Dermatophytosis Importance

Dermatophytosis is a common contagious disease caused by fungi known as

dermatophytes. Dermatophytes belong to a group of organisms that are able to break
Ringworm, Tinea, down the keratin in tissues such as the epidermis, hair, nails, feathers, horns and hooves.
Last Updated: March 2013 Most of these fungi reside in the soil and are involved in decomposition; however, the
dermatophytes can infect living hosts. Some dermatophytes (anthropophilic species)
are adapted to humans, and are usually transmitted from person to person. Others
(zoophilic species) are adapted to animals. A few (geophilic) species normally live in
the environment, but occasionally act as parasites. The zoophilic and geophilic species
are sometimes transmitted from animals to people. It is also possible for humans to
transmit anthropophilic dermatophytes to animals, although this seems to be
uncommon.
In living hosts, dermatophytes usually remain in superficial tissues such as the
epidermis, hair and nails. Serious consequences are uncommon and infections can be
self-limiting. However, the illness may be disfiguring and uncomfortable, especially
when the lesions are widespread. Economic effects, such as damage to hides, are also
important in livestock. Infrequently, dermatophytes may invade subcutaneous tissues
and (very rarely) other sites, especially in immunocompromised hosts.
Etiology
Dermatophytosis is caused by pathogenic, keratin-digesting fungi in the genera
Microsporum, Trichophyton and Epidermophyton. Members of Microsporum and
Trichophyton cause illness in both humans and animals. E. floccosum is the only species
of Epidermophyton known to cause disease, and it usually affects only people. Some
authors use the term “dermatophytoids” for soil-dwelling members of Microsporum,
Trichophyton and Epidermophyton that are never or rarely associated with disease (e.g.,
T. terrestre).
Dermatophytes, like many fungi, may have two different species names. One name
belongs to the asexual form (the anamorph state), which is the form that occurs in
vertebrate hosts. The other name is given to the sexual state of the organism. The latter
form, called the teleomorph form or the “perfect state,” is produced by mating between
anamorphs. For example, the dermatophyte Microsporum canis infects animals;
however, when this organism mates with a compatible environmental organism, the
resulting sexual form is called Arthroderma otae. The teleomorph (perfect) states of
both Microsporum and Trichophyton belong to the genus Arthroderma, and
dermatophytes known to have sexual states are placed in the phylum Ascomycota,
family Arthrodermataceae. Dermatophytes that currently have no known sexual state,
like other medically important fungi with this characteristic, are classified as
Deuteromycota (Fungi Imperfecti).
Although dermatophytes originated from soil-dwelling keratinophilic organisms,
only a few pathogenic species still reside primarily in this niche. These organisms,
known as geophilic dermatophytes, are associated with decomposing keratin sources in
the environment. M. gypseum and M. nanum are the only two geophilic dermatophytes
that are important pathogens in animals. M. gypseum is also seen in people, but M.
nanum occurs infrequently.
Most species that cause dermatophytosis have become adapted to people or
animals, and are now maintained in these reservoirs. Although they can infect other
hosts, each dermatophyte tends to be associated with a particular host or group of hosts,
and it is not maintained in other species long term. Zoophilic dermatophytes are adapted
to various animal species, while anthropophilic dermatophytes occur in humans.
Zoophilic Microsporum species include Microsporum canis, M. gallinae and M.
persicolor. Most sources no longer use the name M. equinum for the organisms found
in horses, but consider them to be equine-adapted M. canis. Zoophilic members of
Trichophyton include Trichophyton equinum, T. bullosum, members of the T.
mentagrophytes complex, T. simii and T. verrucosum. Most or all zoophilic
dermatophytes are thought to be zoonotic, although some are transferred to people more
often than others.

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 Dermatophytosis
There are numerous species of anthropophilic Zoophilic or geophilic species that have new names,
dermatophytes, including T. tonsurans, the T. rubrum under the ITS genetic system, include the following:
complex, T. violaceum, T. mentagrophytes var. interdigitale, • Horse-adapted isolates of M. canis, which do not
T. soudanense, T. schoenleinii, M. audouinii, E. floccosum perforate hair in in vitro tests (unlike most M. canis)
and others. Although anthropophilic dermatophytes can be and produce few conidia, were formerly called M.
transmitted to animals, this seems to be rare. equinum. Based on genetic relatedness, they are
The predominant dermatophytes involved in human now considered to be M canis.
cases vary with the climate, geographic location and other • The organism known as M. gypseum in the
factors such as exposure to livestock, pets or exotic species. traditional taxonomy contains both M. gypseum and
Zoophilic dermatophytes can be a common cause of a M. appendiculatum in the ITS system.
syndrome in one region, while anthropophilic dermatophytes
account for most cases in another. The causative agents can • The species M. gallinae, a zoophilic organism
also change over time, with some species becoming less found in birds, includes the geophilic organism M.
common (e.g., due to the introduction of effective treatments vanbreuseghemii in the ITS system.
or changes in exposure) and others becoming more • T. verrucosum varieties have been eliminated under
prevalent. the current ITS genetic taxonomy, and this
organism is redefined to include only the species
Dermatophyte taxonomy adapted to cattle. The ITS system reassigns T.
The taxonomy of the dermatophytes, particularly verrucosum var. autotrophicum, which occurs in
members of T. mentagrophytes, is controversial. Organisms sheep, to T. interdigitale.
may be assigned different names depending on whether the
source is using traditional identification methods or genetic • The ITS system made major changes in the
typing. taxonomy of T. mentagrophytes. In traditional
taxonomy, zoophilic and anthropophilic isolates of
Diagnostic laboratories have traditionally identified T. mentagrophytes can be separated, in part, by their
dermatophytes based on their colony and microscopic different colony morphologies on primary isolation.
morphology, nutritional and biochemical characteristics, and The species T. mentagrophytes var interdigitale is
other factors. Such methods, together with the ecology of an anthropophilic in this system, and mainly contains
organism (e.g., its adaptation to a particular host) have given isolates associated with tinea pedis (athlete’s foot)
rise to a number of species names. However, some organisms and infections of the nails. Under the ITS
that appear to be different species, based on conventional taxonomy, however, most of the organisms that
typing and/or ecology, may be very closely related previously belonged to T. mentagrophytes were
genetically. Furthermore, the traditional typing methods placed in this variety, and it was elevated to the
have given rise to a situation where a single anamorph can level of a species (T. interdigitale). Thus, T.
have two different teleomorphs, suggesting that such interdigitale in the ITS system includes both
“species” actually contain more than one species. anthropophilic organisms (the former T.
A taxonomic method first proposed in 1999 defines mentagrophytes var. goetzii, T. mentagrophytes var.
dermatophyte species by genetic techniques, specifically the interdigitale, T. mentagrophytes var. nodulare and
sequencing of highly variable internal transcribed spacer T. krajdenii) and zoophilic organisms, including the
(ITS) regions of the ribosomal DNA. Some authors have former T. mentagrophytes var. mentagrophytes, T.
adopted the ITS scheme. Others feel that its adoption is mentagrophytes var. granulosum and T.
premature and based on limited data. ITS taxonomy has been verrucosum var. autotrophicum. Under this system,
criticized because it may place organisms into the same T. mentagrophytes still contains the former T.
species even when they seem to be ecologically distinct mentagrophytes var. quinckeanum and two camel-
based on their adaptation to different hosts; zoophilic, associated species, T. langeronii and T. sarkisovii.
anthropophilic or geophilic nature; or distinctive In addition, the authors of the ITS scheme suggest
characteristics such as opposite mating types or ability to that all three of these species are associated with
penetrate hair in vitro. In addition, the results of ITS typing camels, although T. mentagrophytes var
may not agree with the results of genetic analyses based on quinckeanum was previously linked mainly with
other genes. Some sources also use traditional typing mice. The association of the latter organism with
schemes for practical reasons: genetic typing is not widely camels has been disputed, and the entire
used in diagnostic laboratories, and some species defined by reorganization of T. mentagrophytes is
ITS sequencing can be difficult or impossible to identify by controversial.
conventional methods. This is especially true for T.
• Two other varieties of T. mentagrophytes received
mentagrophytes.
new names in the ITS system. T. mentagrophytes
var. erinacei, which is adapted to hedgehogs, is now
considered to be the species T. erinacei. In addition,

