Dermatophytosis, also known as ringworm, is a

fungal infection Fungal infection, also known as mycosis, is disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common ti ...

of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple areas can be affected at a given time. About 40 types of fungus can cause ringworm. They are typically of the ''

Trichophyton ''Trichophyton'' is a genus of fungi, which includes the parasitic varieties that cause tinea, including athlete's foot, ringworm, jock itch, and similar infections of the nail, beard, skin and scalp. Trichophyton fungi are molds characterized ...

'', '' Microsporum'', or '' Epidermophyton'' type. Risk factors include using public showers, contact sports such as wrestling, excessive sweating, contact with animals, obesity, and

poor immune function Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reacti ...

. Ringworm can spread from other animals or between people. Diagnosis is often based on the appearance and symptoms. It may be confirmed by either culturing or looking at a skin scraping under a microscope. Prevention is by keeping the skin dry, not walking barefoot in public, and not sharing personal items. Treatment is typically with antifungal creams such as

clotrimazole Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock itch ...

or miconazole. If the scalp is involved, antifungals by mouth such as fluconazole may be needed. Globally, up to 20% of the population may be infected by ringworm at any given time. Infections of the groin are more common in males, while infections of the scalp and body occur equally in both sexes. Infections of the scalp are most common in children while infections of the groin are most common in the elderly. Descriptions of ringworm date back to ancient history.

Signs and symptoms

Infections on the body may give rise to typical enlarging raised red rings of ringworm. Infection on the skin of the feet may cause athlete's foot and in the groin, jock itch. Involvement of the nails is termed onychomycosis, and they may thicken, discolour, and finally crumble and fall off. They are common in most adult people, with up to 20% of the population having one of these infections at any given moment. Animals including dogs and cats can also be affected by ringworm, and the disease can be transmitted between animals and humans, making it a zoonotic disease. Specific signs can be: * red, scaly, itchy or raised patches * patches may be redder on outside edges or resemble a ring * patches that begin to ooze or develop a blister * bald patches may develop when the scalp is affected * nails may thicken, discolour or begin to crack

Causes

Fungi thrive in moist, warm areas, such as

locker room A locker is a small, usually narrow storage compartment. They are commonly found in dedicated cabinets, very often in large numbers, in various public places such as locker rooms, workplaces, elementary schools, middle and high schools, trans ...

s, tanning beds,

swimming pool A swimming pool, swimming bath, wading pool, paddling pool, or simply pool, is a structure designed to hold water to enable Human swimming, swimming or other leisure activities. Pools can be built into the ground (in-ground pools) or built ...

s, and skin folds; accordingly, those that cause dermatophytosis may be spread by using exercise machines that have not been disinfected after use, or by sharing towels, clothing, footwear, or hairbrushes.

Diagnosis

Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy.

Classification

A number of different species of fungus are involved in dermatophytosis.

Dermatophytes Dermatophyte (from Greek '' derma'' "skin" (GEN ''dermatos'') and ''phyton'' "plant") is a common label for a group of fungus of ''Arthrodermataceae'' that commonly causes skin disease in animals and humans. Traditionally, these anamorphic (as ...

of the genera ''

'' and '' Microsporum'' are the most common causative agents. These fungi attack various parts of the body and lead to the conditions listed below. The Latin names are for the conditions (disease patterns), not the agents that cause them. The disease patterns below identify the type of fungus that causes them only in the cases listed: * Dermatophytosis **

Tinea pedis Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple ar ...

( athlete's foot): fungal infection of the feet **

Tinea unguium Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple a ...

: fungal infection of the fingernails and toenails, and the nail bed ** Tinea corporis: fungal infection of the arms, legs, and trunk **

Tinea cruris Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates. Typically, over the upper inner ...

( jock itch): fungal infection of the groin area ** Tinea manuum: fungal infection of the

hands A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each " ...

and palm area ** Tinea capitis: fungal infection of the scalp and hair **

Tinea faciei Tinea faciei is a fungal infection of the skin of the face. It generally appears as a photosensitive painless red rash with small bumps and a raised edge appearing to grow outwards, usually over eyebrows or one side of the face. It may feel wet or ...

