Other factors such as increased urbanization including the use of occlusive footwear and tight fashioned clothes, has been linked to higher prevalence. The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedis while highlighting the lack of clarity of certain management issues.ĭermatophytes are the most common agents of superficial fungal infections worldwide and widespread in the developing countries, especially in the tropical and subtropical countries like India, where the environmental temperature and relative humidity are high. Updated Cochrane reviews on the use of topical therapy in tinea corporis, cruris, and pedis, and few on oral therapies have helped to bridge this knowledge gap but still well-designed trials, national and/or international evidence-based guidelines and recommendations on the dose and duration of the use of systemic antifungals in tinea corporis/cruris are conspicuous by their absence. The more recent guidelines published by the British Association of Dermatology and in the British Medical Journal have largely focused on tinea capitis and tinea unguium with scarce reference to tinea corporis/cruris. In fact, one has to go back nearly two decades to find guidelines on the management of tinea corporis and cruris (by the American Academy of Dermatology), and these at best, appear inadequate in today's world. Other clinical variants include tinea imbricata, tinea pseudoimbricata, and Majocchi granuloma.ĭespite the increasing prevalence of cutaneous dermatophytosis across the world, and especially in tropics, research in this area has often been neglected. Finally, based upon the affected site, these have been classified clinically into tinea capitis (head), tinea faciei (face), tinea barbae (beard), tinea corporis (body), tinea manus (hand), tinea cruris (groin), tinea pedis (foot), and tinea unguium (nail). Based upon mode of transmission, these have been classified as anthropophillic, zoophilic, and geophilic. Based upon their genera, dermatophytes can be classified into three groups: Trichophyton (which causes infections on skin, hair, and nails), epidermophyton (which causes infections on skin and nails), and Microsporum (which causes infections on skin and hair). The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedia while highlighting the lack of clarity of certain management issues.ĭermatophytes are fungi that invade and multiply within keratinized tissues (skin, hair, and nails) causing infection. However, due to the lack of updated national or international guidelines on the management of tinea corporis, cruris, and pedis, treatment with systemic antifungals is often empirical. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. Management involves the use of topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. Several new techniques such as polymerase chain reaction (PCR) and mass spectroscopy can help to identify the different dermatophyte strains. Diagnosis, though essentially clinical should be confirmed by laboratory-based investigations. Hence, a lack of delayed hypersensitivity reaction in presence of a positive immediate hypersensitivity (IH) response to trichophytin antigen points toward the chronicity of disease. Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. The prevalence of superficial mycotic infection worldwide is 20–25% of which dermatophytes are the most common agents.
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