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 Dermatophytosis
isolates of T. mentagrophytes found mainly in may remain viable in suitable environments for up to 12-20
guinea pigs (which were usually identified as T. months, and some spores were also reported to persist for at
mentagrophytes var. granulosum) are now called least a year in salt water. Certain types of spores (e.g.,
“the Trichophyton anamorph of A. benhamiae.” microconidia) might be dispersed by airborne means.
This anamorph was not given a separate species
name. Although it is sometimes shortened to “A. Disinfection
benhamiae” in clinical literature, the A. benhamiae Dermatophyte spores are susceptible to benzalkonium
complex also contains several other organisms chloride, dilute chlorine bleach (1% sodium hypochlorite),
(e.g., T. erinacei, T. verrucosum and the enilconazole (0.2%), formaldehyde and some strong
anthropophilic organism T. concentricum). detergents. In one study, a 10% solution of
It should be noted that species names, as currently alkyldimetylbenzylammonium chloride prevented the growth
defined under the ITS genetic taxonomy, may change in the of M. canis from 97% of contaminated hairbrushes, and
future. For instance, T. equinum, which is adapted to horses, Virkon-S® was effective on 87%. Another study found that a
was reassigned to the anthropophilic species T. tonsurans at preparation containing benzylammonium bromide and
one time; however, it was later acknowledged to be a ethoxyllauric alcohol was effective against the anthropophilic
different species. fungi usually found on swimming room floors. Dermatophytes
are also reported to be susceptible to iodophors,
This factsheet generally uses the traditional taxonomy.
glutaraldehyde and phenolic compounds; however, some
Geographic Distribution agents may have limited efficacy in “real life” environmental
Dermatophytes grow best in warm and humid disinfection.
environments and are, therefore, more common in tropical The mechanical removal of any material containing
and subtropical regions. Their distribution varies with the keratin, such as shed skin and hairs, facilitates disinfection.
organism. M. canis, M. nanum, M. gypseum, T. Vacuuming is considered to be the best method in many
mentagrophytes, T. verrucosum and T. equinum, occur cases. Dusting may also be appropriate. After mechanical
worldwide, although their prevalence varies with the region. removal, washable surfaces should be cleaned thoroughly
T. simii was thought to be endemic only in Asia, specifically with detergent and water.
the Indian subcontinent; however, infections acquired in Dermatophytes are susceptible to high heat. Moist heat
Europe and Africa suggest that its distribution might be more of 121°C, applied for at least 20 minutes, or dry heat of 165-
widespread.. T. mentagrophytes var. erinacei (T. erinacei) is 170°C for 2 hours, are reported to be effective.
associated with hedgehogs, and it is found where these
animals occur in the wild (Europe, New Zealand and Africa), Infections in Humans
or in countries where they are kept as pets. M. persicolor has
been reported in Europe, and T. bullosum has been detected Incubation Period
in Tunisia, Sudan, Syria and France. The incubation period in humans is usually 1 to 2 weeks.
Like zoophilic species, anthropophilic dermatophytes
may be either cosmopolitan or more limited in their Clinical Signs
distribution. The latter group may be imported into other Dermatophytes generally grow only in keratinized tissues
countries on infected individuals. such as hair, nails and the outer layer of skin; the fungus
usually stops spreading where it contacts living cells or areas
Transmission of inflammation. Many dermatophytes can invade hairs as
People and animals become infected by dermatophytes well as the skin; however, some anthropophilic species such
after contact with spores (conidia). Dermatophytes growing as E. floccosum and T. rubrum are limited to the skin. Mucus
in a vertebrate host normally form only arthrospores membranes are not affected.
(arthroconidia), asexual spores that develop within the The symptoms of dermatophytosis vary, depending on
hyphae. In the environment (e.g., in laboratory culture), they the infecting organism, affected tissues (e.g., skin, hair or
can also produce microconidia and macroconidia, asexual nails) and area of the body. In unhaired (glabrous) skin, the
spores that develop outside the hyphae. Initially, the lesions are usually characterized by inflammation that is
dermatophyte infects a growing hair or the stratum corneum most severe at the edges, with erythema, scaling and
of the skin. These organisms do not usually invade resting occasionally blister formation. The central area may clear,
hairs, since the essential nutrients they need for growth are resulting in the formation of a classic “ringworm” lesion.
absent or limited. Hyphae spread in the hairs and keratinized In haired areas, the hairs become brittle and areas of
skin, eventually developing infectious arthrospores. alopecia may appear. Dermatophytes acquired from
Anthropophilic and zoophilic dermatophytes are mainly animals or the soil generally produce more inflammatory
transmitted between hosts by arthrospores in hairs or skin lesions than anthropophilic dermatophytes (but not all
scales. Other asexual or sexual spores formed by the individual cases are highly inflammatory). These infections
environmental stages may also be infectious. Fomites such are also less likely to become chronic than those caused by
as brushes and clippers are important in transmission. Spores anthropophilic organisms

