INFORMATION ON TINEA DISEASE

1. ANTIFUNGAL THERAPY
Tinea Infection Treatment
By
SUDIPTO HALDAR

2. Cause Of Fungal Infection
Superficial Fungal Infections may be caused by different
types of Fungi, like -
 Dermatophytes
 Molds
 Yeasts
The most common fungal infections are caused by the
Dermatophytes, which are the most abundant in their
distribution
Such infections are commonly termed as TINEA Infections

3. Tinea Infection:
The common TINEA Infections are :
Tinea corporis
Tinea cruris
Tinea pedis
Tinea capitis
Tinea versicolor
Tinea unguium (Onychomycosis caused by dermatophytes)
Common Superficial infections caused by oher species
include
Onychomycosis (caused by Candida)
Cutaneous candidiasis

4. Tinea Corporis
 Cause: Tinea corporis is a common skin disorder among children.
However, it may occur in people of all ages. It is caused by mold-like
fungi called dermatophytes.
 Fungi thrive in warm, moist areas. The following raise your risk for a
fungal infection:
 Long-term wetness of the skin (such as from sweating)
 Minor skin and nail injuries
 Poor hygiene
 Tinea corporis can spread easily to other people. You can catch the
condition if you come into direct contact with an area of ringworm on
someone's body, or if you touch contaminated items such as:
 Clothing
 Combs
 Pool surfaces
 Shower floors and walls
 The fungi can also be spread by pets (cats are common carriers).

5. Tinea Corporis
Symptoms
Symptoms may include itching.
 The rash begins as a small area of red, raised spots and
pimples. The rash slowly becomes ring-shaped, with a red-
colored, raised border and a clearer center. The border may
look scaly.
 The rash may occur on the arms, legs, face, or other exposed
body areas.

6. Tinea Corporis
Signs and tests
 The health care provider can often diagnose tinea corporis by
how the skin looks.
 In some cases, the following tests may be done:
 Looking at a skin scraping of the rash under the microscope
using a KOH (potassium hydroxide) test
 Skin lesion biopsy

7. Treatment
 TOPICAL THERAPY: Topical therapy should be applied to the
lesion and at least 2 cm beyond this area once or twice a day for at least 2
weeks, depending on which agent is used. Topical azoles and allylamines
show high rates of clinical efficacy. These agents inhibit the synthesis of
ergosterol, a major fungal cell membrane sterol.
 SYSTEMIC THERAPY: Systemic therapy may be indicated for
tinea corporis that includes extensive skin infection, immunosuppression,
resistance to topical antifungal therapy. Use of oral agents requires
attention to potential drug interactions and monitoring for adverse effects.

8. Tinea Cruris
 Tinea cruris, a pruritic superficial fungal infection of the groin
and adjacent skin, is the second most common clinical
presentation for dermatophytosis. Tinea cruris is a common
and important clinical problem that may, at times, be a
diagnostic and therapeutic challenge.

9. PATHOPHYSIOLOGY
 The most common etiologic agents for tinea cruris
include Trichophyton rubrum and Epidermophyton floccosum;
less commonly Trichophyton mentagrophytes and
Trichophyton verrucosum are involved.
 Tinea cruris is a contagious infection transmitted by fomites,
such as contaminated towels or hotel bedroom sheets, or by
autoinoculation from a reservoir on the hands or feet (tinea
manuum, tinea pedis, tinea unguium).
 The etiologic agents in tinea cruris produce keratinases, which
allow invasion of the cornified cell layer of the epidermis. The
host immune response may prevent deeper invasion. Risk
factors for initial tinea cruris infection or reinfection include
wearing tight-fitting or wet clothing or undergarments.

10. Tinea Cruris Treatment
 Clinical cure of an uncomplicated tinea cruris infection usually can be
achieved using topical antifungal agents of the imidazole or allylamine
family. Consider patients unable to use topical treatments consistently or
with extensive or recalcitrant infection as candidates for systemic
administration of antifungal therapy, which has been proven safe in
immunocompetent persons.
 Prevention of tinea cruris reinfection is an essential component of disease
management. Patients with tinea cruris often have concurrent dermatophyte
infections of the feet and hands.
 Treat all active areas of tinea cruris infection simultaneously to prevent
reinfection of the groin from other body sites.
 Advise patients with tinea pedis to put on their socks before their
undershorts to reduce the possibility of direct contamination.
 Advise patients with tinea cruris to dry the crural folds completely after
bathing and to use separate towels for drying the groin and other parts of
the body.

