Tinea pedis, corporis, cruris
Ringworm; dermatophytosis; athlete's foot (tinea pedis); jock itch (tinea cruris); tinea manuum / capitis / barbae / faciei
Tinea is the commonest superficial cutaneous fungal infection in the UK, caused by dermatophytes — Trichophyton, Microsporum, Epidermophyton. Anatomical variants (tinea pedis, corporis, cruris, manuum, capitis, barbae, faciei, unguium) reflect the body site involved. In skin-oncology clinic, tinea is a frequent differential for plaques being considered as Bowen disease, cSCC, psoriasis, DLE and cutaneous lymphoma. The annular configuration with central clearing and active erythematous-scaly border is highly characteristic but is often obscured if topical steroid has been applied ("tinea incognito"). Confirmation by KOH / mycology before treatment is essential.
Anatomical variants
- Tinea pedis (athlete's foot) — interdigital maceration, plantar hyperkeratosis (moccasin distribution), or vesiculobullous variant. T. rubrum, T. interdigitale most common.
- Tinea corporis (ringworm) — annular plaque with active erythematous scaly border and central clearing on trunk / limbs.
- Tinea cruris (jock itch) — groin, often sparing the scrotum (vs candidiasis which involves it).
- Tinea manuum — hand involvement; often unilateral (one foot, two hands ─ "two feet, one hand syndrome").
- Tinea capitis — scalp; children predominantly; alopecia, scaling, kerion. Microsporum / Trichophyton.
- Tinea barbae — beard area in men.
- Tinea faciei — face; often misdiagnosed as eczema or rosacea.
- Tinea incognito — modified by topical steroid; loss of typical features.
- Majocchi granuloma — perifollicular extension of dermatophyte into the dermis; deep papules / pustules; needs systemic antifungal.
Diagnosis
- KOH preparation — skin scraping from active edge; mounted in 10% KOH; reveals hyphae and arthrospores. Quick bedside / clinic test.
- Fungal culture — Sabouraud agar; takes 2–4 weeks.
- PCR for dermatophyte DNA — increasingly available, faster.
- Wood's lamp — Microsporum canis fluoresces green-blue.
- Skin biopsy with PAS / GMS stain — for atypical cases or where confirmation needed; reserve for Majocchi granuloma.
- Always sample BEFORE starting empirical antifungal therapy.
Skin-oncology differentials
- Bowen disease — well-demarcated erythematous scaly plaque; lacks active border; older patient; biopsy.
- cSCC — keratotic, indurated.
- Psoriasis — silvery scale; symmetrical distribution; nail pitting.
- DLE — scarring, follicular plugging; photodistribution.
- Nummular eczema — coin-shaped, less defined border.
- Mycosis fungoides — chronic, refractory to topical antifungal; biopsy.
- Erythema annulare centrifugum — annular figurate erythema; less scale.
- Granuloma annulare — non-scaly annular.
- Pityriasis rosea — herald patch + Christmas-tree distribution.
Management
- Localised tinea pedis / corporis / cruris — topical azole (clotrimazole 1%, miconazole 2%) or terbinafine 1% twice daily for 2–4 weeks.
- Extensive / hyperkeratotic / unresponsive / immunosuppressed — oral terbinafine 250 mg daily for 2–6 weeks; itraconazole pulse therapy alternative.
- Tinea capitis — oral griseofulvin or terbinafine (children); never topical-only.
- Tinea incognito — discontinue topical steroid; KOH; treat as confirmed.
- Majocchi granuloma — systemic antifungal.
- Hygiene — keep affected skin dry; treat fomites; treat household contacts for tinea capitis.
- Always confirm diagnosis before starting empirical therapy.
References
- NICE Clinical Knowledge Summary. Fungal skin infection - body and groin and Fungal nail infection topics. London: NICE; accessed 18 May 2026.
- Drake LA et al. Guidelines of care for superficial mycotic infections of the skin. J Am Acad Dermatol; 1996.
Spot a correction?
If any clinical statement, citation or link on this page needs updating, please email admin@skinoncology.net with the page name, the proposed correction and the supporting source.