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 Dermatophytosis
In humans, dermatophytoses are referred to as “tinea” at the edge. Lesions are variably pruritic. Treatment with
infections, and are named according to the area of the body corticosteroids, or repeated shaving or occlusion of the
involved. Infections can, however, spread from one area to affected area, can result in skin lesions that do not resemble
another. For example, tinea faciei (facial dermatophytosis) in the classic form. Untreated tinea corporis may resolve within
children may result from a tinea capitis (scalp) infection that a few months, particularly if it is caused by a zoophilic or
has spread to the face. geophilic organism, but infections caused by anthropophilic
organisms may be more persistent.
Tinea capitis
Tinea capitis, most often seen in children, is a Tinea faciei and tinea barbae
dermatophyte infection of the hair and scalp. The major Tinea faciei and tinea barbae are dermatophyte
organisms involved in this condition vary with the infections occurring on the face. These infections are often
geographic area. M. canis, a zoophilic species, is often acquired from pets or livestock, but they can also be caused
isolated from tinea capitis cases in continental Europe; by anthropophilic dermatophytes that originally affected
however, the anthropophilic dermatophyte T. tonsurans is other parts of the body such as the scalp or torso.
currently responsible for most cases in the U.S. and the U.K. Tinea barbae is an infection of the hairs and skin in the
Other anthropophilic organisms, whose importance varies beard and mustache area, and is usually seen in men. Some
with the region, include T. violaceum, M. audouinii, T. causative organisms invade the hair and hair follicles, while
schoenleinii, T. megninii, T. soudanense and others. The others (e.g., T. rubrum) are limited to the skin. The lesions of
zoophilic organisms T. mentagrophytes, T. verrucosum, M. tinea barbae may include scaling, follicular pustules and
persicolor and other species, as well the geophilic organisms erythema. The zoophilic organisms T. verrucosum
M. gypseum and (uncommonly) M. nanum, have been (associated with cattle) and T. mentagrophytes can cause a
isolated from some cases. very inflammatory form of this disease, with pustular
Tinea capitis is characterized by spreading, scaly, folliculitis or kerions. Some other species that may be
irregular or well-demarcated areas of erythema and alopecia. involved include M. canis, which is zoophilic, and the
Some anthropophilic dermatophytes may cause dry alopecic anthropophilic organisms T. tonsurans, T. megninii and T.
patches with minimal inflammation (sometimes with black violaceum. Some authors consider tinea barbae to be a form
dots where the hairs break at the follicle). Zoophilic of tinea faciei, rather than a separate condition.
dermatophytes are more likely to cause inflammatory, and in Tinea faciei is seen on the nonbearded parts of the face.
some cases suppurative, lesions, including .boggy, It can be caused by a number of anthropophilic and zoophilic
inflammatory masses called kerions. An anthropophilic organisms including T. rubrum, T. tonsurans, T.
species, T. schoenleinii, causes “favus,” a chronic infection schoenleinii, T. mentagrophytes, M. canis and T. erinacei.
characterized by yellow, cup shaped crusts (scutulae) around The lesions are usually pruritic; itching and burning may
the hairs. Untreated cases of tinea capitis can last for a month become worse after exposure to sunlight. While some lesions
to several years, depending on host factors and the species of may resemble those of tinea corporis, others have little or no
dermatophyte involved. scaling or lack raised edges. In addition, the areas of
Tinea corporis erythema may be indistinct. Due to these atypical
presentations, tinea faciei is often confused with other skin
Tinea corporis, or ringworm, occurs on the trunk and
diseases that affect the face.
extremities (and in some definitions, the face). Infections
often spread to the neck and wrists of adults in contact with Tinea cruris
infected children. Anthropophilic organisms that cause tinea Tinea cruris is an acute to chronic infection of the groin
corporis include T. rubrum and E. floccosum, which infect and adjacent areas, usually caused by anthropophilic
the skin but not the hair, as well as dermatophytes also found dermatophytes. The most commonly involved organisms are
in tinea capitis, such as M. audouinii, T. schoenleinii, T. T. rubrum, T. mentagrophytes var. interdigitale and
tonsurans and T. violaceum. Various zoophilic organisms E. floccosum, although the last species is now uncommon in
such as M. canis, T. verrucosum, T. equinum, T. some areas. The symptoms include burning, pruritus, and
mentagrophytes and M. persicolor, as well as the geophilic erythematous lesions with scales, raised, sharply demarcated
organisms M. gypseum and M. nanum can also cause this borders and central clearing. Pustules and vesicles are
form of tinea. sometimes found at the edges of the lesion. Macerated, moist
One or more lesions may be present in tinea corporis. exudative forms or lesions with an eczematous appearance
These lesions are usually pink to erythematous or scaly, and can be present in acute cases, while dry lesions with little
annular with a slightly elevated, scaly and/or erythematous scaling and an annular form are more characteristic of
edge, sharp margin, and central clearing. Follicular papules, chronic cases. Hyperpigmentation is common in the central
pustules or vesicles may be found on the borders, especially region as the lesion progresses. The same fungi can cause
when the lesion is caused by zoophilic or geophilic organisms. tinea cruris and tinea pedis, and the two conditions may be
The zoophilic organism T. quinckeanum can cause scutulae. In present concurrently.
contrast, some anthropophilic dermatophytes can cause
chronic lesions with little inflammation and very little scaling

