| ICD-9-CM: |
| 110 - | Dermatophytosis |
| 110.0 - | Dermatophytosis, Scalp and Beard; Kerion; Sycosis, Mycotic; Trichophytic Tinea, Scalp |
| 110.1 - | Dermatophytosis, Nail; Dermatophytic Onychia; Onychomycosis; Tinea Unguium |
| 110.2 - | Dermatophytosis, Hand; Tinea Manuum |
| 110.3 - | Dermatophytosis, Groin and Perianal Area; Dhobie Itch; Eczema Marginatum; Tinea Cruris |
| 110.4 - | Dermatophytosis, Foot; Athletes Foot; Tinea Pedis |
| 110.5 - | Dermatophytosis, Body; Herpes Circinatus; Tinea Imbricata |
| 110.6 - | Dermatophytosis, Deep Seated; Granuloma Trichophyticum; Majocchis Granuloma |
| 110.8 - | Dermatophytosis, Specified Sites |
| 110.9 - | Dermatophytosis, Unspecified Site; Favus NOS; Microsporic Tinea NOS; Ringworm NOS |
| 111 - | Dermatomycosis, Other and Unspecified |
| 111.8 - | Dermatomycosis, Other Specified |
| 111.9 - | Dermatomycosis, Unspecified |
| Tinea is an infection of skin, hair, and nails caused by a group of fungi (yeasts) called dermatophytes. The body normally hosts a variety of microorganisms, including bacteria and mold-like and yeast-like fungi. Some microorganisms are useful to the body, while others can multiply rapidly, forming infections. Although tinea is the general term for this group of infections, specific names are assigned according to specific sites of infection.
Infection of the scalp is called tinea capitis; infection of the skin under the beard, tinea barbae; infection of general body skin, tinea corporis; infection of the groin, tinea cruris (jock itch); infection of the hands, tinea manuum; infection of the feet, tinea pedis (athlete's foot); infection of the nails, tinea unguium (also called tinea onychomycosis); and infections of the chest, shoulders and back, tinea versicolor.
A certain type of tinea is sometimes called ringworm. Despite the image the term ringworm conveys, no worms or parasites are involved in the infection. The name is derived from the raised circular rash characteristic of that particular tinea infection.
The infections thrive in warm, moist areas. Susceptibility is increased through friction, poor hygiene, prolonged moist skin, and minor skin or nail injuries. Tinea infections are highly contagious and can be spread by skin-to-skin contact with an infected individual or animal. Tinea is also spread by contact with a contaminated object such as shared towels, shoes, or socks or prolonged exposure to warm, moist surfaces such as in showers or around swimming pools.
People in hot, humid climates have a greater incidence of tinea corporis (general body skin).
Tinea versicolor is spread by intimate contact or through contaminated towels. Tinea unguium (nails) affects toenails more often than fingernails. It is associated with diabetes, older age, poor circulation, poorly fitted shoes, and involvement in sports activities. A suppressed immune system, corticosteroid therapy, Cushing's disease, and adrenalectomy predispose individuals to some forms of tinea.Risk: Tinea infections affect individuals of all ages and races. Tinea pedis (feet) is the most common tinea infection, and it primarily affects men between the ages of 20 and 40 and is associated with sweating, warmth, and tight shoes. Tinea cruris (groin) also primarily affects men. Tinea barbae (beard) primarily affects men who work with animals.
Tinea capitis infects more children than adults. Incidence and Prevalence: Up to 20% of individuals have a tinea infection sometime during their lives. Tinea infections are found worldwide. Incidence varies with the type of infection and country and can range from about 2% for tinea pedis in Saudi Arabia to more than 13% for all types of tinea in Nigeria (Rubeiz). |
Source: Medical Disability Advisor
| History: The individual has a history of a red, slightly raised, scaly, rash with an elevated border that is circular in some cases. The most common location is between the toes, especially for males (athlete's foot). Rash may also be reported in the beard area; the groin, excluding the scrotum or penis (jock itch); under the fingernails or toenails; and on the trunk and shoulders. The rash can be extremely itchy. Individuals with tinea capitis report hair loss. Physical exam: The exam reveals the scaly characteristic rash on one or more parts of the body including the scalp, groin, nails, feet, hands, general body skin, and the skin under the beard. As the fungus grows outward, the central area heals and can leave a red ring where the infection is active. Tinea versicolor appears scaly and bumpy and can make dark skin appear lighter or light skin appear brownish in color.
