DERMATOPHYTOSIS OR RINGWORM OR TINEA
This is the most common fungal infection of the skin caused by the organism belong to any of the three genera namely (i) Microsporon, (ii) Trichophyton, and (iii) Epidermophyton.
The clinical feature and nomenclature of the dermatophytosis depends upon the site of involvement.
When the infection occurs on the scalp, the term tinea capitis is used. It is very common in children but rarely seen in adults. It can manifest as localised form of partial alopecia associated with itching, erythema and scaling. A few patients may present with localised, painful, boggy swelling called kerion. In both these conditions, the hair in the patch are dry, lustreless, brittle and broken at varying lengths from the surface of the skin. In another variety, the hair are broken at the level of the skin surface producing the picture of black dots in an area of alopecia. This is known as black dot tinea capitis. In Kashmir a special type of tinea capitis called favus is very common. It presents as a localised area of loss of hair with plenty of pus discharge and crusting.
When the fungus involves the coarse hair of beard and moustache, it is named as tinea barbae. It occurs only in adult males. It presents as red inflammatory papules or pustules associated with exudation and Hair in the lesion becomes loose and can be removed without much pain. Less severe infections consist of dry, circular, reddish and scaly lesions with lustreless hair stumps which are broken close to the surface of the skin.
Fungal infection of the trunk and extremities is called tinea corporis It manifests in the form of severely itchy, circular or irregular lesions which have well-defined active borders consisting of papulo- vesicles while the central part of the lesions shows erythema, scaling and occasionally hyperpigmentation.
When lesions similar to tinea corporis are seen in the groin, the condition is called tinea cruris. In this condition, scaling is variable and vesiculation is rare. However, central clearance is usually present. It usually occurs in adults wearing clothes made up of synthetic material such as terylene and nylon which tend to accumulate heat and humidity in the skin.
Infection of the skin of face excluding moustache and beard area of the adult male is called tinea faciei. The lesions are like tines corporis. Topical application of the steroids usually alters appearance of the lesions. It is called tinea incognitio
It presents as a circumscribed or diffuse area of scaling, fissuring, and papulo-vesicles with severe itching in the palm(s). It is usually unilateral but occasionally it may involve both the palms.
Infection of soles or toes is called tinea pedis, The commonest presentation is peeling, maceration and erythema of the clefts and occasionally the undersurface of the toes with or without itching and papulo-vesiculation This is called tinea interdigitale. It is particularly common in person who wear shoes and nylon socks in summer. Infection of the sole manifests as circumscribed area of scaling, fissures, papulo-vesicles or even pustules associated with severe itching and some hyperpigmentation Occasionally, both the soles may develop recurrent eruptions of severely itchy vesicular lesions.
Tinea Unguim Fungal infection of nails) is called rinza unguim. It generally starts with involvement of a single nail, though other nails may also get involved in due course. It primarily involves the nail bed and starts from the distal portion and progresses proximally. The nail may become dark brown or black, infection leads to deposition of powdery material under the nail plate which gets lifted up. When the nail plate is primarily involved, it becomes brittle and disintegrates. This also starts from the distal portion and appears as it has been eaten away. The remaining part of the nail plate may become thickened, dull and discoloured.
The patient should be encouraged to clean the area with soap and water regularly. Those who have tinea cruris or tinea pedis should avoid using terylene or nylon clothes at least during summer season. Acid Chrysorbinum 5-10% in equal amounts of glycerin and alcohol each has been used locally for treating tinea of glabrous skin. It should be massaged gently into the areas twice daily.
In cases of tinea with discharges:
Graphites is given in lesions with sticky, yellow and fetid discharge.
Hepar sulph is used in patients having yellowish discharge with severe pain, sensitiveness and desire to cover the lesions.
Kali-s. is used in patients with yellowish green discharge with crusting.
Mezereum is given in cases having crusted lesions with pus underneath with intense itching, burning and erythema around the lesions.
Viol-t. is specifically indicated for lesions on the scalp.
In cases of tinea with ring-shaped lesions.
Sepia is given to patients having isolated lesions on the upper part of the body.
Rhus-t. and Ars. are used in patients having papulo-vesicles with itching and burning.
In cases of the lesions which are itchy, thick, cracked and scaly (tinea manum and tinea pedis).
Sarsaparilla is used in patients having aggravation in summer whereas Petroleum is the drug for winter.
In cases of deformed, crippled, brittle and discoloured nails.
Calc., Calc-s., Lyc. and Sulph. are usually given on general constitutional symptoms?
Tub. and Psor. have also been used occasionally intercurrently.
Bacillinum the well-documented medicine for tinea, has not been found much useful by the authors.