11. Tinea Pedis
Tinea pedis is the term used for a dermatophyte infection of the soles of
the feet and the interdigital spaces. Tinea pedis is most commonly caused
byTrichophyton rubrum, a dermatophyte initially endemic only to a small
region of Southeast Asia and in parts of Africa and Australia. Interestingly,
tinea pedis was not noted in these areas then, possibly because these
populations did not wear occlusive footwear. The colonization of the T
rubrum –endemic regions by European nations helped to spread the fungus
throughout Europe. Wars with accompanying mass movements of troops
and refugees, the general increase in available means of travel, and the rise
in the use of occlusive footwear have all combined to make T rubrum the
world's most prevalent dermatophyte

12. Tinea Pedis
Causes:
 Athlete's foot occurs when a certain fungus grows on your skin in your
feet. In addition to the toes, it may also occur on the heels, palms, and
between the fingers.
 Athlete's foot is the most common type of tinea fungal infections. The
fungus thrives in warm, moist areas. Your risk for getting athlete's foot
increases if you:
 Wear closed shoes, especially if they are plastic-lined
 Keep your feet wet for prolonged periods of time
 Sweat a lot
 Develop a minor skin or nail injury
 Athlete's foot is contagious, and can be passed through direct contact, or
contact with items such as shoes, stockings, and shower or pool surfaces.

13. Symptoms
 The most common symptom is cracked, flaking, peeling skin
between the toes or side of the foot. Other symptoms can
include:
 Red and itchy skin
 Burning or stinging pain
 Blisters that ooze or get crusty
 If the fungus spreads to your nails, they can become
discolored, thick, and even crumble.
 Athlete's foot may occur at the same time as other fungal skin
infections such as ringworm or jock itch.

14. Tinea Pedis Treatment
 Tinea pedis can be treated with topical or oral antifungals or a combination
of both. Topical agents are used for 1-6 weeks, depending on
manufacturers' recommendations. A patient with chronic hyperkeratotic
(moccasin) tinea pedis should be instructed to apply medication to the
bottoms and sides of his or her feet. For interdigital tinea pedis, even
though symptoms may not be present, a patient should apply the topical
agent to the interdigital areas and to the soles because of the likelihood of
plantar-surface infection.

15. Tinea Versicolor
 A fungal infection of the skin caused by Malassezia furfur and
characterized by finely desquamating, pale tan patches on the
upper trunk and upper arms that may itch and do not tan. In
dark-skinned people the lesions may be depigmented. The
fungus fluoresces under Wood's light and may be easily
identified in scrapings viewed under a microscope. Topical
and oral antifungal agents may be used, as well as repeated
applications of selenium sulfide. The pale patches may persist
for up to 1 year after successful treatment, and recurrence is
common.

16. Tinea Versicolor
 Signs & Symptoms: Acidic bleach from the growing yeast
causes areas of skin to be a different color than the skin around
them. These can be individual spots or patches. Specific signs
and symptoms of the infection include:
 Patches that may be white, pink, red, or brown and can be
lighter or darker than the skin around them.
 Spots that do not tan the way the rest of your skin does.
 Spots that may occur anywhere on your body but are most
commonly seen on your neck, chest, back, and arms.
 The spots may disappear during cool weather and get worse
during warm and humid weather. They may be dry and scaly
and may itch or hurt, although this is not common.

17. Treatment Of Tinea Versicolor
 Treatment of tinea versicolor can consist of creams, lotions, or
shampoos that are put on the skin. It can also include
medication given as pills. The type of treatment will depend
on the size, location, and thickness of the infected area.
Treatment options include:
 Topical anti-fungals:These products are applied directly to
your skin and may be in the form of lotions, shampoos,
creams, or soaps. They keep the growth of the yeast under
control. Over-the-counter anti-fungal topical products
containing ingredients such as selenium sulfide, miconazole,
clotrimazole, and terbinafine are available. But sometimes
prescription medications may be needed.