(face fungus): fungal infection of the face ** Tinea barbae: fungal infestation of facial hair * Other superficial mycoses (not classic ringworm, since not caused by dermatophytes) ** Tinea versicolor: caused by ''

Malassezia furfur ''Malassezia furfur'' (formerly known as ''Pityrosporum ovale'' in its hyphal form) is a species of yeast (a type of fungus) that is naturally found on the skin surfaces of humans and some other mammals. It is associated with a variety of dermat ...

'' ** Tinea nigra: caused by ''

Hortaea werneckii ''Hortaea werneckii'' is a species of yeast in the family Teratosphaeriaceae. It is a black yeast that is investigated for its remarkable halotolerance. While the addition of salt to the medium is not required for its cultivation, ''H. werneckii' ...

Prevention

Advice often given includes: * Avoid sharing clothing, sports equipment, towels, or sheets. * Wash clothes in hot water with

fungicidal Fungicides are biocidal chemical compounds or biological organisms used to kill parasitic fungi or their spores. A fungistatic inhibits their growth. Fungi can cause serious damage in agriculture, resulting in critical losses of yield, quality, ...

soap after suspected exposure to ringworm. * Avoid walking barefoot; instead wear appropriate protective shoes in locker rooms and sandals at the beach. * Avoid touching pets with bald spots, as they are often carriers of the fungus.

Vaccination

no approved human vaccine exist against ''Dermatophytosis''. For

horses The horse (''Equus ferus caballus'') is a domesticated, one-toed, hoofed mammal. It belongs to the taxonomic family Equidae and is one of two extant subspecies of ''Equus ferus''. The horse has evolved over the past 45 to 55 million yea ...

dogs The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...

and

cats The cat (''Felis catus'') is a domestic species of small carnivorous mammal. It is the only domesticated species in the family Felidae and is commonly referred to as the domestic cat or house cat to distinguish it from the wild members of t ...

there is available an approved inactivated vaccine called ''Insol Dermatophyton'' (

Boehringer Ingelheim C.H. Boehringer Sohn AG & Co. is the parent company of the Boehringer Ingelheim group, which was founded in 1885 by Albert Boehringer in Ingelheim am Rhein, Germany. As of 2018, Boehringer Ingelheim is one of the world's largest pharmaceutical ...

) which provides time-limited protection against several

trichophyton ''Trichophyton'' is a genus of fungi, which includes the parasitic varieties that cause tinea, including athlete's foot, ringworm, jock itch, and similar infections of the nail, beard, skin and scalp. Trichophyton fungi are molds characterized ...

and microsporum fungal strains. With cattle, systemic vaccination has achieved effective control of ringworm. Since 1979 a Russian live vaccine (LFT 130) and later on a Czechoslovakian live vaccine against bovine ringworm has been used. In Scandinavian countries vaccination programmes against ringworm are used as a preventive measure to improve the hide quality. In Russia, fur-bearing animals (silver fox, foxes, polar foxes) and rabbits have also been treated with vaccines.

Treatment

Antifungal treatments include

topical agent A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

s such as miconazole, terbinafine,

ketoconazole Ketoconazole, sold under the brand name Nizoral among others, is an antiandrogen and antifungal medication used to treat a number of fungal infections. Applied to the skin it is used for fungal skin infections such as tinea, cutaneous candid ...

, or tolnaftate applied twice daily until symptoms resolve — usually within one or two weeks. Topical treatments should then be continued for a further 7 days after resolution of visible symptoms to prevent recurrence. The total duration of treatment is therefore generally two weeks, but may be as long as three. In more severe cases or scalp ringworm, systemic treatment with oral medications may be given. To prevent spreading the infection, lesions should not be touched, and good hygiene maintained with washing of hands and the body. Misdiagnosis and treatment of ringworm with a

topical steroid Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have anti-inflammatory properties and are classifie ...

, a standard treatment of the superficially similar

pityriasis rosea Pityriasis rosea is a type of skin rash. Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by an eruption of many smaller scaly spots; pinkish with a red edge i ...

, can result in

tinea incognito Tinea incognita or Tinea incognito is a fungal infection of the skin masked and often exacerbated by application of a topical immunosuppressive agent. The usual agent is a topical corticosteroid. As the skin fungal infection has lost some of the ...

, a condition where ringworm fungus grows without typical features, such as a distinctive raised border.

