What are the different types of ringworm infections. How can you identify ringworm symptoms. What are the most effective treatments for tinea fungal skin infections. How can you prevent the spread of ringworm.

What is Ringworm? Demystifying the Fungal Skin Infection

Ringworm, medically known as tinea, is a highly contagious fungal infection that affects the skin, nails, and scalp. Despite its name, ringworm is not caused by a worm but by various types of fungi called dermatophytes. These fungi thrive in warm, moist environments, making certain areas of the body more susceptible to infection.

Ringworm can spread through direct skin-to-skin contact with an infected person or animal, or indirectly through contact with contaminated items such as towels, clothing, or floors. The infection is characterized by a ring-shaped, red, scaly rash that can be itchy and uncomfortable.

Common Types of Ringworm: Understanding the Different Forms

Ringworm infections are classified based on the part of the body affected. Here are the most common types:

• Tinea pedis (Athlete’s foot): Affects the feet, particularly between the toes
• Tinea cruris (Jock itch): Occurs in the groin area
• Tinea capitis: Infects the scalp and hair, primarily affecting children
• Tinea corporis: Appears on the body, often as circular patches
• Tinea unguium (Onychomycosis): Affects the toenails or fingernails

Athlete’s Foot (Tinea Pedis)

Athlete’s foot is perhaps the most common form of ringworm. It typically affects the skin between the toes but can spread to the soles and sides of the feet. Symptoms include:

• Itching, stinging, and burning sensations
• Cracking and peeling skin, especially between toes
• Redness and scaling on the soles
• Blisters in severe cases

Jock Itch (Tinea Cruris)

Jock itch affects the groin area and inner thighs. It’s more common in men and often occurs in people who sweat heavily. Symptoms include:

• Red, itchy rash in the groin area
• Burning sensation
• Flaking or cracking skin
• Redness extending to the inner thighs

Recognizing Ringworm Symptoms: Key Signs to Watch For

While symptoms can vary depending on the type of ringworm infection, some common signs include:

• Circular, red, scaly patches with raised edges
• Intense itching in the affected area
• Skin that appears red, inflamed, or cracked
• Hair loss in patches (for scalp infections)
• Thick, discolored, or brittle nails (for nail infections)

It’s important to note that ringworm symptoms can mimic other skin conditions. If you’re unsure about a skin issue, it’s best to consult a healthcare professional for an accurate diagnosis.

Diagnosing Ringworm: Methods Used by Healthcare Professionals

How do doctors diagnose ringworm infections? There are several methods:

1. Visual examination: In many cases, a healthcare provider can diagnose ringworm by simply looking at the affected area.
2. Skin scraping: A small sample of skin may be taken and examined under a microscope to identify the fungus.
3. Wood’s lamp examination: Some types of fungi glow under ultraviolet light, which can help in diagnosis.
4. Fungal culture: In more challenging cases, a sample may be sent to a laboratory for culture and identification of the specific fungus.

Effective Treatments for Ringworm: From Over-the-Counter to Prescription Options

Ringworm is typically treated with antifungal medications. The choice of treatment depends on the severity and location of the infection.

Over-the-Counter Treatments

For mild cases, over-the-counter antifungal creams, lotions, or powders may be sufficient. These often include active ingredients such as:

• Clotrimazole
• Miconazole
• Terbinafine
• Tolnaftate

Prescription Medications

For more severe or persistent infections, prescription-strength medications may be necessary. These can include:

• Topical antifungals: Stronger versions of the over-the-counter treatments
• Oral antifungals: Such as fluconazole, itraconazole, or terbinafine, which are particularly effective for scalp and nail infections

The duration of treatment can vary from a few weeks to several months, depending on the type and severity of the infection.

Preventing Ringworm: Essential Tips for Avoiding Infection

While ringworm is highly contagious, there are several steps you can take to reduce your risk of infection:

• Practice good hygiene: Wash your hands regularly and keep your skin clean and dry
• Avoid walking barefoot in public areas: Wear flip-flops or sandals in locker rooms, public showers, and around swimming pools
• Don’t share personal items: Avoid sharing towels, clothing, or grooming tools with others
• Keep skin dry: Use antiperspirants and wear breathable, moisture-wicking fabrics
• Treat pets promptly: If you suspect your pet has ringworm, take them to a veterinarian for treatment

Ringworm in Children: Special Considerations for Pediatric Cases

Ringworm is particularly common in children, especially tinea capitis (scalp ringworm). Here are some important points to consider:

• Scalp ringworm often requires oral antifungal medication for effective treatment
• Children with ringworm should avoid sharing combs, brushes, or hats
• Regular shampooing can help prevent scalp infections
• If one child in a family has ringworm, all family members should be checked

Parents should be aware that ringworm in children can sometimes be mistaken for other conditions, such as cradle cap or dandruff. If you’re unsure, it’s best to consult a pediatrician.