18. Treatment Of Tinea Versicolor
 Anti-fungal pills: These may be used to treat more serious or
recurrent cases of tinea versicolor. Or in some cases they may
be used because they can provide a simpler and quicker
resolution of the infection. These medicines are given by
prescription and can have side effects. So it's important to be
monitored by your doctor while using anti-fungal pills.
Treatment usually eliminates the fungal infection. However, the
discoloration of the skin may take up to several months to
resolve.

19. Onychomycosis
 Onychomycosis is a fungal infection of the toenails or
fingernails.
 Cause: Onychomycosis causes fingernails or toenails to
thicken, discolor, disfigure, and split. At first, onychomycosis
appears to be only a cosmetic concern. Without treatment,
however, the toenails can become so thick that they press
against the inside of the shoes, causing pressure, irritation,
and pain. Fingernail infection may cause psychological, social,
or employment-related problems.

20. Onychomycosis Symptoms & Signs
 Onychomycosis usually does not cause any symptoms unless
the nail becomes so thick it causes pain when wearing shoes.
People with onychomycosis usually go to the doctor for
cosmetic reasons, not because of physical pain or problems
related to onychomycosis.
 As the nail thickens, onychomycosis may interfere with
standing, walking, and exercising.
 Paresthesia (a sensation of pricking, tingling, or creeping on
the skin having noobjective cause and usually associated
with injury or irritation of a nerve), pain, discomfort, and loss
of agility (dexterity) may occur. Loss of self-esteem,
embarrassment, and social problems can also develop.
 Severe cases of Candida infections can disfigure the fingertips
and nails.

21. Treatment on Onychomycosis
 In the past, medicines used to treat onychomycosis (OM) were
not very effective. OM is difficult to treat because nails grow
slowly and receive very little blood supply. However, recent
advances in treatment options, including oral (taken by mouth)
and topical (applied on the skin or nail surface) medications,
have been made. Newer oral medicines have revolutionized
treatment of onychomycosis. However, the rate of
recurrence is high, even with newer medicines. Treatment is
expensive, has certain risks, and recurrence is possible.

22. Dosage & Administration Of Terbinafine to
Eradicate Tinea
 The Oral dose of Terbinafine is a constant 250 mg O.D. in adults
 The duration can vary considerably, depending on the condition (severity,
area of distribution and duration of the disease)
 ADULT DOSAGE
 Tinea Corporis : Topical application once or twice daily, for 1 to 2 wks;
Orally 250 mg O.D. for up to 4 weeks
 Tinea Cruris : Topical application once or twice daily for 1 to 2 weeks;
Orally 250 mg O.D. for 2 to 4 weeks
 Tinea Pedis : Topical application once or twice daily for 1 week;
 Orally 250 mg O.D. for up to 6 weeks
 Tinea Capitis : Orally 250 mg O.D. for 4 weeks (rarely found in adults)
 Tinea Versicolor : Topical application once or twice daily for 1 to 2
weeks, suitable oral antimycotic drug may be co-prescribed, like
Terbinafine itself, or Fluconazole.

23. Dosage & Administration Of Terbinafine
 PAEDIATRIC DOSAGE
 Terbinafine can be safely used in children over 1 year of age, for Tinea infections,
Onychomycosis, and especially Tinea Capitis, in the following per kg body wt.
dose:
 10 - 20 kg - 62.5 mg O.D.
 20 - 40 kg - 125 mg O.D.
 >40 kg - 250 mg O.D.
 The indication-wise dosage in children is as follows :
 Tinea Capitis - 2 weeks to 4 weeks
 Tinea Cruris - 2 to 4 weeks
 Tinea Corporis - 4 weeks
 Onychomycosis - Up to 6 weeks, in case of fingernail, or
longer
Up to 12 weeks, in case of toenail, or
longer

24. Adjuvant therapy with Ketoconazole in Tinea
Infection
2% Ketoconazole w/w offers freedom from and protects against
Tinea Versicolor, and also effective as an adjuvant therapy
along with topical and oral antifungal drugs to treat tinea and
candida skin infections.