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Am Fam Physician. 2025;112(4):382-392

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Tinea infections (often called ringworm) are caused by dermatophyte fungi and classified by the body site involved. Tinea corporis and tinea capitis are most common in prepubertal children, and tinea cruris, tinea pedis, and tinea unguium (most common type of onychomycosis) are more likely in adolescents and adults. Clinical diagnosis without testing may be unreliable because other conditions can resemble tinea infections (eg, tinea corporis can be confused with eczema, and onychomycosis with dystrophic toenails from repeated low-level trauma or psoriasis). Tinea corporis, tinea cruris, and tinea pedis generally respond to inexpensive topical antifungal agents, but oral antifungal agents may be indicated for patients with extensive disease, lack of response to topical treatment, immunocompromise, or hair follicle involvement (eg, tinea capitis). Oral terbinafine is considered first-line therapy for tinea capitis and onychomycosis because it is well tolerated, effective, and inexpensive. Emerging tinea infections may be more severe than classic tinea infections and generally do not improve with first-line topical or oral antifungals. These infections may require prolonged oral antifungal therapy and specialized diagnostic testing. Antifungal stewardship, including avoiding the use of combination antifungal-corticosteroids, should be emphasized to optimize outcomes and help prevent resistance.

Tinea infections (often called ringworm) are common superficial fungal infections caused by dermatophyte molds1,2 (Table 11). The word tinea is usually followed by a Latin term to indicate the body site involved, such as tinea corporis or tinea pedis. Onychomycosis is a general term for fungal nail infections, which are most often caused by dermatophytes (tinea unguium) but may be caused by yeasts or non-dermatophyte molds.3,4 The most common dermatophytes that cause human infections are from the genera Trichophyton, Microsporum, and Epidermophyton.37

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