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Tinea pedis and tinea manuum Communicability
Tinea pedis is usually caused by anthropophilic Dermatophytes acquired from animals can be
dermatophytes such as T. rubrum, T. mentagrophytes var. transmitted between people, but this is uncommon and the
interdigitale and E. floccosum. Interdigital tinea pedis number of transfers is limited. In contrast, anthropophilic
(athlete’s foot) is an infection of the foot, characterized dermatophytes are readily spread from person to person.
either by dryness, fissures and scales or white, moist Anthropophilic dermatophytes can be transmitted to
macerated lesions in some or all of the spaces between the animals, although this seems to be rare.
toes. Another form of tinea pedis (the chronic,
erythematosquamous or “moccasin” form) appears as Diagnostic Tests
scaling of the soles and lateral surfaces of the feet, with Diagnosis is based on the history, physical examination,
variable degrees of inflammation and dryness. A third form and microscopic examination of scrapings and hairs from the
of tinea pedis is characterized by erythema, vesicles, lesions, sometimes in conjunction with fungal culture and
pustules and bullae mainly on the soles of the feet. The nails other techniques such as Wood’s lamp examination and
are also involved in many cases. histology of the tissues.
Tinea manuum is a dermatophyte infection that tends Some dermatophytes fluoresce when they are stimulated
to affect one hand, although involvement of both hands is by the wavelengths of ultraviolet (UV) light in a Wood’s
possible. In this form, the palms become diffusely dry, lamp. Organisms that exhibit fluorescence include some
scaly and erythematous. Inflammatory (vesicular or strains of the zoophilic dermatophytes M. canis and T.
pustular) lesions can be seen occasionally. Tinea manuum quinckeanum, as well as a few anthropophilic species, such
is most often caused by anthropophilic dermatophytes, as M. audouinii. T. tonsurans and T. violaceum, which are
particularly T. rubrum (cases are frequently an extension of the most common agents in some regions, are not revealed
athlete’s foot) but occasional cases may be caused by by this technique. Certain topical preparations may mask the
zoophilic organisms such as M. canis, T. mentagrophytes, fluorescence, and alcohol can either suppress it or cause non-
T. verrucosum and T. erinacei, or the geophilic organism specific fluorescence.
M. gypseum.
Dermatophytes can often be detected by microscopic
Tinea unguium examination of infected hairs and skin or nail scrapings.
Tinea unguium (or onchomycosis) is a dermatophyte Hyphae rounding up into arthroconidia are diagnostic, but
infection of the nails. It is characterized by thickened, hyphae alone could be caused by other fungi, including
opaque, discolored, broken and dystrophic nails. The nail contaminants. In hairs, arthroconidia may be found outside
plate may be separated from the nail bed. Toenails are (ectothrix) or inside (endothrix) the hair shaft. Skin scrapings
affected more often than fingernails, and individual nails should be taken from the edge of the lesion, and hairs should
are sometimes spared. There are several different forms of be plucked (not cut) from this area. The best hairs to select
tinea unguium, ranging from superficial, roughened white are those that fluoresce under a Wood's lamp, or are broken
patches to almost complete breakdown of the nail. Most or scaly. Nail scrapings are generally taken from the nail bed,
infections are caused by anthropophilic Trichophyton or from deeper portions of the nail after removing the outer
species, particularly T. rubrum and less frequently T. layers (except in cases where the infection is entirely
mentagrophytes var interdigitale. M. canis has been superficial). Samples are usually cleared with potassium
involved occasionally in immunosuppressed patients. hydroxide (KOH) or other agents to help visualize the
organism. Various stains such as chlorazol black E, Parker
Dermatophytes in immunosuppressed blue-black ink, Swartz-Lamkin stain or Congo red stain may
individuals be added. Fluorescence microscopy, using calcofluor white
In immunosuppressed individuals with impaired cell- or other stains, can also be used to visualize dermatophyte
mediated immunity (e.g., HIV-infected patients with low T structures.
cell counts, or organ transplant recipients), dermatophytes Fungal cultures, which identify the species of
can cause extensive lesions. In rare cases, they may also dermatophyte, can be useful in understanding the source of
penetrate more deeply into the skin than usual, resulting in the infection and targeting preventive measures appropriately.
abscesses, exophytic nodules, and pseudomycetomas Culture may also be necessary if the diagnosis is uncertain, or
(granulomatous or pyogranulomatous masses surrounding the infection is resistant to standard treatment. However,
fungal hyphae). Although pseudomycetomas can also occur recommendations vary in the literature, and uncomplicated
in healthy people, they are less common. Dissemination to cases are not always cultured in practice. Samples for culture
internal organs (e.g., lymph nodes, bones, spleen, brain, include hair, skin and nail samples, as for microscopic
liver) is possible, but very rare. Immunosuppressed patients examination. In some situations (e.g., infections in sensitive
may also be extensively infected with species that rarely sites, or the identification of asymptomatic carriers), other
affect healthy people, such as M. gallinae. techniques such as brushing the hair, using adhesive tape to
collect samples, or rubbing the area with a sterile toothbrush
or moistened, sterile cotton swab may also be effective.