On the skin, the patches grow to about one inch in diameter. Under a beard, an itchy scaly rash may develop. Infections of the groin often show concentric rings. On the feet, dry scaling is apparent. Cracking of the skin between the toes and on the arch of the foot may develop. Nails of the toes or fingers may become red, swollen, and painful. A nonspecific dermatitis may develop at other sites on the hands or feet. Tinea versicolor appears in scaly brownish or white patches. Uncommonly, tinea skin rashes may blister, break open, ooze, and become crusty. Tests: Diagnosis is primarily based on the appearance of the skin. Identification of the yeast in microscopic examination of skin scrapings using potassium hydroxide (KOH) confirms the diagnosis. Tinea capitis is sometimes diagnosed using ultraviolet (UV) light; the infected hairs fluoresce when exposed to UV wavelengths.
Fungal cultures are not routinely performed unless the diagnosis remains in question or the species identification of yeast is needed in order to choose a treatment medication. |
Source: Medical Disability Advisor
| Tinea infections of the scalp, the skin under the beard, and nails are treated with an oral antifungal drug, as is infection of the general body skin (tinea corporis). Treatment of nail infections may require a prolonged therapy (up to 8 weeks). If only one or two patches of rash are present, a topical over-the-counter antifungal cream may be used. Tinea infections of the groin (jock itch), feet (athlete's foot), and hands are also treated with over-the-counter antifungal cream. Topical steroid creams may be used to ease itching. Selenium shampoo may be used for the scalp.
Infected skin should be kept clean and dry. Talcum or medicated powders may be used. Damp compresses help clean blistered or oozing lesions. Because tinea is highly contagious, any clothing, towels, or linen coming in contact with infected skin should be changed and cleaned frequently.
Some oral antifungal drugs must be taken with a fatty meal. Other drugs need stomach acid in order to be absorbed, so individuals taking this type of drug should not take antacids, proton pump inhibitors, or histamine H2-receptor blockers. |
Source: Medical Disability Advisor
| Without treatment, tinea infection is chronic. With treatment using antifungal drugs, the prognosis for tinea infection is excellent. Cosmetic changes may develop if the infection is not treated immediately, but many of these effects are temporary. |
Source: Medical Disability Advisor
| Left untreated, tinea may cause allergic dermatitis to develop. It may also cause hair loss and extensive cracking or eroding of the skin between toes and fingers. Secondary bacterial infections can develop in cracked skin or in hair follicles. |
Source: Medical Disability Advisor
| Severe infections involving the skin of the hands or feet may require work restrictions until the skin heals. Accommodations may be required if severe foot or hand infections limit the ability of the individual to stand for extended periods of time or to operate machinery. Healthcare workers must take precautions to prevent the spread of infection when the hands are infected. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis of tinea confirmed through microscopic examination of skin scrapings using potassium hydroxide (KOH)? Were conditions such as viral, bacterial, Candida infections, psoriasis, seborrheic dermatitis, alopecia, eczema, and contact dermatitis, ruled out?
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What type of tinea infection does individual have? On the feet, hands, groin, or under beard?
Regarding treatment:
- Has appropriate antifungal medicine (oral or topical) been used?
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Did individual follow special instructions when taking an oral antifungal drug?
Regarding prognosis:
- Did individual seek prompt treatment?
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Has individual been compliant in prescribed medication regimen?
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Have appropriate environmental or lifestyle changes been made to reduce the likelihood of reinfection? For example, does individual share towels or shoes? Walk barefoot in public showers or pool areas?
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Has individual experienced any complications such as allergic dermatitis, hair loss, extensive cracking or eroding of the skin between toes and fingers or secondary bacterial infections of the skin or hair follicles?
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Does individual have an underlying condition such as an immune system disorder that may affect recovery?
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Source: Medical Disability Advisor
| Rubeiz, Nelly, and Zeina Tannous. "Tinea." eMedicine. Eds. Theodore Gaeta, et al. 12 Oct. 2004. Medscape. 5 Jan. 2005 <http://emedicine.com/emerg/topic592.htm>. |
Source: Medical Disability Advisor
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