When to See a Doctor: Red Flags for Ringworm Infections

While many cases of ringworm can be treated at home, there are situations where medical attention is necessary. Consult a healthcare provider if:

• The rash doesn’t improve after two weeks of over-the-counter treatment
• The infection appears to be spreading or worsening
• You develop a fever or other signs of a secondary bacterial infection
• The rash is on your scalp or beard area
• You have a weakened immune system

Remember, early treatment can help prevent the spread of ringworm to others and reduce the risk of complications.

Ringworm Myths Debunked: Separating Fact from Fiction

There are several misconceptions about ringworm that can lead to confusion and improper treatment. Let’s address some common myths:

Myth 1: Ringworm is caused by a worm

Fact: Despite its name, ringworm is caused by fungi, not worms. The name comes from the ring-like appearance of the rash.

Myth 2: Only dirty people get ringworm

Fact: Anyone can get ringworm, regardless of personal hygiene. However, good hygiene can help prevent its spread.

Myth 3: Ringworm always forms a perfect circle

Fact: While ringworm often creates circular patches, the rash can take various shapes and may not always form a complete ring.

Myth 4: You can’t get ringworm from animals

Fact: Many animals, including dogs, cats, and livestock, can carry ringworm fungi and transmit them to humans.

Living with Ringworm: Managing Symptoms and Preventing Recurrence

If you’re dealing with a ringworm infection, here are some tips to manage symptoms and prevent future outbreaks:

• Follow your treatment plan diligently, even if symptoms improve quickly
• Keep the affected area clean and dry
• Avoid scratching, which can spread the infection and lead to secondary bacterial infections
• Wash bedding, clothing, and towels frequently in hot water
• Replace potentially contaminated items like nail files or toothbrushes
• Consider using antifungal powders or sprays in shoes to prevent reinfection

Remember, while ringworm can be frustrating, it’s typically not serious and can be effectively managed with proper treatment and preventive measures.

Ringworm in Athletes: Special Considerations for Sports Participants

Athletes are particularly susceptible to ringworm infections due to factors like close physical contact, shared equipment, and moist environments. Here are some specific considerations for athletes:

• Shower immediately after practices and competitions
• Use a separate towel for your feet when drying off
• Wear moisture-wicking socks and breathable shoes
• Disinfect mats and other shared equipment regularly
• Don’t share personal items like towels or razors

Coaches and athletic trainers should be aware of the signs of ringworm and encourage prompt treatment to prevent spread within teams.

Natural Remedies for Ringworm: Complementary Approaches to Treatment

While medical treatments are the most reliable way to treat ringworm, some people find relief with natural remedies. It’s important to note that these should not replace conventional treatments, and you should consult a healthcare provider before trying any alternative approaches. Some natural remedies that have shown potential include:

• Tea tree oil: Known for its antifungal properties
• Apple cider vinegar: May help create an inhospitable environment for fungi
• Garlic: Contains compounds with antifungal effects
• Coconut oil: Has both moisturizing and antifungal properties

Remember, while these remedies may provide some relief, they haven’t been scientifically proven to cure ringworm. Always use caution and discontinue use if you experience any adverse reactions.

The Future of Ringworm Treatment: Emerging Research and Developments

As with many areas of medicine, research into fungal infections like ringworm is ongoing. Some promising areas of study include:

• New antifungal drugs with improved efficacy and fewer side effects
• Topical treatments that can penetrate the nail more effectively for treating nail infections
• Novel delivery systems for antifungal medications, such as nanoparticles
• Exploration of natural compounds with antifungal properties
• Development of vaccines against dermatophyte infections

While current treatments are generally effective, these advancements could lead to faster, more efficient ways to combat ringworm infections in the future.

In conclusion, ringworm is a common fungal infection that, while uncomfortable, is typically not serious and can be effectively treated. By understanding the different types of ringworm, recognizing symptoms early, and following proper treatment and prevention strategies, you can minimize the impact of these infections on your life. Remember, if you’re ever unsure about a skin condition, it’s always best to consult with a healthcare professional for proper diagnosis and treatment.

Tinea – Better Health Channel

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Summary

Read the full fact sheet

• Tinea is a highly contagious fungal infection of the skin.
• Fungi thrive in hot, moist areas. Common infection sites are the feet and groin.
• Good hygiene can prevent recurring attacks of tinea.

Tinea is a contagious fungal skin infection. The most commonly affected areas include the feet, groin, scalp and beneath the breasts. Tinea can be spread by skin-to-skin contact or indirectly through towels, clothes or floors. Tinea is also known as ringworm, which is a misleading name as no worm is involved.