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Colonies appear in 5 days to 4 weeks, depending on the Better surveillance, improved living conditions and
organism. Colony morphology can differ with the medium. improved treatments can decrease the overall prevalence of
Descriptions are usually based on Sabouraud agar, but anthropophilic dermatophytes, while hygiene, and
dermatophyte medium or other fungal culture media can also prevention of contact are helpful in individual cases.
be used for isolation. Dermatophyte species can be identified Measures such as moisture control (e.g., in tinea pedis) are
by the colony morphology; the appearance of microconidia, important in reducing susceptibility to some forms of tinea.
macroconidia and other microscopic structures; biochemical
characteristics such as urease production; and nutritional Morbidity and Mortality
requirements. Specialized tests such as the ability to penetrate Dermatophyte infections are common in people,
hairs in vitro, or mating tests (which are usually available only although the prevalence varies with the climate and various
at reference laboratories) may be used occasionally. risk factors including animal contact. Up to 60% of children
Differential media (e.g., bromocresol purple-milk solids may be affected by tinea capitis in some regions, and more
glucose) can be helpful during differentiation. Some fungal than 50% of the population in some parts of Europe is
cultures from infected people are negative. reported to have tinea pedis. With the exception of tinea
Histology (biopsy) is occasionally helpful, especially in cruris (which is typically seen in adults), dermatophytosis is
deep mycoses and some infections of the nails. The more common in children.
organisms are visualized best with periodic acid–Schiff Exposure to dermatophyte spores does not always lead
(PAS) staining, although they may also be found in to infection. Skin injuries (e.g., burns, maceration or
hematoxylin-eosin stained preparations. chafing), as well as high temperatures and humidity, increase
PCR tests have been published for a number of susceptibility. For example, tinea cruris is more common in
organisms, and molecular methods of diagnosis might hot climates and in people who wear tight clothing.
become more common in the future. Most dermatophyte infections are not serious in healthy
people, although some conditions are easier to treat than
Treatment others. Infections in glabrous skin usually resolve within 2-4
Dermatophyte infections are treated with a variety of weeks with treatment. In contrast, dermatophytosis of the nails
topical and oral antifungal drugs. may be difficult to cure (although the prognosis is better with
In immunocompetent patients, topical agents are usually newer drugs), and relapses can occur. In addition, damaged
effective in cases that are limited to glabrous skin (e.g., tinea nails do not always return to a normal appearance even if the
corporis, tinea cruris, and tinea pedis). Systemic (oral) fungal infection is eliminated. Infections with opportunistic
antifungal drugs may be necessary in severe cases, or if the bacteria can cause cellulitis in skin damaged by interdigital
infection does not respond to treatment or reappears. fungal infections, and are a particular concern in diabetics.
Topical agents are ineffective against organisms that Dermatophytosis has the potential to be more serious in
infect the hairs. These infections are usually treated with immunosuppressed individuals, who may have atypical and
systemic antifungals, although topical lotions or shampoos locally aggressive dermatophyte infections, including
are sometimes used concurrently to decrease shedding of extensive skin disease and subcutaneous abscesses.
fungi and spores, or to help treat kerions. Topical agents may Disseminated disease is also possible, though very rare.
also be used to treat asymptomatic carriers or prevent
reinfection. Tinea capitis is reported to be more difficult to Infections in Animals
treat when it is caused by M. canis than Trichophyton spp.
and may not respond as well to some drugs. Species Affected
Dermatophyte infections of the nails (tinea unguium) are All domesticated mammals are susceptible to
usually treated with oral antifungal drugs. Concurrent dermatophytes. Wildlife can also be affected. The most
therapies may include debridement of the nail or nail avulsion. common agents vary with the host and the geographic region,
Treatment should consider sources of reinfection, such and may also be affected by management practices (e.g.,
as pets, family members or other close contacts. Some whether animals can contact other species). Overall, the most
authors suggest treating all family members when the case is common dermatophytes in domesticated mammals are M.
caused by certain anthropophilic organisms. canis, M. gypseum, T. mentagrophytes, T. verrucosum, T.
equinum and (in pigs) M. nanum. Birds can also be affected by
Prevention some organisms, such as M. gallinae and T. mentagrophytes.
Controlling dermatophytes in animals can prevent some Reptiles are not usually affected by the dermatophytes
cases of zoonotic dermatophytosis in humans. Infected of mammals or birds; however, rare clinical cases associated
animals should be treated, and the premises and fomites with Trichophyton spp. have been reported in lizards, snakes
cleaned and disinfected as much as possible. (Some (green anacondas, Eunectes murinus) and an olive ridley sea
environments can be difficult to decontaminate.) Contact with turtle (Lepidochelys olivacea). One case report in iguanas
infected animals should be limited, and gloves and protective identified the species as T. interdigitale, possibly of
clothing should be used if these animals are handled. anthropophilic origin.

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 Dermatophytosis
Zoophilic dermatophytes • Trichophyton verrucosum, which is adapted to
• Microsporum canis is the most common species of cattle, is the most important dermatophyte in this
dermatophyte in cats and dogs, with cats considered species. T. verrucosum readily infects other hosts,
to be the most important reservoir hosts. This especially sheep, goats, South American camelids
organism is also found regularly in horses and and camels, but it can also be found occasionally in
rabbits, and it has been reported in other animals other species such as horses, donkeys, pigs, dogs
including cattle, sheep, goats, camelids and swine. and rabbits.
Isolates that appear to be adapted to horses were • T. verrucosum var. autotrophicum affects sheep.
previously called Microsporum equinum, but were
moved to M. canis based on genetic analyses. Geophilic species

• Microsporum gallinae occurs in birds, including • M. gypseum is detected occasionally in a wide

poultry. This organism seems to be uncommon in variety of animals, including cats and dogs,
wild birds. Infections are reported occasionally in ruminants, camelids, horses, pigs, rodents, rabbits,
mammals including livestock, especially in some birds and others. It is the most frequently isolated
parts of the world. geophilic dermatophyte in animals.

