erythrasma.

reserved.
Candidal intertrigo
Erythematous plaque with satellite papules and pustules.
Majocchi's granuloma
Papules and pustules within an erythematous plaque on the dorsal hand.
Papular and pustular eruption on the extremity secondary to dermatophyte infection.
A 14-year-old boy with tinea pedis developed a pruritic eruption of

erythematous papules and small pustules on the leg that progressed after
topical corticosteroid use.
Copyright © Bernard Cohen, MD, Dermatlas; http://www.dermatlas.org.
Tinea faciei
An erythematous, oval plaque and pustules on the face.
Tinea pedis and tinea manuum
This image shows concomitant tinea pedis and tinea manuum, also known as
the "two feet, one hand" presentation.

Tinea capitis
Scaly patch with hair loss on the posterior scalp.
Tinea barbae
Large, erythematous papulopustular lesions in the beard area of a patient with

Trichophyton infection.
Tinea barbae
Follicular pustules and crusted lesions in a patient with tinea barbae.
Tinea imbricata
Scaly eruption in a concentric pattern on the extremity.
Tinea imbricata
Patterned, scaly eruption on the extremity.
Autoeczematization (id reaction)
Numerous pinpoint vesicles are present on the hand.
Dermatophytid reaction (autoeczematization or id

reaction due to dermatophyte infection)
A widespread eczematous eruption primarily distributed on the face, neck, and

ears developed in this child with tinea capitis. The terms autoeczematization and
id reaction are also used to refer to this phenomenon.
Copyright © Bernard Cohen, MD, Dermatlas; http://www.dermatlas.org.
Contributor Disclosures
Adam O Goldstein, MD, MPH Nothing to disclose Beth G Goldstein, MD Nothing to disclose Robert P
Dellavalle, MD, PhD, MSPH Grant/Research/Clinical Trial Support: Pfizer [Development of patient decision aids];
Pfizer [Inflammatory and Immune-mediated Skin Disease Fellowship grant to the University of Colorado [The
fellowship will train a fellow in inflammatory and immune-mediated skin disease outcomes research].
Consultant/Advisory Boards: Altus Labs [Itch (Cannabidiol)]. Equity Ownership/Stock Options: Altus Labs [Itch
(Cannabidiol)]. Other Financial Interest: Stipends from the Journal of Investigative Dermatology (Podcast editor),
Journal of the American Academy of Dermatology (Dermatology section editor); expense reimbursement for
attending Cochrane Council meetings (Coordinating Editors Representative). Moise L Levy,
MD Grant/Research/Clinical Trial Support: Amicus Therapeutics [Epidermolysis bullosa (Novel topical therapy)];
Janssen Pharmaceutica [Psoriasis (Guselkumab)]; Pfizer [Atopic dermatitis (Janus kinase inhibitor)].
Consultant/Advisory Boards: Pfizer; Regeneron Pharmaceuticals [Atopic dermatitis (Janus kinase inhibitor,
dupilumab)]. Patent Holder: Incontinentia pigmenti (NEMO gene mutations). Other Financial Interest: Castle Creek
Pharmaceuticals [Epidermolysis bullosa (Diacerein ointment)]. Ted Rosen, MD Consultant/Advisory Boards:
Medimetriks; Cutanea [Impetigo (Ozenoxacin)]; Menlo [Prurigo nodularis (Serlopitant)]; Foamix [Acne (Minocycline
foam)]. Abena O Ofori, MD Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be provided
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Dermatophyte (Tinea) Infections

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Dermatophyte (tinea) infections

The major clinical subtypes of dermatophyte infections are:

● Hyperkeratotic (moccasin-type) tinea pedis – Hyperkeratotic tinea pedis is characterized by a

● Vesiculobullous (inflammatory) tinea pedis – Vesiculobullous tinea pedis is characterized by a

● Interdigital tinea pedis

● Hyperkeratotic (moccasin-type) tinea pedis

• Palmoplantar psoriasis (picture 10)

● Vesiculobullous (inflammatory) tinea pedis

● Terbinafine: 250 mg per day for two weeks

• 10 to 20 kg: 62.5 mg per day

• Less than 25 kg: 125 mg per day

● Itraconazole: 3 to 5 mg/kg per day

● Fluconazole: 6 mg/kg once weekly

Reasonable regimens in adults include [19]:

● Terbinafine 250 mg per day for one to two weeks [20,21]

● Itraconazole 200 mg per day for one week

● Fluconazole 150 to 200 mg once weekly for two to four weeks

• 10 to 20 kg: 62.5 mg per day

• Less than 25 kg: 125 mg per day

● Itraconazole 3 to 5 mg/kg per day (up to 200 mg per day)

● Fluconazole 6 mg/kg once weekly

In immunosuppressed patients, the depression of cell-mediated immunity and the inflammatory

Immunocompromised patients may present similarly to immunocompetent patients or with

OTHER CLINICAL VARIANTS

DERMATOPHYTID (ID) REACTIONS

SOCIETY GUIDELINE LINKS

INFORMATION FOR PATIENTS

SUMMARY AND RECOMMENDATIONS

● Dermatophytid reactions are secondary dermatitic eruptions that may be precipitated by an

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1. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide.

2. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections.

3. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol 2010; 28:197.

6. Greenberg HL, Shwayder TA, Bieszk N, Fivenson DP. Clotrimazole/betamethasone diproprionate:

7. Rosen T, Elewski BE. Failure of clotrimazole-betamethasone dipropionate cream in treatment of

17. Panagiotidou D, Kousidou T, Chaidemenos G, et al. A comparison of itraconazole and griseofulvin

Topic 4030 Version 35.0

Topical antifungal agents

Drug Dose How supplied*

Clotrimazole Δ Twice per day Cream 1%

Ketoconazole Once per day (shampoo is usually one use) Cream 2%

Shampoo 2% (1% shampoo is available over-

Luliconazole Once per day Cream 1%

Oxiconazole Once to twice per day Cream 1%

Sertaconazole Twice per day Cream 2%

Sulconazole Once or twice per day Cream 1%

Polyene: Treats Candida infections only

Nystatin Two to three times per day Cream 100,000 units/gram

Ointment 100,000 units/gram

Powder 100,000 units/gram

Ciclopirox ¥ Twice per day Cream 0.77%

* Preparations available in United States and some other countries.

Graphic 76148 Version 11.0

Tinea pedis with interdigital maceration

Graphic 76067 Version 7.0

Hyperkeratotic (moccasin-type) tinea pedis

Diffuse scale on the plantar surface and side of the foot.

Graphic 103981 Version 2.0

Bullous tinea pedis

Graphic 82787 Version 6.0

Ulcerative tinea pedis