Skin Care and Diseases

Tinea corpis

09/28/2001

Question:

I need some information on long term management of tinea corpis. What type of disinfectant should I use on inanimate surfaces? Should bedding and clothing be disposed of, washed or boil washed? How long should the infection be considered contagious? For how long do spores remain viable? Can severe stress be a factor in rate of spreading, persistence and recurrence? Is a 2 weeks of oral Lamistil (terbenafine) followed by 4 weeks topical miconazole sufficient for body and nail involvement? And lastly can I expect scarring or hyper-, hypopigmentation as a result? Have explored dozens of sites, found good general advice, but no information adressing the above concerns. I would be very grateful for any additional information. Thank you.

Answer:

Be certain that you do have tinea corporis. In order for you to be certain you probably need to see a dermatologist who is board certified and to have culture verification of the infection and the type of organism present. That information will help answer some of the questions that you have. Spores are the protective phase of the fungi`s life cycle and they may exist for long periods of time in unfavorable environmental conditions such as drying, low humidity and unavailability of skin. Many of the fungi that infect humans also infect animals and they may be the reservoir. Suffice it to say there are, however, some fungi that do infect human beings, and the human being is the reservoir. I would urge you to carefully clean surfaces with an antibacterial spray or liquid and would urge you to cleanse your bedding with laundry detergent that contains a bleach. That, in most cases, followed by dryer heat will clear most of the spores in your clothing. The spores, infected scale, and infected hair may remain infectious for relatively long periods of time. As I indicated, you should vacuum the headrests and body of your chairs, and change the bed linens frequently for several weeks while you are taking medication and while you are cleaning the scale and hair from the floor, carpet, and seating areas of your home.
The treatment for tinea of the scalp, body and nails varies. Nails require several months of treatment. Hair infections may be treated for relatively short periods of time if the correct antifungal drug is chosen and if they are taken appropriately. For one or two small areas of tinea corporis two weeks of oral Lamisil might control a few small areas, and certainly topical Miconazole would be helpful. The significance of the infection, its extent, the etiology, and your health are all important in determining the length of therapy. That is why I have asked you to see a board certified dermatologist to help you arrive at the correct medication sequence for you.
Severe inflammatory reactions to fungi may leave you with scarring and post-inflammatory hyper and/or hypopigmentation. In severe inflammatory responses to the fungi enough skin can be destroyed to leave you with an area of pigmentary loss and/or hypopigmentation. Frequently at the margins of such a lesion there is hyperpigmentation.
The treatment of pigmentary changes may be difficult but your board certified dermatologist can help you with trying to minimize the cosmetic defect.

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Response by:

Charles L. Heaton, MD
Professor
Department of Dermatology
College of Medicine
University of Cincinnati