Tinea Infections: Common Types (Pediatric Nursing)

00:00 Now we'll cover the tinea infections. Tinea infections are fungal infections and these are classified according to their site of infection. Some examples are ringworm, athlete's foot, and Jock itch. The signs, symptoms, and management depend on the site involved and classically we'll see a ring-shaped, red, scaly patch. These tinea infections are very common and we treat them with antifungal medications. So, these are caused by dermatophytes and these are aerobic fungi. They live on dead tissue; on hair, nails, and the outer layers of the skin. These are common in children but we see tinea infections in all ages. They're also common in most countries because they thrive in warm, moist areas. This is the 4th most prevalent disease worldwide and 10%-20% of people will get a dermatophyte infection in their lifetime. There are some risk factors to tinea infection including having a prolonged exposure to wet skin including patients who sweat or swim, minor skin and nail injuries, patients who do not bathe or wash their hair often, and patients who are immunocompromised. The transmission is not hard. This is going to spread easily and this involves contact with infected people. This can also be spread via fomites and around pool surfaces, on the pool deck. We also see patients who've been exposed from gym mats, shower floors, and walls. And tinea can also be spread by pets. The signs and symptoms depend on the type and these are the common types. First, tinea capitis. This is when it occurs on the scalp and you can remember this as your patient puts their cap on their head. The next is tinea corporis. This is when it involves the body and this is also known as ringworm. And when I say the term ringworm, patients always get really worried and I remind them this is not a worm infection, this is from a fungus. Tinea cruris or tinea inguinalis. This is in the groin and this is also known as Jock itch. Tinea pedis.

02:07 This involves the feet and this is referred to as athlete's foot. And then there's tinea unguium and this is a nail infection, also known as onychomycosis. First, let's talk about tinea capitis.

02:19 Remember this is on the head, on the scalp. This is 2 different dermatophytes, streptophyta and microsporum, that are going to invade the hair shaft and this is going to have multiple patches of hair loss or alopecia. And this is the classic symptom, it disrupts the hair growth.

02:35 Patients may have inflammation, scaling, pustules, and itching on their scalp. This is more common in males and it's more common in children. And the diagnosis is mostly clinical, you look for that patch of hair that's missing but you can do a scraping from the hair shaft to do KOH microscopy. We'll learn about that procedure later. So, tinea capitis. This can exist in a carrier state and it requires oral antifungals. I've seen patients come in and they say they have tried all kinds of creams and powders on their hair. They think they have a fungal infection. They know they have tinea capitis and they don't understand why it's not working.

03:12 It's because orals are required. Griseofulvin is the most common medication, but we can also use terbinafine, itraconazole, and fluconazole as alternatives. You can also apply a topical selenium sulfide shampoo, but this is not an independent treatment. Treatment should continue for 1+ weeks until it's visibly resolved. And again, these are adjuncts so these are not primary therapies but you can also use selenium sulfide and the patient's going to put the shampoo on their scalp, wait about 10 minutes and then wash this off in the shower. Next, let's talk about tinea corporis. This is ringworm. This is when it occurs on the body commonly the face, the arms, the legs, and the trunk. You'll see an annular, itchy, marginated plaque with a thin scale and a central clearing and marginated means that the borders are clear.

04:03 This is what differentiates this rash from eczema. It's a clinical diagnosis, but if you're not quite sure maybe you think the patient has eczema, you can do a KOH microscopy and look at the scrapings. So you can treat this with topicals or orals and I always look at the patient and decide how big is the area and is it reasonable to put a cream on this patient. Often the patient needs to put this on and then put their clothes on so they can go to work or school so sometimes creams just rub off on their clothing and sometimes oral treatment is a better option for those patients. You can use griseofulvin, terbinafine, itraconazole, and then topical clotrimazole cream. And same, the treatment should continue for 1+ weeks after the resolution.

04:47 So, what is Jock itch? It's a medical term for tinea cruris, which is a skin fungal infection.

04:54 Jock itch is a dermatophyte infection in the groin and it's commonly found on the medial portions of the upper thighs as well. This is more often seen in male patients but it can be common in females who are overweight and wear tight pants. The penis and the scrotum are usually spared so you will not see the infection there and this is more common in the adult population. So, what are the signs and symptoms? You want to evaluate and treat their feet if this is the source. So let's think about this. If your patient has a fungal infection on their feet and then they get dressed. They stepped into their underwear and they stepped into their pants and they pulled those items up, they can introduce this fungus into their groin.

05:33 You can treat this with topical therapy and terbinafine cream or spray once a day for a week.

05:39 Now let's talk about athlete's foot or tinea pedis. This is caused by the same dermatophyte species as tinea cruris. It's most commonly seen in adolescents. So there are some risk factors, exposure to a moist environment and maceration of the skin. So, we see this a lot in athletes that's why we call this athlete's foot. They'll be running or jogging or playing a sport and their feet will get really sweaty and they often don't change out of those socks right away. This causes white macerated tissues between the toes and they'll get vesiculobullous eruptions on the soles of their feet. The symptoms are itching, stinging, and burning. Now this is usually managed with topical agents. Patients can use butenafine 1% topically for 2 weeks or topical Lotrimin. Miconazole is also used. Sometimes systemic therapy is needed.

06:30 So here are some tips to prevent and manage athlete's foot. You want to encourage your patients to wash their feet. The next step is really important. They need to dry their feet and the area between their toes and we don't want them washing their feet and then having moist feet and then putting the socks back on because that will actually make the problem worse. We want to encourage the patient to wear cotton socks to allow their feet to breathe and if they wear flip flops in public moist environments such as swimming pool decks and public showers, they are less likely to get athlete's foot. Now we'll cover tinea unguium. This is also called onychomycosis. This is a fungal nail infection and the toenails are more commonly affected than the fingernails. This involves a thickened, yellow, jagged nail that can separate from the nail bed. There are certain risk factors including peripheral vascular disease, immunosuppression such as our patients with diabetes and patients with athlete's foot. Now this is uncommon in the pediatric population, but this can happen. So, trimming the nails can be helpful for these patients and the problem with these nail infections is topical agents are not usually effective. These patients usually require oral therapy. So, the problem with these oral antifungals is they're very hepatotoxic. They can damage the liver so the clinician needs to monitor this liver function test. I typically do baseline testing and then I'll start my patient on therapy and I'll follow up in a few weeks to see how their liver is tolerating the medication. This is usually managed by a primary care provider, a dermatologist, or a podiatrist.