All fungi need warm, moist environments and tinea is no exception. This is why the hottest, most sweat-prone areas of the body are the most likely areas for a tinea infection to occur. Communal showers and locker rooms are typical places where infection may be spread.

Treatment includes antifungal medication, antiperspirants and good hygiene.

Types of tinea

Tinea infections are known by specific names, depending on the part of the body that is affected. The most common types of tinea include:

• Athlete’s foot – tinea of the foot, known as tinea pedis
• Jock itch – tinea of the groin, known as tinea cruris
• Ringworm of the scalp – tinea of the head, known as tinea capitis (mainly affects children)
• Ringworm of the body – tinea of the body, known as tinea corporis
• Nail infection (onychomycosis) – tinea of the toe or finger nails, known as tinea unguium.

Symptoms of tinea

The symptoms can include:

• Itching and stinging
• Red scaly rash that is shaped like a ring (annular)
• Cracking, splitting and peeling in the toe web spaces
• Blisters
• Yellow or white discoloration of the nails
• Bald spots on the scalp.

How to avoid tinea infection

Overheating and perspiration contribute to tinea infections. Suggestions to avoid tinea infection include:

• After washing, dry the skin thoroughly, particularly between the toes and within skin folds.
• Expose the skin to the air as much as possible.
• Wear cotton socks instead of synthetics.
• Use antiperspirants to control excessive perspiration (sweating).
• Wear thongs to swimming pools, locker rooms, gyms and other communal areas.

Treating a tinea infection

Tinea infections respond well to antifungal creams. Some infections are harder to shift and might also require an antifungal medication in the form of a tablet.

Preventing the spread of tinea

It is important to remember that tinea is contagious. Suggestions on how to prevent the spread of infection to others include:

• Treat tinea infections with antifungal cream.
• Wash your hands after touching infected areas.
• Do not share towels.
• Do not walk around barefoot if you have tinea pedis (tinea of the feet).
• Clean the shower, bath and bathroom floor after use.

Where to get help

• Your doctor
• Your pharmacist
• Dermatologist
• Australasian College of DermatologistsExternal Link Tel. 1300 361 821
• Communicable Disease Prevention and Control UnitExternal Link, Department of Health Victoria Tel. 1300 651 160.

• Ringworm or tineaExternal Link, Infectious diseases epidemiology and surveillance, Department of Health, Victorian Government

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 15-07-2020

Diagnosis and Management of Common Tinea Infections

SARA L. NOBLE, PHARM.D., ROBERT C. FORBES, M.D., AND PAMELA L. STAMM, PHARM.D.

Am Fam Physician. 1998;58(1):163-174

See related patient information handout on tinea infections, written by the authors of this article.

The estimated lifetime risk of acquiring a dermatophyte infection is between 10 and 20 percent. Recognition and appropriate treatment of these infections reduces both morbidity and discomfort and lessens the possibility of transmission. Dermatophyte infections are classified according to the affected body site, such as tinea capitis (scalp), tinea bar-bae (beard area), tinea corporis (skin other than bearded area, scalp, groin, hands or feet), tinea cruris (groin, perineum and perineal areas), tinea pedis (feet), tinea manuum (hands) and tinea unguium (nails). To determine the best treatment approach, the physician must consider several factors: (1) the anatomic locations of the infection, (2) the safety, efficacy and cost of treatment options and (3) the likelihood that the patient will comply with treatment. Newer medications in both oral and topical forms, including imidazoles and allylamines, have greatly increased the cure rate for tinea infections. Certain types of tinea may be treated with “pulse” regimens; these innovative therapies lower treatment costs and improve patient compliance.

Superficial fungal infections are among the most common skin diseases,¹ affecting millions of people throughout the world.² These infections, which occur in both healthy and immunocompromised persons, are caused by dermatophytes, yeasts and nondermatophyte molds. Effective treatment can reduce the duration of symptoms in patients with superficial fungal infections.

Dermatophytes, specifically Trichophyton, Epidermophyton and Microsporum species, are responsible for most superficial fungal infections.^1,3,4 The estimated lifetime risk of acquiring a dermatophyte infection is between 10 and 20 percent.⁵

The term “tinea” refers exclusively to dermatophyte infections. Tinea infections are classified according to their anatomic location. (Pityriasis versicolor, sometimes referred to as tinea versicolor, is caused by Malassezia furfur and therefore is not discussed in this article.)

