Ringworm and other Tineas
Fungal Infections of the Skin
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Scalp Infections - Tinea Capitis
Pityriasis Versicolor - Tinea Versicolor
Nail Infections - Tinea Unguium
Fungal infections affecting the skin (tinea corporis; tinea versicolor), feet (tinea pedis), scalp (tinea capitis) and nails (tinea unguium). These infections may be contagious.
RINGWORM - TINEA CORPORIS
ICD 10 code: B35.4
DESCRIPTION
- Clinical features include:
- Itchy ring-like patches
- Raised borders
- Patches slowly grow bigger
- As the patch extends a clear area develops in the centre which may become hyper-pigmented in dark skin
- Extensive disease is common in HIV, often with no evidence of the patches developing clear centres
GENERAL MEASURES
- Prevent spreading the infection to others
- Do not share:
- Clothes
- Towels
- Toiletries (especially combs and hair brushes)
- Wash skin well and dry before applying medicine treatment
MEDICINE TREATMENT
- Imidazole, e.g.:
- Clotrimazole 1%, topical, apply 3 times daily
- Continue using cream for at least 2 weeks after lesions have cleared
Note:
Treat any secondary skin infection with antibiotics. See: Impetigo
REFERRAL
- Extensive disease
ATHLETE'S FOOT - TINEA PEDIS
ICD 10 code: B35.3
DESCRIPTION
- A common contagious fungal infection of the foot, characterised by itching, burning and stinging between the toes or the sole
- The skin between the toes is moist and white (maceration) and may become fissured. There is also associated erythema, scaling and peeling
- Secondary eczema of the hands may be an associated condition. See: Eczema, atopic
- Vesicles may occur in inflammatory cases
- Pain and tenderness in the web spaces may indicate secondary bacterial infection
- Re-infection is common
GENERAL MEASURES
- Discourage the use of shared bathing or swimming areas, whilst infected
- Keep feet dry:
- Wear open sandals
- Do not wear socks of synthetic material
- Dry between toes after washing the feet or walking in water
- Wash and dry feet twice daily before applying medicine treatment
MEDICINE TREATMENT
- Imidazole cream, e.g.:
- Clotrimazole 1%, topical, apply twice daily for 4 weeks
REFERRAL
- No improvement after 4 weeks
SCALP INFECTIONS - TINEA CAPITIS
ICD 10 code: B35.0
DESCRIPTION
- Round or patchy bald areas with scales and stumps of broken off hair
GENERAL MEASURES
- Avoid shaving head in children
- Do not share toiletries such as combs and hair brushes
MEDICINE TREATMENT
Children
- Fluconazole, oral, 6 mg/kg once daily, for 28 days. See: dosing table
LoE: IIb10
Adults
- Fluconazole, oral, 200 mg weekly, for 6 weeks
LoE:IIIb11
Note:
Do not give to women of child-bearing age unless they are using an effective contraceptive.
PITYRIASIS VERSICOLOR - TINEA VERSICOLOR
ICD 10 code: B36.0
DESCRIPTION
- Round macules which are often lighter than normal skin (but may be darker)
- Mostly found on the upper chest and back, less common on the neck, face, abdomen and upper limbs
- Macules on the chest and back often coalesce, and the condition spreads with the formation of new macules on the periphery
- Pigmentation may take months to return to normal after treatment
- Recurrences are common, especially in hot weather
GENERAL MEASURES
- Avoid wearing clothing that impairs ventilation in hot weather to reduce perspiration
MEDICINE TREATMENT
Oral antifungal therapy is not indicated
- Selenium sulphide, 2.5% suspension, apply once weekly for three weeks
- Lather shampoo on affected parts
- Leave on overnight, then wash off the following day
LoE:IVb12
NAIL INFECTIONS - TINEA UNGUIUM
See: Nail infections – tinea unguium
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.5.2 Ringworm and other Tineas