• Microsporum persicolor primarily affects wild • M. nanum is the most important agent in swine. This
rodents (bank voles and mice). It is found dermatophyte is thought to be uncommon in most
occasionally in other species, especially rabbits and other species, although it has been found
pigs, and dogs that burrow and hunt rodents. This occasionally in rabbits and cattle.
organism infects the skin, but does not invade hairs. Anthropophilic species
• Trichophyton bullosum has been found in horses. It Anthropophilic dermatophytes are reported infrequently
is related to T. verrucosum. in animals (although it is possible that some of these reverse
• Trichophyton equinum, adapted to horses, is an zoonoses are missed). Some species that have been
important cause of dermatophytosis in this species. documented in case reports include M. audouinii, T.
Infections have also been reported in cats, dogs, schoenleinii, T. rubrum, T. tonsurans, T. violaceum and E.
goats, sheep and other species. floccosum. Livestock (e.g., a goat) as well as pets have been
infected. Potential predisposing factors, such as tumors or
• Trichophyton langeronii seems to be adapted to treatment with immunosuppressive drugs, were reported in
camels. some cases.
• Trichophyton mentagrophytes has been reported in
many species of animals, especially rodents and Incubation Period
rabbits. It also affects horses, ruminants, swine, Fluorescence produced by some dermatophytes, such as
cats, dogs, birds and other hosts. M. canis, can appear on the fur within 7 days of exposure,
and clinical signs can develop within 2 to 4 weeks.
• T. mentagrophytes var. erinacei (or T. erinacei)
occurs in the European hedgehog (Erinaceus Clinical Signs
europeus) and the African hedgehog (Atelerix
Dermatophytes usually grow only in keratinized tissues
albiventris). It is seen in pet hedgehogs as well as
such as hair, nails and the outer layer of skin; the fungus stops
animals in the wild. This organism sometimes
spreading where it contacts living cells or areas of
occurs in hunting dogs.
inflammation. Mucus membranes are not affected.
• T. mentagrophytes var. granulosum affects rodents. Dermatophyte lesions in animals are characterized by
One group of organisms, (identified as “the areas with varying degrees of alopecia, scaling, crusts and
Trichophyton anamorph of A. benhamiae” in the erythema, and may or may not be pruritic. Hairs in the
ITS taxonomy) is often associated with guinea pigs, affected area are usually brittle and break near the skin
and appears to the most common dermatophyte in surface, often giving the lesion a “shaved” appearance;
this species. truncated hair shafts may be seen through the scales and
• T. mentagrophytes var. quinckeanum has crusts. Occasionally, dermatophytes may die at the center of
traditionally been associated with mice. However, a lesion and that area resolves, leaving a circular lesion with
it is considered to be a camel-associated isolate in central crusts or hair regrowth. Some degree of folliculitis
the ITS genetic taxonomy. occurs in most cases; papules or pustules involving the hair
• Trichophyton sarkisovii seems to be adapted to follicle or conical dilation of the hair follicle ostium are
camels. suggestive of dermatophytosis in small animals.
Asymptomatic infections are also common, particularly in
• Trichophyton simii affects nonhuman primates, but adult animals.
some authors believe the primary host is a ground-
dwelling animal. It has also been reported from
other mammals and birds.

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 Dermatophytosis
Cats immunosuppressed animals, especially those that have
Many cats infected with dermatophytes have few or no hyperadrenocortictropism or have been treated with
lesions. Long-haired adults, in particular, can be subclinical corticosteroids.
carriers or have only minimal signs, such as patchy areas of Horses
short stubble, alopecia, scales or erythematous plaques,
In horses, most dermatophyte lesions are found in areas
visible only on close inspection. More apparent cases tend
of contact with saddles or other tack. They usually begin as
to be seen in kittens, with the early lesions often found on
small patches of raised hairs, and progress to hair loss, with
the face, ears and paws. In addition to focal alopecia and
variable amounts of scaling, erythema, crusting and
scales, affected areas may develop a thin, grayish white
exudation. M. canis lesions are reported to be milder, in most
crust or a thick, moist scab. They may or may not be
cases, than T equinum. Kerions may occur in some animals,
pruritic. The cat’s grooming behavior may eventually
especially on the face. Miliary dermatitis may also be seen,
spread the infection to the entire body. Other presentations
with small crusted lesions especially on the flanks. Early
that have been reported in cats include miliary dermatitis
dermatophyte lesions can sometimes resemble papular
and recurrent chin acne. Severe cases of dermatophytosis,
urticaria, but more characteristic signs develop within a few
with large, erythematous, alopecic, exudative lesions, may
days. Lesions may coalesce, especially where the skin is
be seen in debilitated cats, or in animals that have been
abraded from tack.
treated with corticosteroids. Onchomycosis can occur
concurrently in cats with dermatophytosis; the nails may be Cattle
opaque, with whitish mottling, and shredding of the nail In cattle, dermatophytosis varies from small focal
surface. lesions to extensive generalized skin involvement. The initial
In some cats, dermatophytosis may appear as one or lesions may be discrete, scaly and alopecic with grayish-
more firm, subcutaneous nodules known as white crusts, and tend to appear on the face and neck in
pseudomycetomas, Pseudomycetomas tend to occur in long- calves. Cows and heifers may have lesions more often on the
haired cats, especially Persians, and are most often found on chest and limbs, and bulls on the dewlap and intermaxillary
the back and the neck. They sometimes ulcerate or form skin. Some areas may become suppurative and thickly
draining sinus tracts. Some cats, but not others, have crusted. Lesions resembling light brown scabs may also be
concurrent cutaneous signs such as alopecia and scaling. seen; when these scabs fall off, they leave an area of alopecia.
True mycetomas have also been reported, though rarely. The clinical signs usually resolve spontaneously in 2 to 4
Uncomplicated dermatophyte lesions are usually self- months.
limiting within a few weeks to a few months in short-haired Sheep and goats
cats; however, the organisms may persist, either
Dermatophytosis tends to be seen in show lambs, but
symptomatically or asymptomatically, in long-haired cats.
appears to be uncommon in production flocks. The most
Dogs noticeable signs are usually circular, alopecic areas with
Dermatophytosis is seen most often in puppies. The thick scabs on the head, face and non-wooled areas of the
lesions frequently develop on the face and limbs, although legs; however, widespread lesions may be found under the
they may occur on any part of the body. M. canis tends to wool when lambs are sheared for showing. In healthy lambs,
appear as small circular areas of alopecia. The hairs are the disease is usually self-limiting.
typically broken at the base, giving the appearance of having Swine
been shaved. The center of the lesion usually contains pale
Pigs may develop a wrinkled lesion covered by a thin,
skin scales in the early stage, giving it a powdery appearance,
brown, easily removed scab, or a spreading ring of
and the edges are generally erythematous. Vesicles and
inflammation. Dermatophyte infections are often
pustules may also be seen. In later stages, the area is often
covered by a crust and the edges swollen. Individual lesions asymptomatic in adult swine.
may coalesce to form large, irregular patches. Lesions caused Rodents
by T. mentagrophytes and T erinacei tend to be more Most rodents infected with T. mentagrophytes are
thickened and inflammatory than those caused by M. canis, asymptomatic or have few clinical signs. There may be areas
while M persicolor typically causes localized or generalized of partial or complete alopecia, erythema, scales, and crusts
scaling with little erythema and minimal alopecia. Other forms in symptomatic animals. In guinea pigs, the lesions tend to
of dermatophytosis can include kerions (localized severe appear first on the face, then spread to the back and limbs. In
inflammation with swollen, boggy skin oozing pus) and mice, the lesions are often found on the tail.
pseudomycetomas. Onchomycosis may occur concurrently
with dermatophytosis. Rabbits
Although dermatophytosis is often self-limited in dogs, Focal alopecia, with erythema, crusts, scales and scabs,
some animals can develop severe, chronic cases with is initially seen mainly around the eyes, nose, ears and dorsal
widespread lesions, and severe inflammation and alopecia. neck. The lesions may later spread to other areas of the body.
Generalized cases in adult dogs usually occur in The disease is usually self-limiting.

