TINEA - Full extract 

Karl is about 70 and loves his daily walk. He hasn't changed a jot in the 15 years I've known him. One morning he came in complaining of itchy sore feet and toes.

When he removed his sneakers and socks, the problem was fairly evident. The skin between his toes was very moist and broken in places, especially between the fourth and fifth toes of each foot. The tops of his toes also looked rather inflamed, as if he had been scratching them.

There seemed little doubt Karl had a tinea infection and I prescribed an anti-fungal cream. I also suggested he keep his sneakers off for a while and take extra care drying in between his toes.

When he came in for a flu shot recently I had another look at his feet. They were considerably improved. I suggested he try dusting powder between his toes to prevent the condition recurring.

Tinea is a group of fungal infections that have a special affinity for the skin, nails and hair. They are very common, not always obvious, and sometimes difficult to treat.

Certain types of tinea have a preference for areas of the body not exposed to light and air, for instance around the groin and between the toes. Excessive perspiration can be a factor; must fungal infections are more common in humid conditions. Some people are also more prone to tinea than others.

If a sample of tissue affected by tinea is viewed under the microscope, branching strands of fungus can usually be seen. Tinea can be further identified by putting the tissue on special culture media, although it may take several weeks for positive identification.

Tinea can sometimes be quite persistent. In these cases the urine should be checked for sugar to rule out diabetes. 

There are several different types of tinea:

Tinea of the feet (athlete's foot). This is more frequently seen when feet perspire a lot. Gym shoes seem to aggravate the condition, especially if the socks become damp and are left on for a long time. Occasionally a secondary bacterial infection will occur through breaks of the skin between the toes. When this happens, it may result in a severe infection of the leg. Tinea of the feet usually responds well to topical solutions and creams as well as local measures to keep the feet dry. Family members should use their own towel.

Tinea of the groin is also common, especially in men. It is characterised by a red rash around the top of the leg. The affected area usually has quite a sharp edge and may be rather itchy. Various forms of eczema can appear similar to tinea. The distinction is important because if the usual eczema creams are used, the tinea rash is likely to worsen. Again, perspiration is often a factor; the condition does seem common in young sportsmen. Secondary bacterial infection can occur and a course of antibiotic treatment may be required. If there is any doubt about the diagnosis, a skin scraping may be performed. A few superficial pieces of skin are shaved off with a blade and sent for inspection under the microscope and culturing in the laboratory.

Treatment consists of applications of anti-fungal cream. A dusting powder may help prevent a recurrence. If it persists, further testing may be required. If the person has any foot tinea, that should be treated at the same time.

Tinea of the scalp can be an alarming condition because it can cause localised bald patches. The hair shafts look broken and the affected part of the scalp may be very inflamed. A hand-held UV light helps diagnosis. If scalp tinea is present, the affected hairs fluoresce a yellow-green color. A course of oral medication is usually advised. If there is any doubt about the diagnosis, a dermatological opinion can be arranged.

With some anti-fungal tablets, blood tests are necessary to check that the liver does not become inflamed with the treatment. Likewise, some anti-fungals can interact with medications such as certain anti-allergy tablets. Possible side effects of these medications should be discussed with your doctor.

Tinea elsewhere on the body is characterised by spreading reddened patches that usually have a sharp margin. Often the central part fades and reverts to normal-looking skin again. The diagnosis may not be obvious and skin scrapings may be necessary.

In some cases, a few smaller discrete rings may form, hence the name ringworm. This particular infection is seen in cats but can be transmitted to people in close contact.

Tinea affecting the nails may cause a pale crumbly discolouration under the nails of the fingers and toes. It can last for months or years. The diagnosis can be confirmed by taking clippings of the nails for inspection under the microscope and then culturing them in the laboratory. Usually a prolonged course of oral medication is required.

Health Tips:
* Be careful with tinea infections between the toes. Sometimes they can lead on to more serious foot infections. 

* Recurrent tinea infections can sometimes be a manifestation of diabetes. If you have repeated episodes of tinea see your doctor for a check-up.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001