History

Dermatophytosis has been prevalent since before 1906, at which time ringworm was treated with compounds of

mercury Mercury commonly refers to: * Mercury (planet), the nearest planet to the Sun * Mercury (element), a metallic chemical element with the symbol Hg * Mercury (mythology), a Roman god Mercury or The Mercury may also refer to: Companies * Merc ...

or sometimes

sulfur Sulfur (or sulphur in British English) is a chemical element with the symbol S and atomic number 16. It is abundant, multivalent and nonmetallic. Under normal conditions, sulfur atoms form cyclic octatomic molecules with a chemical formula ...

iodine Iodine is a chemical element with the symbol I and atomic number 53. The heaviest of the stable halogens, it exists as a semi-lustrous, non-metallic solid at standard conditions that melts to form a deep violet liquid at , and boils to a vi ...

. Hairy areas of skin were considered too difficult to treat, so the scalp was treated with X-rays and followed up with

antifungal An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as crypto ...

medication. Another treatment from around the same time was application of

Araroba powder Araroba powder, also known as Bahia powder and Goa powder, is a drug occurring in the form of a yellowish-brown powder, varying considerably in tint, from the Portugal, Portuguese colony of Goa, where it appears to have been introduced about the ye ...

Terminology

The most common term for the infection, "ringworm", is a

misnomer A misnomer is a name that is incorrectly or unsuitably applied. Misnomers often arise because something was named long before its correct nature was known, or because an earlier form of something has been replaced by a later form to which the name ...

, since the condition is caused by fungi of several different species and not by parasitic worms.

Other animals

Ringworm caused by ''

Trichophyton verrucosum ''Trichophyton verrucosum'', commonly known as the cattle ringworm fungus, is a dermatophyte largely responsible for fungal skin disease in cattle, but is also a common cause of ringworm in donkeys, dogs, goat, sheep, and horses. It has a worldw ...

'' is a frequent clinical condition in cattle. Young animals are more frequently affected. The lesions are located on the head, neck, tail, and perineum. The typical lesion is a round, whitish crust. Multiple lesions may coalesce in "map-like" appearance. File:Toplin des dieles tiesse vea.jpg, Multiple lesions, head File:Dieles åtoû d' l' ouy åmea.JPG, Around the eyes and on ears File:2 dieles mashale.jpg, On cheeks: crusted lesion (right) File:Viye diele did près.JPG, Old lesions, with regrowing hair File:Diele vea waerot.jpg, On neck and withers File:Dieles cawî åmea.JPG, On perineum Clinical dermatophytosis is also diagnosed in sheep, dogs, cats, and horses. Causative agents, besides ''Trichophyton verrucosum, are'' ''T. mentagrophytes'', ''T. equinum'', ''Microsporum gypseum'', ''M. canis'', and ''M. nanum''. Dermatophytosis may also be present in the holotype of the Cretaceous eutriconodont mammal '' Spinolestes'', suggesting a Mesozoic origin for this disease.

Diagnosis

Ringworm in pets may often be asymptomatic, resulting in a carrier condition which infects other pets. In some cases, the disease only appears when the animal develops an

immunodeficiency Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

condition. Circular bare patches on the skin suggest the diagnosis, but no lesion is truly specific to the fungus. Similar patches may result from allergies, sarcoptic mange, and other conditions. Three species of fungi cause 95% of dermatophytosis in pets: these are ''

Microsporum canis ''Microsporum canis'' is a pathogenic, asexual reproduction, asexual fungus in the phylum Ascomycota that infects the upper, dead layers of skin on domesticated cats, and occasionally dogs and humans. The species has a worldwide distribution. Ta ...

'', ''

Microsporum gypseum ''Microsporum gypseum'' is a soil-associated dermatophyte that occasionally is known to colonise and infect the upper dead layers of the skin of mammals. The name refers to an asexual "form-taxon" that has been associated with four related biolo ...

