Clinical Review

The diagnosis and management of tinea

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4380 (Published 10 July 2012) Cite this as: BMJ 2012;345:e4380
  1. Blaithin Moriarty, specialist registrar, dermatology,
  2. Roderick Hay, professor of dermatology,
  3. Rachael Morris-Jones, consultant dermatologist
  1. 1Dermatology Department, King’s College Hospital, London SE5 9RS, UK
  1. Correspondence to: R Morris-Jones themojos{at}doctors.org.uk

Summary points

  • Tinea is increasingly a problem worldwide

  • Tinea may affect any body site and is named according to the anatomical area infected

  • Pathogenic organisms have a variable geographical distribution

  • Mycology samples should be taken before and after appropriate treatment

Tinea refers to superficial infection with one of three fungal genera—Microsporum, Epidermophyton, and Trichophyton—collectively known as dermatophytes. These infections are among the most common diseases worldwide and cause serious chronic morbidity. Griseofulvin treatment and school screening programmes almost eradicated tinea capitis (scalp infection) as an endemic condition in the developed world in the 1950s, but it re-emerged as a public health problem in the United Kingdom in the 1990s, with infection rates of at least 12% in school children.1 Increased mass tourism and mobile populations may have contributed to the changing epidemiological trends.2 Newly developed polymerase chain reaction based techniques, although useful in rapid diagnosis of dermatophytosis,3 are still not widely available. Although the number and range of antifungal drugs are limited compared with antibiotics, most are highly effective for fungal disease acquired in temperate climates. This review aims to familiarise the reader with the various clinical presentations of tinea, to outline the steps that should be taken for accurate diagnosis, and to evaluate the most appropriate treatment regimens.

Sources and selection criteria

We based this review on a detailed review of English language publications. We also drew on the British Association of Dermatologists’ clinical guidelines for the management of tinea capitis and the management of onychomycosis, Health Protection Agency guidelines, and extensive clinical experience.

What is tinea?

All three genera of dermatophytes grow in keratinised environments such as hair, skin, and nails.4 Anthropophilic dermatophytes are restricted to human hosts and produce mild chronic inflammation. The main reservoirs of zoophilic dermatophytes are pets, livestock, and horses; infection with such organisms usually …

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