Fungal transmission occurs through direct contact with infected persons, animals, soil or fomites. Depending on their habitat, dermatophytes are described as anthropophilic (human), zoophilic (animal) or geophilic (soil). Anthropophilic dermatophytes are the most common sources of tinea infections, but zoophilic sources should be identified (if possible) and treated to prevent human reinfection.⁶

The classic presentation of tinea infection, known as “ringworm,” is a lesion with central clearing surrounded by an advancing, red, scaly, elevated border. One or more lesions may appear. Inflammation assists in colonization and may result in vesicles on the border of the affected area. Atopic persons and those infected with zoophilic fungi tend to have more inflammation.

The presentations of tinea infections range from mild scaling and erythema to severe inflammation with bacterial superinfection. The differential diagnosis for suspected tinea infection is listed in Table 1.

Type	Common causative species	Differential diagnosis
Tinea capitis	Trichophyton tonsurans	Alopecia areata
	Microsporum andouinii*	Impetigo
	Microsporum canis*†	Pediculosis
		Psoriasis
		Seborrhea
		Trichotillomania
Tinea barbae	Trichophyton verrucosum	Folliculitis
		Malignant lymphoma
		Sporotrichosis
Tinea corporis	Trichophyton rubrum	Cutaneous lupus erythematous
	M. canis*	Drug eruption
	T. tonsurans	Eczema
	T. verrucosum	Erythema multiforme
		Granuloma annulare
		Nummular dermatitis
		Pityriasis rosea
		Pityriasis versicolor*
		Psoriasis
		Secondary syphilis
Tinea cruris	T. rubrum	Candidal intertrigo
	Epidermophyton floccosum	Contact dermatitis
		Erythrasma*
		Psoriasis
		Seborrhea
Tinea pedis	T. rubrum	Bacterial or candidal infection
	Trichophyton mentagrophytes	Contact or atopic dermatitis
	var interdigitale	Dyshidrosis
	E. floccosum	Eczema
		Pitted keratolysis
		Psoriasis
Tinea manuum	T. rubrum	Same as for tinea pedis
Tinea unguium	T. rubrum	Contact dermatitis
	Trichophyton mentagrophytes	Lichen planus
	var mentagrophyte†	Onychodystrophy
		Psoriasis

Diagnosis

Wood’s Light Examination

Most dermatophytes do not fluoresce. The exceptions are two zoophilic dermatophytes, Microsporum canis and Microsporum andouinii. These minor causes of tinea capitis fluoresce blue-green. Wood’s light examination can also help to differentiate erythrasma caused by the bacterium Corynebacterium minutissimum, which fluoresces coral-red, from tinea cruris, which does not fluoresce.

When positive, a Wood’s light examination can be helpful in determining the extent of infection, identifying areas for sampling and evaluating treatment response. The examination is also useful for examining the contacts of an infected person.

Microscopy

Microscopic examination is central to the office diagnosis of any tinea infection.⁷ Material is scraped from an active area of the lesion, placed in a drop of potassium hydroxide solution and examined under a microscope. The examination, which can be done quickly and easily, is highly sensitive and specific for dermatophyte identification.

Microscopy is positive if hyphae are identified in fungal infections and if pseudohyphae or yeast forms are seen in Candida or Pityrosporum infections. A positive examination is sufficient to justify starting treatment,^7,8 because species identification does not usually influence treatment choices.⁷

Culture

Because cultures are both expensive and time-consuming, they are not routinely performed in suspected tinea infections. However, cultures should be obtained when long-term oral drug therapy is being considered, the patient has a recalcitrant infection or the diagnosis is in doubt.

Identification of a specific zoophilic species as the infection source can be helpful in preventing recurrent infection. It is also important to confirm the specific fungus that is causing a nail infection, because the spectrum of activity for oral antifungal agents varies.

Clinical Presentations

Tinea Capitis

Tinea capitis, sometimes called “ringworm of the scalp,” primarily affects school-aged children. It often appears as one or more annular patches of inflammatory or noninflammatory alopecia. Noninflamed areas, characteristic of Trichophyton tonsurans infection, may appear as black dots, which are actually infected hair shafts broken off at the scalp. Sometimes tinea capitis appears only as non-specific dandruff. Microsporum infection presents as gray patches of hairs that are lusterless because of a coating of spores. Inflamed areas usually have scales, pustules and erythema. Some patients develop a localized, boggy, indurated granuloma called a “kerion” (Figure 1). A kerion can cause scarring and permanent hair loss.

Tinea capitis should be treated with oral therapy. Griseofulvin (Fulvicin PG, Gris-PEG, Grisactin Ultra) is the only oral anti-fungal agent approved by the U.S. Food and Drug Administration for the first-line treatment of tinea capitis. However, itraconazole (Sporanox) and terbinafine (Lamisil) are good alternatives.^9–11

Tinea Barbae

Tinea barbae affects the beard area of men who work with animals (Figure 2). It is often accompanied by bacterial folliculitis and inflammation secondary to ingrown hairs. In the treatment of tinea barbae, oral therapy is preferred over topical therapy because the involved hair follicles do not respond well to topical therapy. The agents used to treat tinea capitis are also used to treat tinea barbae.