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 Dermatophytosis
Hedgehogs or from the entire lesion if there is no inflammatory margin.
Asymptomatic infections are common in hedgehogs. In The best hairs to select are those that fluoresce under a
symptomatic animals, scales may be found on the head, base Wood's lamp, or are broken or scaly. Samples are usually
of the nails and under the pads, but lesions are difficult to see cleared with potassium hydroxide (KOH) to help visualize
between the spines. the organism, although other clearing agents may be used. A
longer clearing time can be helpful when the hair is thicker
Birds and more heavily pigmented, or if the sample is taken from
In cage birds, there may be alopecia and scales, a thick, crusted lesion. Various stains such as chlorazol black
particularly on the face, head, neck and chest, as well as auto- E, Parker blue-black ink, Swartz-Lamkin stain, Congo red
mutilation and feather plucking. The head and neck, stain or Giemsa can aid the visualization of fungal structures.
especially the comb, are often affected in fowl. The lesions In practices where fluorescence microscopy is available,
may include white crusts or plaques and hyperkeratosis. calcofluor white staining can be used.
Although feathers may be lost in birds, they are not infected. Skin scrapings or plucked hair samples for culture should
Reptiles be taken from active lesions, as for microscopic examination.
Reptiles are not usually affected by the dermatophytes Nail beds and claws are cultured in cases of onchomycosis.
of mammals or birds; however, there are rare case reports of Swabbing dermatophyte lesions first with alcohol may
dermal lesions in lizards and green anacondas. Clinical signs decrease contaminants, especially in livestock. Additional
reported during a Trichophyton outbreak in iguanas included collection methods, which are especially helpful in
scaling, crusting, thickening of the skin and ulcerative asymptomatic animals suspected of being carriers, including
dermatitis. Trichophyton spp. infection was associated with brushing the fur with a disinfected toothbrush or other small
papular and pustular cutaneous lesions in a Tenerife lizard. brush, or rubbing it with a sterile piece of carpet.
This animal died of an undetermined illness, soon afterward. Dermatophytes can be cultured on various fungal media,
Trichophyton spp. was also detected by including Sabouraud agar (with cycloheximide and
immunohistochemistry from systemic lesions in a moribund antibiotics) and dermatophyte test medium (DTM). Cultures
sea turtle. are usually incubated at room temperature (20–28ºC), but
higher temperatures can be used when certain organisms
Communicability (e.g., T. verrucosum) are suspected. Colonies often become
Most animal dermatophytes are readily transmitted to visible within 1-2 weeks but, some species grow more slowly
other susceptible hosts, including humans, by contact and and may require longer to appear. Colony morphology can
contamination of the environment. M. nanum of pigs and T. differ with the medium; descriptions are usually based on
gallinae of birds are generally reported to be uncommon in Sabouraud agar. DTM contains a pH indicator (phenol red)
healthy people; however, this may not be the case in all that will turn the medium red when a dermatophyte is growing.
locations. One study found that T. gallinae was the third most However, the mycelial growth must also be examined
frequent dermatophyte of children in Nigeria. microscopically, as this color change alone is not diagnostic
and could be produced by other fungal or bacterial organisms.
Post Mortem Lesions Click to view images In addition, the color change may be delayed with certain
Gross post-mortem lesions are usually identical to those dermatophytes such as M. persicolor. In asymptomatic
in live animals; with the exception of pseudomycetomas and animals, caution must be used to distinguish infection from
mycetomas, dermatophytes are restricted to the hair, nails contamination of the coat with organisms from the
and superficial skin. environment.
Dermatophyte species can be identified by the colony
Diagnostic Tests morphology; the appearance of microconidia, macroconidia
Dermatophytosis is usually diagnosed by a combination and other microscopic structures; biochemical characteristics
of direct microscopic examination, culture and Wood’s lamp such as urease production; and nutritional requirements.
examination. Biopsy (histopathology) tends to be used Microconidia and macroconidia can be used to distinguish the
mainly when the presentation is unusual. genera Microsporum, Trichophyton and Epidermophyton.
A Wood’s lamp examination for fluorescence can be Members of Microsporum spp. produce microconidia and
helpful in detecting some species of dermatophytes, such as rough-walled, multiseptate macroconidia. The thickness of
M. canis and T. quinckeanum. Not all strains of these the wall, shape and number of macroconidia vary with the
organisms exhibit fluorescence. Certain topical preparations species. Trichophyton spp. produce microconidia and
may mask the fluorescence, and alcohol can either suppress smooth, thin-walled, cigar shaped macroconidia.
it or cause non-specific fluorescence. Macroconidia are rarely seen with some species. E.
Microscopic examination of skin scrapings or plucked floccosum, which is anthropophilic and has very rarely been
hairs may reveal hyphae or arthroconidia. Hyphae rounding reported in animals, produces large, thin-walled,
up into arthroconidia are diagnostic; however, hyphae alone multicellular, club-shaped, clustered macroconidia. This
could be caused by other fungi, including contaminants. organism does not produce microconidia. Specialized tests,
Samples should be selected from the margins of active lesions, such as the ability to penetrate hairs in vitro, or mating tests

