GPAtlas🧭 When to suspect
Suspect a dermatophyte (tinea) infection – a fungal infection of keratin in the skin, hair or nails, commonly called ringworm – whenever there is an itchy, red, scaly rash that is asymmetrical or has a leading edge.
• The classic body lesion is annular (ring-shaped) with a raised, advancing scaly edge and central clearing.
• Dermatophytes need keratin to grow, so infection is confined to skin, hair and nails and does not involve mucosal surfaces.
The presentation is named by site.
• Tinea pedis (athlete's foot) is the commonest pattern in adults.
• In children, the one to think of is tinea capitis (scalp ringworm).
Infection readily spreads from one site to another – for example athlete's foot seeding the groin.
• Always look for a second site.
• Ask about communal areas, occlusive footwear, sport, animal contact, and household members with a similar rash.
| Type (site) | Common name | Typical features |
|---|---|---|
| Tinea corporis (body) | Ringworm | Annular scaly plaque with a raised advancing edge and central clearing |
| Tinea cruris (groin) | Jock itch | • Itchy red scaly rash of groin/inner thigh, usually bilateral • Often spares the scrotum |
| Tinea pedis (foot) | Athlete's foot | Itchy maceration/fissuring between the toes, or dry "moccasin" scaling of the soles |
| Tinea capitis (scalp) | Scalp ringworm | • Scaly patches with broken hairs/hair loss, ± a kerion (boggy inflamed swelling) • Mainly children |
| Tinea unguium (nail) | Onychomycosis (fungal nail) | Thickened, discoloured (white/yellow/brown), crumbly nail with onycholysis (lifting off the bed) |
| Tinea manuum (hand) | – | Dry scaling of one palm, classically with both feet involved ("two feet–one hand") |
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