Tinea Corporis

Tinea corporis, also called “ringworm of the body,” often affects children and adults who live in hot, humid climates. The classic presentation of this infection is a circular plaque with a well-demarcated border (Figure 3). Since tinea corporis can be asymptomatic, it can spread rapidly among children in day-care settings.

Unless only one or two lesions are present, tinea corporis should be treated orally. Terbinafine and itraconazole are equally effective in treating tinea corporis.^12,13 Furthermore, these agents each have a better mycologic cure rate and a lower relapse rate than griseofulvin.^14–16 An alternative is fluconazole (Diflucan), which is given orally once a week for up to four consecutive weeks. ^17,18

Tinea Cruris

Tinea cruris, commonly referred to as “jock itch,” involves the medial aspect of the upper thighs (groin). Unlike yeast infections, tinea cruris generally does not involve the scrotum or the penis (Figure 4). This dermatophyte infection occurs more often in men than in women and rarely affects children.

In this infection, erythematous plaques often develop bilaterally. Pruritus is common.

Topical therapy is sufficient in most patients with tinea cruris. If the infection spreads to the lower thighs or buttocks, oral therapy is preferred. Itraconazole and terbinafine are more efficacious than griseofulvin.^14,15

Tinea Pedis

Tinea pedis, generally known as “athlete’s foot,” is the most common dermatophyte infection. Tinea pedis infection is usually related to sweating and warmth, and use of occlusive footwear. Men between 20 and 40 years of age are most frequently affected. The infection often presents as white, macerated areas in the third or fourth toe webs (Figure 5). It may also present with a classic pattern on the dorsal surface of the foot or as chronic dry, scaly hyperkeratosis of the soles and heels. Because of its distribution, the latter presentation, which is typical of Trichophyton rubrum infection, is sometimes referred to as “moccasin type.”

Occasionally, tinea pedis may produce acute, highly inflamed, sterile vesicles and pustules at distant sites (arms, chest, sides of fingers). Referred to as the “dermatophytid” or “id” reaction, these vesicles and pustules probably represent an immunologic response to the fungus; they subside when the primary infection is controlled. The “id” reaction can be the only manifestation of an asymptomatic web space maceration.

Tinea pedis is often treated with topical therapy. Since oral agents provide better skin penetration than most topical preparations, oral therapy may be more efficacious in the treatment of hyperkeratotic tinea pedis. Itraconazole, terbinafine and griseofulvin are good choices for oral therapy. Itraconazole and terbinafine are slightly more effective than griseofulvin.^14,19 Once-weekly dosing with fluconazole is another option, especially in non-compliant patients.¹⁷

Tinea Manuum

Tinea manuum (Figure 6), a fungal infection of the hands, is less common than tinea pedis. Like tinea pedis, tinea manuum also presents with the classic pattern of erythema and mild scaling on the dorsal aspect of the hands or as a chronic, dry, scaly hyperkeratosis of the palms. When the palms are infected, the feet are also commonly infected. A typical pattern of involvement is either one hand and both feet or both hands and one foot. Treatment options are the same as for tinea pedis.

Tinea Unguium

Tinea unguium is a dermatophyte infection of the nails. It is a subset of onychomycosis, which includes dermatophyte, nondermatophyte and yeast infections of the nails. Toe-nails are involved more frequently than fingernails. Tinea unguium affects adults more often than children. Risk factors for this fungal infection include increasing age, diabetes, poor venous and lymphatic drainage, ill-fitting shoes and sports participation. However, most infections have no underlying cause. Involvement of the toenail usually implies an extremely resistant infection with a tendency to recur. Chemical or surgical avulsion may be helpful in patients with recalcitrant infection, especially when only a single nail is involved.

The clinical presentation of tinea unguium depends on whether the fungus has invaded the distal, proximal or superficial nail. Distal involvement is the most common presentation. With distal involvement, the affected nail is hyperkeratotic, chalky and dull. The brownish-yellow debris that forms beneath the nail causes the nail to separate from its bed. The nail plate may become brittle, but the nail fold is seldom involved (Figure 7). Although inflammation is uncommon, up to 45 percent of patients experience pain.²⁰ Coexistent tinea manuum or tinea pedis is common.