'', and '' Trichophyton mentagrophytes''. Veterinarians have several tests to identify ringworm infection and identify the fungal species that cause it: Woods test: This is an ultraviolet light with a magnifying lens. Only 50% of ''M. canis'' will show up as an apple-green fluorescence on hair shafts, under the UV light. The other fungi do not show. The fluorescent material is not the fungus itself (which does not fluoresce), but rather an excretory product of the fungus which sticks to hairs. Infected skin does not fluoresce. Microscopic test: The veterinarian takes hairs from around the infected area and places them in a staining solution to view under the microscope. Fungal spores may be viewed directly on hair shafts. This technique identifies a fungal infection in about 40%–70% of the infections, but cannot identify the species of dermatophyte. Culture test: This is the most effective, but also the most time-consuming, way to determine if ringworm is on a pet. In this test, the veterinarian collects hairs from the pet, or else collects fungal spores from the pet's hair with a toothbrush, or other instrument, and inoculates fungal media for culture. These cultures can be brushed with transparent tape and then read by the veterinarian using a microscope, or can be sent to a pathological lab. The three common types of fungi which commonly cause pet ringworm can be identified by their characteristic spores. These are different-appearing

macroconidia A conidium ( ; ), sometimes termed an asexual chlamydospore or chlamydoconidium (), is an Asexual reproduction, asexual, non-motility, motile spore of a fungus. The word ''conidium'' comes from the Ancient Greek word for dust, ('). They are al ...

in the two common species of ''Microspora'', and typical

microconidia A conidium ( ; ), sometimes termed an asexual chlamydospore or chlamydoconidium (), is an asexual, non-motile spore of a fungus. The word ''conidium'' comes from the Ancient Greek word for dust, ('). They are also called mitospores due to th ...

in ''Trichophyton'' infections. Identifying the species of fungi involved in pet infections can be helpful in controlling the source of infection. ''M. canis'', despite its name, occurs more commonly in domestic cats, and 98% of cat infections are with this organism. It can also infect dogs and humans, however. ''T. mentagrophytes'' has a major reservoir in rodents, but can also infect pet

rabbit Rabbits, also known as bunnies or bunny rabbits, are small mammals in the family Leporidae (which also contains the hares) of the order Lagomorpha (which also contains the pikas). ''Oryctolagus cuniculus'' includes the European rabbit speci ...

s, dogs, and horses. ''M. gypseum'' is a soil organism and is often contracted from gardens and other such places. Besides humans, it may infect rodents, dogs, cats, horses, cattle, and swine.

Treatment

Pet animals

Treatment requires both systemic oral treatment with most of the same drugs used in humans—terbinafine, fluconazole, or itraconazole—as well as a topical "dip" therapy. Because of the usually longer hair shafts in pets compared to those of humans, the area of infection and possibly all of the longer hair of the pet must be clipped to decrease the load of fungal spores clinging to the pet's hair shafts. However, close shaving is usually not done because nicking the skin facilitates further skin infection. Twice-weekly bathing of the pet with diluted lime sulfur dip solution is effective in eradicating fungal spores. This must continue for 3 to 8 weeks. Washing of household hard surfaces with 1:10 household sodium hypochlorite

bleach Bleach is the generic name for any chemical product that is used industrially or domestically to remove color (whitening) from a fabric or fiber or to clean or to remove stains in a process called bleaching. It often refers specifically, to ...

solution is effective in killing spores, but it is too irritating to be used directly on hair and skin. Pet hair must be rigorously removed from all household surfaces, and then the vacuum cleaner bag, and perhaps even the vacuum cleaner itself, discarded when this has been done repeatedly. Removal of all hair is important, since spores may survive 12 months or even as long as two years on hair clinging to surfaces.

Cattle

In bovines, an infestation is difficult to cure, as systemic treatment is uneconomical. Local treatment with

compounds is time-consuming, as it needs scraping of crusty lesions. Moreover, it must be carefully conducted using

glove A glove is a garment covering the hand. Gloves usually have separate sheaths or openings for each finger and the thumb. If there is an opening but no (or a short) covering sheath for each finger they are called fingerless gloves. Fingerless glov ...

s, lest the worker become infested.