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 Dermatophytosis
performed at reference laboratories, may occasionally be Prevention
used in the differentiation process. Differential media (e.g., To prevent the introduction of dermatophytes into herds
bromocresol purple - milk solids glucose) can also be or kennels, newly acquired animals should be isolated and
helpful. cultured. Wild rodent control can decrease exposure to T.
Histology may be used in some cases, especially in mentagrophytes. Some organisms can be acquired by contact
animals with pseudomycetomas. The organisms are with infected soil.
visualized best with periodic acid–Schiff (PAS) staining, To prevent infected animals from transmitting
although they may also be found in hematoxylin-eosin dermatophytes to others, they should be isolated until the
stained preparations. infection has resolved. The premises should be cleaned and
PCR tests have been published for a number of disinfected. Some environments (e.g., barns) may be difficult
organisms, including zoophilic organisms, and molecular or impossible to decontaminate completely. Animals that
methods of diagnosis might become more common in the have been in contact with the patient should be checked for
future. asymptomatic infections. Some veterinarians use topical
antifungals prophylactically for in-contact animals.
Treatment Dermatophytes can be difficult to eradicate from
Healthy animals often have self-limiting infections that environments such as kennels, catteries and animal shelters.
resolve within a few months, but treatment can speed Successful treatment of these premises must be based on
recovery, prevent the lesions from spreading, and decrease good environmental control, as well as treatment of
the risk of transmission to people or other animals. Some symptomatically and asymptomatically infected animals.
individual animals, particularly those that are debilitated or
Vaccines are available in some countries for certain
unusually susceptible, may not clear the infection without
organisms, such as T. verrucosum and T. mentagrophytes in
treatment.
livestock, farmed foxes, chinchillas and rabbits; T. equinum
Drugs available to treat dermatophytosis in animals in horses; and M canis in cats and dogs. A feline vaccine
include topical antifungal creams or shampoos, and systemic licensed for M. canis in the U.S. was found to be ineffective
antifungals. The same treatment principles apply in animals under field conditions, and was withdrawn by the
as people; however, practical considerations limit the use of manufacturer in 2003. Studies of other vaccines have
systemic antifungals in some species. Topical drugs are demonstrated varying efficacy.
unable to eliminate dermatophytes from within hairs and hair
In some countries, vaccines have been used in
follicles, but they may be effective against organisms in
dermatophyte eradication campaigns for cattle. In Norway,
superficial sites (e.g., in the skin), and they can decrease
there is a program to eradicate T. verrucosum from cattle
contamination and transmission to others. The optimal
herds by vaccination, disinfection of contaminated stables,
treatment in small animals is combined topical and systemic
isolation of infected animals and good hygiene. In one region
treatment. Systemic antifungals are rarely used in large
of Norway, where 95% of herds participated, the prevalence
animals, due to the cost of these drugs and the typically self-
of cattle ringworm decreased from 70% to 0% over a period
limited nature of the disease. The side effects of systemic
of 8 years. In the former Soviet Union, a vaccination
drugs should also be taken into consideration when choosing
campaign reduced the prevalence of T. verrucosum in cattle
a treatment plan. Clipping the hair before treatment is
to less than 1% by 1984.
controversial. It may aid the penetration of topical drugs, as
well as remove infected hairs. However, it may also result in Morbidity and Mortality
trauma to the skin and help disseminate the infection. If the Whether an animal becomes infected after contact with
animal is clipped, this should be done with care.. Some a dermatophyte may depend on the animal’s age, the
animals such as cattle develop thick crusts, which should be condition of its exposed skin, general health and grooming
removed by gentle brushing. behavior. Young animals, including puppies, kittens, calves,
Onchomycosis can be very difficult to cure; long term lambs and young camelids, are more likely to have
treatment or surgical declawing may be necessary. symptomatic infections than adults. Clinical
Pseudomycetomas and mycetomas are also reported to be dermatophytosis is also thought to be more common in
difficult to treat, often recur after surgery, and may not respond immunosuppressed animals. Most infections in healthy
to some drugs. Nevertheless, some cases have been treated animals heal spontaneously within one to a few months. Hair
successfully with drugs and/or surgery. loss is not permanent unless the follicle has been destroyed
Animals should be isolated until the infection resolves. by inflammation. Infections can be more persistent or
Confining the animal to an environment that is easily cleaned widespread in young or sick animals. Breeds reported to
can facilitate environmental control. Dermatophytes can be more susceptible to dermatophytes include some long haired
difficult to eradicate from environments such as kennels, cats, and possibly Yorkshire terriers. Long-haired cats,
catteries and animal shelters. especially Persians, are also more likely to develop
pseudomycetomas and mycetomas.

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 Dermatophytosis
Dermatophytes can be isolated from animals with or Ameen M. Epidemiology of superficial fungal infections. Clin
without clinical signs. Highly variable infection rates, Dermatol. 2010;28(2):197-201.
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catteries. The estimated prevalence among pet cats and dogs M. Is Trichophyton simii endemic to the Indian subcontinent?
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interdigitale revisited: a multigene phylogenetic approach.
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Med Mycol. 2012;50(8):871-82.
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periods of time. This disease usually becomes endemic in Canine dermatophytosis caused by an anthropophilic species:
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stabled indoors in winter, and to resolve when they are turned Cafarchia C, Camarda A, Coccioli C, Figueredo LA, Circella E,
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(USDA APHIS) provided funding for this factsheet through
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development of resources for initial accreditation training. species of clonal fungi. Med Mycol. 2006;44(3):199-209.
The following format can be used to cite this factsheet. Gräser Y, Scott J, Summerbell R. The new species concept in
Spickler, Anna Rovid. 2013. Dermatophytosis. Retrieved dermatophytes-a polyphasic approach. Mycopathologia.
from http://www.cfsph.iastate.edu/DiseaseInfo/ 2008;166(5-6):239-56.
factsheets.php. Gupta AK, Cooper EA. Update in antifungal therapy of
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