Tinea unguium requires oral antifungal therapy. Itraconazole, terbinafine and, to a lesser extent, griseofulvin are effective in treating fingernail infections.^21–23 Itraconazole or terbinafine are better choices for treatment of toenails.² The FDA has approved the use of itraconazole “pulse” therapy (i.e., a series of brief medication courses) for the treatment of tinea unguium of the fingernails. The total drug exposure is less with pulse therapy²¹; therefore, its cost is also lower than traditional treatment. Furthermore, because of the drug-free intervals, patients may be more likely to comply with therapy.

For toenail infections, itraconazole pulse therapy appears to be as effective as daily dosing.^24–26 However, the FDA has not approved pulse therapy for treatment of tinea unguium of the toenails.

Terbinafine pulse therapy may also be effective. At this time, however, data are insufficient to recommend pulsed terbinafine therapy. ²⁶ Data suggest that fluconazole may be another alternative for treatment of fungal nail infections, especially if yeast is involved. To date, however, few trials of this therapy have been conducted, and only small numbers of patients have been studied.^27–29

When itraconazole or terbinafine is used in the treatment of tinea unguium, the nail may not appear clinically cured at the end of therapy. A new nail may require three to 12 months to grow out. Thus, patients should be reminded that the resolution of tinea unguium requires four to six months for fingernails and even longer for toenails.

Treatment Selection

Topical Antifungal Preparations

The topical antifungal agents currently available in the United States are listed in Table 2.³⁰ Although tinea infections are most commonly treated with topical preparations, therapeutic success is limited because of the lengthy duration of treatment, poor patient compliance and high relapse rates at specific body sites.

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Factors to consider in selecting an antifungal agent include the route of delivery, efficacy (defined as mycologic and/or clinical cure, and duration of remission), patient compliance and cost. Compared with fungistatic drugs, fungicidal agents are associated with higher cure rates, lower relapse rates and shorter treatment periods.

The clinical state of the lesion also must be considered. Ointment preparations soften thickened, hyperkeratotic lesions. Lotions and solutions prevent maceration in intertriginous areas and hairy areas of the body. They are also appropriate for treating moist, oozy, weepy lesions. Cream formulations are beneficial in the treatment of scaling, non-oozing lesions. Powders alone are less effective in treating existing tinea infections. However, they are helpful as adjunctive agents for reducing moisture and maceration, and they can prevent fungal infections in intertriginous areas.

Topical antifungal agents have been reviewed in American Family Physician.³⁰ Since that time, the first prescription spray, terbinafine 1 percent solution, and a new topical antifungal agent, butenafine 1 percent cream (Mentax), have been approved for use in the treatment of interdigital tinea pedis, tinea corporis and tinea cruris. Butenafine and terbinafine appear to have similar mycologic cure rates, although no direct comparative studies have been performed. Compared with terbinafine, butenafine is effective against fewer organisms. Average wholesale costs for the two drugs are the same.³¹

Oral Antifungal Agents

Oral therapy is often chosen because of its shorter duration and the potential for greater patient compliance. However, oral agents must be used in the treatment of disease that is extensive, that affects hair and nails, and that does not respond to topical agents.² Important information about the oral antifungal agents currently available in the United States is presented in Table 3. ^4,23 Physicians also must be aware of the hematotoxicity and drug interactions of these agents. Drug regimens and medication costs for the treatment of different types of tinea are provided in Table 4.^{4,9,12–14,16–19,26,32–35} (Ketoconazole [Nizoral] is omitted because it is not a first-line therapy.)

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Absorption properties of oral antifungal agents vary. For optimal absorption, griseofulvin should be taken with a fatty meal.²³ Ultramicrosize griseofulvin was designed to decrease the need to be taken with food to achieve the best drug absorption. Itraconazole and ketoconazole rely on gastric acidity for optimal absorption. Therefore, patients being treated with these agents should avoid taking antacids, proton pump inhibitors and histamine H₂-receptor blockers.

Achlorhydria also decreases the absorption of itraconazole and ketoconazole. If patients drink a cola beverage before they take these drugs, they may acidify their stomach and thereby increase drug absorption by up to 60 percent.^36,37 Because the absorption of terbinafine and fluconazole is not influenced by gastric pH, these agents are preferable for use in patients with achlorhydria.^22,38 Many oral antifungal agents interact with other medications (Table 3).^4,23 Terbinafine has fewer drug interactions because it minimally affects the cytochrome P₄₅₀ enzyme system.²² Itraconazole, fluconazole and ketoconazole significantly inhibit this system, particularly the subgroup 3A4.^21,38,39 Side effects that influence the selection of an oral antifungal agent are also listed in Table 3. ^4,23 For example, griseofulvin causes side effects in 20 percent of patients.³⁴ This agent most often causes headache or gastrointestinal complaints, but it can also cause rare and more serious adverse reactions, such as toxic epidermal necrolysis and photodermatitis myositis.^22,34

