TINEA CORPORIS

Tinea corporis refers to any dermatophytosis of glabrous skin except palms, soles, and the groin.
EPIDEMIOLOGY. Tinea corporis may be transmitted directly from infected humans or animals, via
fomites, or it may occur via autoinoculation from reservoirs of dermatophyte colonization on the feet.44
Children are more likely to contract zoophilic pathogens, especially M. canis, from dogs or cats.
Occlusive clothing and a humid climate are associated with more frequent and severe eruptions.45
Wearing of occlusive clothing, frequent skin-to-skin contact, and minor traumas such as the mat burns
competitive wrestling create an environment in which dermatophytes flourish. Tinea corporis
gladiatorum is caused most commonly by T. tonsurans, and it occurs most frequently on the head,
neck, and arms.46

ETIOLOGY. Although any dermatophyte may cause tinea corporis, it is caused most commonly by T.
rubrum. T. rubrum is also the most likely candidate in cases with concomitant follicular involvement.35
Epidermophyton floccosum, T. interdigitale (anthropophilic and zoophilic strains), M. canis, and T.
tonsurans are also common pathogens.1 Tinea imbricata, caused by T. concentricum, is limited
geographically to areas of the Far East, South Pacific, and South and Central America.

CLINICAL FINDINGS. The classic presentation is that of an annular (ring-worm-like; Fig. 188-9A) or
serpiginous plaque with scale across the entire active erythematous border. The border, which may be
vesicular, advances centrifugally. The center of the plaque is usually scaly but it may exhibit complete
clearing. Whereas concentric vesicular rings suggest tinea incognito, often caused by T. rubrum, the
erythematous concentric rings of tinea imbricata demonstrate little to no vesiculation. T. rubrum
infections may also present as large, confluent polycyclic (Fig. 188-9B) or psoriasiform (Fig. 188-9C)
plaques, especially in immunosuppressed individuals.

Figure 188-9 Tinea corporis. A. Annular. Tinea corporis demonstrating the classic annular or ring worm
like configuration and advancing raised erythematous and scaly border. Note that because the dorsum
of the foot is predominantly involved, this eruption is considered tinea corporis and not pedis. B.
Polycyclic. Tinea corporis demonstrating multiple polycyclic red erythematous plaques with a raised
scaly border. C. Psoriasiform. Tinea corporis resembling psoriasis.

Majocchis granuloma is a superficial and subcutaneous dermatophytic infection involving deeper

portions of the hair follicles that presents as scaly follicular papules and nodules that coalesce in an
annular arrangement (Fig. 188-10). It is caused most commonly by T. rubrum, T. interdigitale, and M.
canis. Majocchis granuloma is observed on the legs in women who become inoculated after shaving or
who apply topical corticosteroids to the involved area, which facilitates infection. It is also observed
increasingly among immunocompromised patients.47

Figure 188-10 Majocchis granuloma. Follicular papules and nodules with scale coalescing to form an
annular shaped plaque on the leg of a woman applying topical corticosteroids to the area. DIFFERENTIAL
DIAGNOSIS. (Box 188-3)

BOX 188-3 DIFFERENTIAL DIAGNOSIS OF TINEA CORPORIS Most Likely Erythema annulare centrifugum,
nummular eczema, psoriasis, tinea versicolor, subacute cutaneous lupus erythematosus, cutaneous
candidiasis Consider Contact dermatitis, atopic dermatitis, pityriasis rosea, seborrheic dermatitis Rule
Out Mycosis fungoides, parapsoriasis, secondary syphilis
LABORATORY TESTS. (See Tables 188-4, 188-6) HISTOPATHOLOGY. (See Table 188-4)

TINEA CRURIS

Tinea cruris is a dermatophytosis of the groin, genitalia, pubic area, and perineal and perianal skin. The
designation is a misnomer, because in Latin cruris means of the leg. It is the second-most common
type of dermatophytosis worldwide. 3255

EPIDEMIOLOGY. Much like tinea corporis, tinea cruris spreads via direct contact or fomites, and it is
exacerbated by occlusion and humid climates. Autoinfection from distant reservoirs of T. rubrum or T.
interdigitale on the feet, for example, is common.44 Tinea cruris is three times more common in men,
and adults are affected more commonly than children.

ETIOLOGY. Most tinea cruris is caused by T. rubrum and E. floccosum, the latter being most often
responsible for epidemics.42 T. interdigitale and T. verrucosum are implicated less commonly.

CLINICAL FINDINGS. Tinea cruris presents classically as a well-marginated annular plaque with a scaly
raised border which extends from the inguinal fold on to the inner thigh, often bilaterally. Erythematous
scaly patches with papules and vesicles involving the inner thighs is also a common but perhaps less
obvious presentation. Pruritus is common, as is pain when plaques are macerated or secondarily
infected. Plaques in tinea cruris due to E. floccosum are more likely to demonstrate central clearing, and
are more often limited to the genitocrural crease and the medial upper thigh. In contrast, plaques in
tinea cruris due to T. rubrum coalesce with extension to the pubic, perianal, buttock, and lower
abdominal areas (Fig. 188-11). Genitalia including the scrotum are infrequently affected.42

Figure 188-11 Tinea cruris. Annular eythematous plaques with a raised scaling border expanding from
the inguinal on the inner thighs and pubic region. DIFFERENTIAL DIAGNOSIS. (Box 188-4)

BOX 188-4 DIFFERENTIAL DIAGNOSIS OF TINEA CRURIS

Most Likely Erythrasma, cutaneous candidiasis, intertrigo, contact dermatitis, psoriasis, seborrheic
dermatitis, lichen simplex chronicus, folliculitis Consider Familial benign pemphigus, Darier-White
disease, histiocytosis

3256

LABORATORY TESTS. (See Tables 188-4, 188-6) HISTOPATHOLOGY.