Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Tinea


Related Terms

  • Athlete's Foot
  • Dermatomycosis
  • Dermatophytosis
  • Epidermophytosis
  • Jock Itch
  • Microsporosis
  • Pityriasis Versicolor
  • Ringworm
  • Trichophytosis

Differential Diagnosis

Specialists

  • Dermatologist
  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Compromised immune system
  • Diabetes

Factors Influencing Duration

Length of disability is influenced by the severity and length of time the infection is present. If the infection occurs on the feet or hands or if skin erosion has occurred, disability may extend until the skin heals, sometimes several weeks. Individuals with HIV/AIDS or other immune system disorders may have increased duration of infection.

Medical Codes

ICD-9-CM:
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
111.8 - Dermatomycosis, Other Specified
111.9 - Dermatomycosis, Unspecified

Overview

Tinea is a superficial fungal infection of skin, hair, and nails caused by a group of keratinophilic fungi (yeasts) of the genera Trichophyton, Microsporum, and Epidermophyton 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 (onychomycosis); and infections of the chest, shoulders and back, tinea versicolor (produced by Malassezia sp.). Tinea corporis, cruris, and pedis being the most common (Weinstein).

A certain type of tinea is sometimes called ringworm. Despite the image conveyed by the term ringworm, 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.

Tinea versicolor is spread by intimate contact or through contaminated towels. Tinea unguium 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.

Incidence and Prevalence: Tinea infections are found worldwide. Incidence varies with the type of infection and country. Up to 70% of individuals will have tinea pedis sometime during their lives (Robbins). Tinea capitis is rare in adults; it accounts for up to 92.5% of dermatophytoses in children aged 10 or younger (Kao).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Tinea infections affect individuals of all ages and races. Tinea pedis 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 closed tight shoes. Tinea cruris also primarily affects men. Tinea barbae primarily affects men who work with animals.

Tinea capitis infects more children than adults.

Source: Medical Disability Advisor



Diagnosis

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 scaling and broken hair shafts.

Physical exam: The exam reveals the scaly characteristic rash on one or more parts of the body, including the scalp, groin, 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.

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. A nonspecific dermatitis may develop at other sites on the hands or feet. Uncommonly, tinea skin rashes may blister, break open, ooze, and become crusty.
Nails of the toes or fingers may have white or powdery patches, subungual hyperkeratosis, separation or loosening of the nail from its nail bed (onycholysis), yellow-brown or white discoloration, thickening, and disfigurement.

Tinea versicolor appears in scaly and bumpy brownish or white patches, and can make dark skin appear lighter or light skin appear brownish in color.

Tests: Diagnosis is primarily based on the appearance of the skin. Identification of the yeast through microscopic examination of skin scrapings using potassium hydroxide (KOH) confirms the diagnosis. Tinea capitis is sometimes diagnosed using ultraviolet (UV) light (Wood's 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



Treatment

Tinea infections of the scalp are treated with an oral antifungal drug such as griseofulvin, terbinafine, or itraconazole. Selenium shampoo may be used for the scalp.
Mild cases of tinea infections of the skin under the beard, general body skin, groin, feet, and hands (presence of only one or two patches of rash), as well as nails, may be treated with topical over-the-counter antifungal agents; however, more severe cases require an oral antifungal drug or combined oral/topical therapy. Treatment of nail infections may require a prolonged therapy (up to 8 weeks). Topical steroid creams may be used to ease itching.

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 (such as itraconazole) must be taken with a fatty meal. Other drugs (such as itraconazole and ketoconazole) 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



Prognosis

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



Complications

Left untreated, tinea may continue. Some forms may also cause hair loss (alopecia) 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



Ability to Work (Return to Work Considerations)

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. Health care workers must take precautions to prevent the spread of infection when the hands are infected.

Risk: Infected individuals should refrain from sharing clothes, shoes, combs, brushes, hats, towels, and other personal items with coworkers. Individuals with tinea manuum may need to wear appropriate protective gloves to prevent the spread of infection and to keep the hands clean and dry. Jobs in hot humid environments may present a problem for some workers.

Capacity: Capacity is typically unaffected with tinea infection, unless the infection is severe. Individuals with severe tinea manuum or tinea pedis may require short breaks to clean and dry the skin while at work if the extremities become damp.

Tolerance: Individuals with severe tinea capitis that causes alopecia may feel self-conscious about their appearance and may temporarily be unwilling to work in positions that require public interaction until the infection has resolved and the hair has regrown.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 days.

Source: Medical Disability Advisor



Failure to Recover

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?
  • What type of tinea infection does individual have? On the feet, hands, groin, or under beard?

Regarding treatment:

  • Has appropriate antifungal medicine (oral and/or topical) been used?
  • Did individual follow special instructions when taking an oral antifungal drug?

Regarding prognosis:

  • Did individual seek prompt treatment?
  • Has individual been compliant in prescribed medication regimen?
  • 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?
  • Has individual experienced any complications such as ongoing infection, alopecia, extensive cracking or eroding of the skin between toes and fingers or secondary bacterial infections of the skin or hair follicles?
  • Does individual have an underlying condition such as an immune system disorder that may affect recovery?

Source: Medical Disability Advisor



References

Cited

Kao, Grace F. "Tinea Capitis." eMedicine. 21 Jul. 2014. Medscape. 20 Jul. 2015 <http://emedicine.medscape.com/article/1091351-overview>.

Robbins, Courtney M. "Tinea Pedis." eMedicine. 10 Dec. 2014. Medscape. 20 Jul. 2015 <http://emedicine.medscape.com/article/1091684-overview>.

Weinstein, Andrew. "Topical Treatment of Common Superficial Tinea Infections." American Family Physician 65 10 (2002): 2095-2103. American Family Physician. American Academy of Family Physicians (AAFP). 20 Jul. 2015 <http://www.aafp.org/afp/2002/0515/p2095.html>.

Source: Medical Disability Advisor






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