Paeds · paediatric-dermatology
Tinea and fungal skin infection
Also known as Tinea · Dermatophytosis · Ringworm · Tinea capitis · Kerion
Fellowship guide to tinea and fungal skin infection in children: the annular scaly ringworm plaque of tinea corporis with its active advancing border, the prepubertal bald scaly patch of tinea capitis and the boggy inflammatory kerion, the black-dot and ectothrix or endothrix hair invasion, confirmation by potassium hydroxide (KOH) microscopy showing branching septate hyphae and by Wood's lamp green fluorescence for Microsporum, the species-specific oral therapy of tinea capitis with griseofulvin (favoured for Microsporum) versus weight-banded terbinafine (favoured for Trichophyton), the topical treatment of corporis, cruris and pedis, kerion management with an oral antifungal and corticosteroid without incision, household carrier screening and pet source control, and the emerging terbinafine-resistant Trichophyton indotineae.
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Target exams
Red flags
- Tinea capitis always needs an oral antifungal because topical agents cannot penetrate the hair follicle; a topical cream alone will fail and allow ongoing hair loss and transmission
- A painful, boggy, purulent scalp mass in a child is kerion, an intense hypersensitivity reaction to a dermatophyte rather than a bacterial abscess; treat with an oral antifungal plus a short corticosteroid course and do not incise and drain
- A topical corticosteroid applied to an annular scaly plaque produces tinea incognito; it suppresses the border and itch, allows unchecked fungal spread, and falsely reassures both family and clinician
- Extensive, highly inflamed or rapidly spreading tinea, or tinea in an immunocompromised child, needs prompt oral therapy and dermatology review rather than topical treatment alone
- Recurrent tinea capitis in a family signals undiagnosed asymptomatic carriers and untreated pets; failing to screen and treat the household and animal source leads to reinfection
Life stages
Care settings
Clinical exam formats
Board mappings
- Paediatric dermatology
- Common skin infections
- Tinea (dermatophyte) infections
- General Paediatrics learning goal — diagnose and treat tinea capitis, corporis, pedis and kerion in children
- Species-guided oral antifungal choice and household carrier screening
- Recognition and avoidance of tinea incognito and kerion mismanagement
- Dermatology
- Infectious diseases
- Clinical Applications — superficial fungal infections
- Short Cases
- Long Cases
- Communication scenarios
- Dermatology: recognises and manages tinea and fungal skin infections
- Common skin presentations in children
- Health promotion around contagious skin disease
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Tinea capitis, corporis and kerion
- Clinical
- History
- Communication
- Skin examination
- General Pediatrics Content Outline — Dermatology
- Infectious Diseases — superficial fungal infections
- Tinea capitis and kerion
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge of dermatophyte infections
- Systems-Based Practice 1: family and school public-health measures
- Medical Expert
- Collaborator
- Pediatrics: Core EPA — diagnose and manage superficial fungal infections
Overview & Definition
Picture the seven-year-old who itches at an expanding pink ring on her forearm. The edge is raised and scaly, the centre has cleared, and over two weeks it has slowly grown outward. This is tinea corporis, the archetypal ringworm lesion, and the pattern of an active advancing border with central clearing is the single most useful clue that a scaly patch is fungal rather than eczema or psoriasis. [6]
Now picture a different child: a four-year-old with a patch of hair loss and broken-off stubs on his scalp, a little scaly, with a firm lump of enlarged nodes at the back of his neck. The hair loss is not alopecia areata, and the lump is not a bacterial abscess — this is tinea capitis, the one dermatophyte infection that lives inside the hair shaft and that a cream can never reach. [1]
Tinea, also called dermatophytosis or ringworm, is a superficial infection of keratinised tissue — the stratum corneum, the hair shaft and the nail plate — by a small group of fungi called dermatophytes. They belong to three genera: Trichophyton, Microsporum and Epidermophyton. Dermatophytes digest keratin using secreted keratinases, so they live in dead keratinised tissue and do not invade living skin, which is why the disease stays superficial but keeps spreading outward across the skin surface. The name ringworm describes the expanding annular lesion and has nothing to do with a worm. [1] [6]
Three ideas anchor the whole topic for a fellowship candidate. First, the site decides the name and the treatment: scalp disease is capitis and always needs tablets, whereas body and groin disease usually needs only a cream. Second, the infecting species guides the drug: terbinafine works better for Trichophyton and griseofulvin better for Microsporum. Third, this is a contagious household and community problem: untreated carriers, siblings, classmates and pets keep reinfecting the child, so curing one child often means looking at the whole family. [2] [3]
References12ShowHide
- [1]Gupta AK, Polla Ravi S, Wang T, et al. An update on tinea capitis in children. Pediatr Dermatol, 2024.PMID 39113245
- [2]Fuller LC, Barton RC, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of tinea capitis 2014. Br J Dermatol, 2014.PMID 25234064
- [3]Gupta AK, Friedlander SF, Simkovich AJ Tinea capitis: An update. Pediatr Dermatol, 2022.PMID 35075666
- [4]Tey HL, Tan AS, Chan YC Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis. J Am Acad Dermatol, 2011.PMID 21334096
- [5]Gupta AK, Drummond-Main C Meta-analysis of randomized, controlled trials comparing particular doses of griseofulvin and terbinafine for the treatment of tinea capitis. Pediatr Dermatol, 2013.PMID 22994156
- [6]Leung AK, Lam JM, Leong KF, et al. Tinea corporis: an updated review. Drugs Context, 2020.PMID 32742295
- [7]Sahoo AK, Mahajan R Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J, 2016.PMID 27057486
- [8]Leung AK, Barankin B, Lam JM, et al. Tinea pedis: an updated review. Drugs Context, 2023.PMID 37415917
- [9]Leung AKC, Lam JM, Leong KF, et al. Onychomycosis: An Updated Review. Recent Pat Inflamm Allergy Drug Discov, 2020.PMID 31738146
- [10]Dessinioti C, Papadogeorgaki E, Athanasopoulou V, et al. Screening for asymptomatic scalp carriage in household contacts of patients with tinea capitis during 1997-2011: a retrospective hospital-based study. Mycoses, 2014.PMID 24372570
- [11]White JM, Higgins EM, Fuller LC Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London. J Eur Acad Dermatol Venereol, 2007.PMID 17714125
- [12]Uhrlaß S, Verma SB, Gräser Y, et al. Trichophyton indotineae-An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide-A Multidimensional Perspective. J Fungi (Basel), 2022.PMID 35887512