Studies of tinea unguium show that itraconazole is better tolerated than griseofulvin.^33,40 As with griseofulvin, the most common complaints with itraconazole are headache and gastrointestinal distress. Reversible elevations in liver enzyme levels occur in 0.9 percent of patients treated with itraconazole.⁴¹ More serious but rare events include hepatotoxicity, hallucinations, hypokalemia and edema.^34,41

Ketoconazole is reserved for the second-line treatment of recalcitrant superficial fungal infections. Of the antifungal agents, this drug has the highest risk for hepatotoxicity, with a reported incidence ranging from one case per 10,000³⁹ to one case per 70,000⁴¹ recipients. Patients who are taking ketoconazole should be instructed to immediately report symptoms of hepatotoxicity such as anorexia, nausea and vomiting. Hepatotoxicity appears to be idiosyncratic.⁴² Risk factors possibly associated with ketoconazole-induced hepatotoxicity include female gender, onychomycosis, alcoholism, ketoconazole therapy lasting more than two weeks and previous griseofulvin treatment.⁴¹ Ketoconazole therapy should be discontinued if symptomatic liver inflammation occurs or if the results of liver function tests are three times higher than normal. Liver enzyme levels usually return to normal after ketoconazole is discontinued.⁴²

Ketoconazole is also associated with asymptomatic increases in transaminase levels in 5 to 10 percent of patients.³⁴ More common side effects include gastrointestinal complaints and pruritus.³⁹

The side effects most often associated with fluconazole are rash, headache, gastrointestinal disorders and elevated liver function levels. ^35,38 Rarely, erythema multiforme can occur in patients treated with this antifungal agent.³⁵

Skin rashes and gastrointestinal side effects are common with terbinafine. Terbinafine has also been associated with Stevens-Johnson syndrome, blood dyscrasias, hepatotoxicity and ocular disturbances, as well as elevated liver enzyme levels in 0.5 percent of recipients.^22,41 In addition, some patients have noted losing their sense of taste for up to six weeks.^22,41

Adjunctive Topical Corticosteroids

Topical corticosteroids are commonly used as adjuncts to antifungal therapy. These agents are especially beneficial in the initial stages of treatment because they suppress the inflammatory response and provide symptomatic relief. Because of the possibility of fungal proliferation, topical corticosteroids should not be used alone in the treatment of tinea infections.

Types Flat, Round and Annelids – what is it, definition and answer

Flatworms

Class Ciliary

Representatives: White (milk) planaria 9 0005

White planaria

Way of life: free-living

Features of the body: The body is delicate, soft, leaf-shaped; suckers are usually absent; body covered with ciliated epithelium0005

Support system (skeleton): Special tissue between organs – parenchyma

Muscular system: Muscle fibers

Digestive system: there is an intestine

90 003 Circulatory system: missing

Respiratory system: missing

Nervous system: Stair type ! = paired cerebral ganglion, 2 nerve trunks connected by annular bridges. Only adults have sense organs .

Reproductive system: hermaphrodites (have both female and male reproductive organs)

Development: simple life cycle

Are a link in the food chain

Class Belt

Representative: Bull , pork tapeworm, wide tapeworm

Way of life: endoparasites

Features of the body: Body elongated, dissected into segments capable of separating; suction cups and hooks on the head; thick cuticle, to protect against the gastrointestinal juices of the host in which the parasite lives

Support system (skeleton): Special tissue between organs – parenchyma

Muscular system: Muscle fibers

Digestive system: No intestines, absorption by the entire body surface

90 002 Circulatory system: missing

Respiratory system: absent

Nervous system: Stair type ! = paired cerebral ganglion, 2 nerve trunks connected by annular bridges. Sense organs only in free-living forms .

Reproductive system: hermaphrodites (have both female and male reproductive organs)

Development: Complicated life cycle with change of owners, huge fecundity.

Cause diseases in humans and animals

Representative of parasitic tapeworms: Tapeworm

Primary host: Human

Intermediate host: Cattle

Infection: When eating raw, half-cooked, low-salted and dried meat containing tapeworm larvae (Finns)

Place of parasitism: Small intestine

90 003 Class Flukes

Representatives: Lanceolate fluke, Siberian fluke, liver fluke

Liver fluke

Lifestyle: endoparasites

Features of the body: Leaf-shaped body; Usually, in addition to the oral sucker, there is a ventral sucker; thick cuticle, to protect against the gastrointestinal juices of the host in which the parasite lives

Support system (skeleton): Special tissue between organs – parenchyma

Muscular system: Muscle fibers

Digestive system : There is a gut

Circulatory system: absent

Respiratory system: missing

Nervous system: Stair type ! = paired cerebral ganglion, 2 nerve trunks connected by annular bridges. Sense organs only in free-living forms .