Epidemiology

Worldwide, superficial fungal infections caused by dermatophytes are estimated to infect around 20-25% of the population and it is thought that dermatophytes infect 10-15% of the population during their lifetime.Pires, C. A. A., Cruz, N. F. S. da, Lobato, A. M., Sousa, P. O. de, Carneiro, F. R. O., & Mendes, A. M. D. (2014). Clinical, epidemiological, and therapeutic profile of dermatophytosis. ''Anais Brasileiros de Dermatología'', ''89''(2), 259–264

/ref>Oumar Coulibaly, Coralie L'Ollivier, Renaud Piarroux, Stéphane Ranque, Epidemiology of human dermatophytoses in Africa, ''Medical Mycology'', Volume 56, Issue 2, February 2018, Pages 145–161. The highest Incidence (epidemiology), incidence of superficial mycoses result from dermatophytoses which are most

prevalent In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...

in tropical regions.Rajagopalan, M., Inamadar, A., Mittal, A., Miskeen, A. K., Srinivas, C. R., Sardana, K., Godse, K., Patel, K., Rengasamy, M., Rudramurthy, S., & Dogra, S. (2018). Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). ''BMC dermatology'', ''18''(1), 6

/ref> Onychomycosis, a common infection caused by dermatophytes, is found with varying prevalence rates in many countries.Hayette, M.-P., & Sacheli, R. (2015). Dermatophytosis, Trends in Epidemiology and Diagnostic Approach. ''Current Fungal Infection Reports'', ''9''(3), 164–179

/ref> ''Tinea pedis'' + onychomycosis, ''Tinea corporis'', ''Tinea capitis'' are the most common dermatophytosis found in humans across the world. ''Tinea capitis'' has a greater prevalence in children. The increasing prevalence of dermatophytes resulting in ''Tinea capitis'' has been causing epidemics throughout Europe and America. In pets, cats are the most affected by dermatophytosis.Gordon, E., Idle, A., & DeTar, L. (2020). Descriptive epidemiology of companion animal dermatophytosis in a Canadian Pacific Northwest animal shelter system. ''The Canadian veterinary journal = La revue veterinaire canadienne'', ''61''(7), 763–770. Pets are susceptible to dermatophytoses caused by ''Microsporum canis'', ''Microsporum gypseum'', and ''Trichophyton''. For dermatophytosis in animals, risk factors depend on age, species, breed, underlying conditions, stress, grooming, and injuries. Numerous studies have found ''Tinea capitis'' to be the most prevalent dermatophyte to infect children across the continent of Africa. Dermatophytosis has been found to be most prevalent in children ages 4 to 11, infecting more males than females. Low

socioeconomic status Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...

was found to be a risk factor for ''Tinea capitis''. Throughout Africa, dermatophytoses are common in hot- humid climates and with areas of overpopulation.

Chronicity A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...

is a common outcome for dermatophytosis in India. The prevalence of dermatophytosis in India is between 36.6 and 78.4% depending on the area, clinical subtype, and dermatophyte isolate. Individuals ages 21–40 years are most commonly affected. A 2002 study looking at 445 samples of dermatophytes in patients in Goiânia, Brazil found the most prevalent type to be ''

Trichophyton rubrum ''Trichophyton rubrum'' is a dermatophytic fungus in the phylum Ascomycota. It is an exclusively clonal, anthropophilic saprotroph that colonizes the upper layers of dead skin, and is the most common cause of athlete's foot, fungal infectio ...

'' (49.4%), followed by ''Trichophyton mentagrophytes'' (30.8%), and ''Microsporum canis'' (12.6%). A 2013 study looking at 5,175 samples of ''Tinea'' in patients in Tehran, Iran found the most prevalent type to be ''Tinea pedis'' (43.4%), followed by ''Tinea unguium''. (21.3%), and ''Tinea cruris'' (20.7%).Rezaei-Matehkolaei, A., Makimura, K., de Hoog, S., Shidfar, M. R., Zaini, F., Eshraghian, M., Naghan, P. A., & Mirhendi, H. (2013). Molecular epidemiology of dermatophytosis in Tehran, Iran, a clinical and microbial survey. ''Medical Mycology (Oxford)'', ''51''(2), 203–207

/ref>

References

External links

Tinea photo library at Dermnet
{{Authority control Animal fungal diseases Mycosis-related cutaneous conditions Wikipedia medicine articles ready to translate Cat diseases Wikipedia emergency medicine articles ready to translate

Signs and symptoms

Causes

Diagnosis

Classification

Prevention

Vaccination

Treatment

History

Terminology

Other animals

Diagnosis

Treatment

Pet animals

Cattle

Epidemiology

See also

References

Further reading

External links