CHILD HEALTH / DERMATOLOGY

TINEA INFECTION –
AN ILLUSTRATED GUIDE
Tinea is an infection of keratinised tissues, including skin, hair, or nails, caused
by a group of fungi known as dermatophytes. It is a common presentation in
children and young people, but differential diagnosis can be challenging.

Pictures and Tinea may infect various parts of the body and is termed accordingly, eg:
information
courtesy of  Tinea capitis (scalp)  Tinea pedis (feet)  Tinea unguium (nails)
Timothy G  Tinea corporis (body)  Tinea manuum (hand)  Tinea versicolor (trunk)
Berger MD
Source: The  Tinea cruris (groin)  Tinea faciale (face)
Dermatology
Glossary, Figure 2b: The lesions are often arranged in an
UCSF School FIGURE 1: TINEA CAPITAS annular configuration and often have an elevated,
of medicine serpiginous border

FIGURE 2: TINEA CORPORIS

Figure 2a: Fungal infection of the skin that
presents as FIGURE 3A: TINEA PEDIS (ATHLETE’S FOOT)
well-defined, erythematous, scaling papules or Fungal infection of the feet that presents as
plaques. scalingon the sole of the foot and scaling,
maceration, bullae, vesicles,fissures, and erosions
between the toes.

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Figure 3b: Bullous tinea pedis – showing
presentation of bullae. Presentation of vesicles may
also be seen in this condition
FIGURE 4: TINEA UNGUIUM, SHOWING SEVERE
DISCOLOURATION OF THE NAILS
FIGURE 5: TINEA VERSICOLOR
This shows infection of the skin at the stratum
corneum that has caused pigmentary changes
and scaling in the epidermis. The lesions appear
as patches with fine scale and can be pink, tan, or
most commonly, white.
The usual distribution for tinea versicolor is that
of a short-sleeved turtleneck sweater – neck, trunk,
upper arms. The responsible organism is the yeast
Pityrosporum orbiculare (called Malassezia furfur
when in the infectious hyphal form). Fungal enzymes
produce compounds that inhibit melanin production.
Often the lesions are asymptomatic and patients
become aware of the lesions because affected areas
do not tan.
INVESTIGATIONS
FIGURE 6: POSTASSIUM HYDROXIDE
PREPARATION
A diagnostic test using potassium hydroxide (KOH)
to diagnose a fungal infection of the skin.
The test involves vigorous scraping of scale from the
edge of a scaling lesion. If vesicles or pustules are
being tested, the underside of the vesicle is sampled.
The scraping is deposited onto a glass slide and a drop
of 10 to 20% KOH is added before covering with
the cover slip. The undersurface of the slide is gently
heated before microscopic examination. Under 100X
magnification, the entire cover slip is scanned for the
presence of hyphae which are thread-like branching
tubular cells interconnected by septa.
Microscopically, a KOH preparation shows a
combination of fungal hyphae and yeast forms in a
“spaghetti and meatballs” appearance within the
superficial layers of the epidermis.
FIGURE 7: MICROSCOPY
Microscopically there are septate fungal hyphae in the
superficial layers of epidermis which are more easily
demonstrated with PAS (periodic acid Schiff) stains that
stain fungal hyphae walls. The epidermis may show
hyperkeratosis with variable neutrophil infiltrates and
spongiosis. The dermis may have a mixed inflammatory
infiltrate and tinea can cause subepidermal bulla
Formation. Speciation of fungi is not reliable by simple
microscopic methods and is not needed for therapy.
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