Reproductive system: hermaphrodites (have both female and male reproductive organs)

Development: Complicated life cycle with change of owners, huge fecundity.

Cause disease in humans and animals

Representative of parasitic flukes: Liver fluke

Primary host: cattle, rarely humans

Intermediate host: small pond snail 900 05

Infection: By eating unwashed herbs or vegetables washed with water from reservoir where the faces live.

Place of parasitism: Bile ducts, liver

Roundworms

The type includes a sufficient number of classes, about 20,000 species, but we will consider roundworms proper.

Nematode class (roundworms proper)

Representatives: Onion nematode, human roundworm, baby pinworm.

Structural features:

• Three-layered – the body consists of three layers of cells: ectoderm, endoderm and mesoderm

• Bilaterally symmetrical multicellular animals .

• Body non-segmented (unsegmented), round in cross section.

• Primary cavity. The internal (primary) cavity of the body is filled with a liquid under pressure and ensures the constancy of the shape of the body.

• They have a musculocutaneous sac.

• Digestive system through .

In the body they have a through intestinal tube, which begins at the front end of the body with a mouth opening and ends with an anus (first appeared in the course of evolution).

• Circulatory and respiratory system absent

• Nervous system: peripharyngeal ring + nerve trunks.

Nerve cells are concentrated in the form of strands in muscle rollers, there is a nerve ring at the front end of the body.

• All representatives are dioecious. Development in some is through the larva, in others it is direct.

Roundworm structure

• Currently, about 10 thousand species of nematodes are known.

• Free-living species are found on the bottom of the seas and oceans, in fresh waters and soil. Many roundworms have mastered the decaying organic remains of animals and plants for life.

Among roundworms there are many parasites living in plant and animal organisms, for example roundworms.

One of the parasites among roundworms is Ascaris human

Primary host: Man!

Infection: By eating food contaminated with soil containing Ascaris eggs

Place of parasitism: Intestines

Prevention of parasitic worm infestation

To So that animals do not get parasitic diseases, contaminated watering places or pastures should be avoided.

For humans, as well as for animals, many worms are dangerous, and it can be quite difficult to get rid of them. In order not to get infected with them, you should drink water from open reservoirs only after it has been boiled, wash your hands, vegetables and fruits thoroughly. In order not to get infected from meat, it is necessary to thoroughly boil or fry meat or fish, do not eat meat with blood.

Annelids

Approximately 10,000 species. The type includes classes: Polychaetes, Few-bristle and Leeches.

Features of the annelids type:

• Three-layered

• have bilateral (bilateral) symmetry

9000 2 • These are the first segmented animals!

• Between organs – cavity filled with liquid acts as a skeleton.

• Digestive system through consists of foregut, midgut and hindgut,

• No respiratory system ( gas exchange is carried out by the entire body surface ), some have primitive gills

• Closed circulatory system!

Circulatory system

• Nervous system = parapharyngeal nerve ring + abdominal nerve chain

Nervous system

• Sense organs: tactile structures – tentacle appendages, eyes, but not all, and olfactory pits

• Dioecious and hermaphrodites (have female and male genital organs)

Class 9000 4 Multi-bristle

Representatives : Nereis, sandworm

Number of species: 6000-10000

Habitat: Seas and oceans

Reproductive system: dioecious

Nereis

Peskozhil

9000 6 Class Small-bristle

Representatives: Earthworm

Number of species: 3000

9000 3rd place Habitat: Fresh water and moist soil

Reproductive system: Hermaphrodites (have both male and female reproductive organs)

They are a link in the food chain, participate in soil formation, filter water

Earthworm

Class Leeches 90 005

Representatives: Medical leech, Tatar, Mexican (poisonous), horse

Number of species: 400-500

Habitat: Fresh and slightly saline waters, soil, can fall into anabiosis

Reproductive system: Hermaphrodites

They are a link in the food chain, used for hypertension (high blood pressure) and the threat of hemorrhage

Leeches

Importance of worms in nature and for humans

Worms are part of the food chain , being predators in them (dairy planaria) or food, for example, for birds or amphibians.

Annelids living in the soil, loosen the soil , contribute to the penetration of water and air into it, which is important for plant roots. And annelids living in water pass silt through themselves, freeing it from organic substances, thereby playing a significant role in biological water treatment .

As mentioned above, there are flatworms and roundworms that cause parasitic diseases .

Leeches are used in medicine in the fight against hypertension (high blood pressure) and the threat of hemorrhage.

Biology Type Annelids. Class Polychaete worms