Friday, 9 October 2015

Use of oral antifungals in the treatment of tinea circinata (tinea corporis)

The infection can be caused by any of the dermatophytes. T. rubrum, M. canis, and T. mentagrophytes are common causes. The source of infection is usually an active lesion on an animal or on another human (children infections may come from their parents). Spread from existing localized infection (e.g. feet, groins, scalp and nails) is not uncommon. Multiple small lesions are commonly caused by exposure to a pet with M. canis.  Fomites transmission is known to occur, and infection from soil is a well-established if unusual occurrence.  Tinea gladiatorum is a common problem among wrestlers. Opponents (frequent skin-to-skin contact), equipment, and mat burns (induced by wrestling) represent potential sources of infection. Wearing of occlusive clothing and a humid climate create an environment in which dermatophytes flourish. Use of topical corticosteroids, occlusion, and shaving are associated with fungal folliculitis. Majocchi’s  granuloma tends to occur on the legs of women after shaving or application of topical steroids to the involved areas (facilitating infection). It is also seen increasingly among immunocompromised patients.  Tinea imbricata (Tokelau) resulting from T. concentricum, an anthropophilic dermatophyte found in southern Asia, the islands of the South Pacific and in Guatemala, southern Mexico and Brazil, causes a distinctive infection. Tinea incognito is a term applied to atypical clinical lesions of tinea, usually produced by treatment with a topical corticosteroid or occasionally a calcineurin inhibitor.

Tinea circinata, especially of recent origin, responds to topical therapy. Systemic therapy is appropriate if topical therapy fails, if many areas are affected and in fungal folliculitis. Oral triazole antifungals (particularly itraconazole) and terbinafine are used more frequently than griseofulvin because they have a broader spectrum of activity and require a shorter duration of treatment.  Terbinafine therapy for M. canis typically requires higher doses and longer courses of therapy. With T. concentricum, treatment failures may occur with griseofulvin.

The use of oral terbinafine, itraconazole  fluconazole, or  griseofulvin in the treatment of tinea circinata. The first three are preferable to the fourth. With griseofulvin, longer term treatment is needed with extensive infections. Note that the BNF/BNFC state that terbinafine treatment is usually for 4 weeks in tinea corporis.  

Central resolution is common but many lesions lack any tendency to central clearing.

Central resolution is common but many lesions lack any tendency to central clearing.

This page was last updated in October 2015

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology