The term “tinea” refers exclusively to dermatophyte infections. It is also known as Dermatophytosis, ringworm, or candida infection. The frequency of occurrence of such infection has drastically increased in the past few years.[1] They usually appear in ring like patterns and hence the term ringworm. Tinea continues to become a worldwide problem especially in tropical countries. The increased incidence is usually due to lack of awareness about the prevention and management of this condition. As per recent data, it is estimated that around 10% to 20% of the world’s population is affected by fungal skin infections.[2]The Royal College of General Practitioner’s Birmingham Research Unit reported an annual incidence of dermatomycosis of 16 per 10,000 persons (age standardised).[3] Many homeopathic medicines have been found to be effective in the treatment of Tinea infections. It is considered much safer and curative in such conditions as compared to conventional treatments.
Common causes, symptoms, and diagnosis of Tinea
Trichophyton, epidermophyton and microsporum species of dermatophyte are responsible for most of the superficial fungal infections.[4]Fungi invade the dermis of the skin and start growing in dead keratin. Tinea infection can spread from human to human, animal to human, soil to human and any object to human through touch. Using public showers, contact sports such as wrestling, excessive sweating, contact with animals, obesity, and poor immune function are some of the common risk factors.[5],[6] Tinea corporis (ringworm on body), athlete’s foot (tinea pedis), jock itch (tinea cruris)tinea unguium (infection of the nail), tinea faciei, tinea manuum, tinea barbae, tinea imbricata and ringworm of the scalp (tinea capitis) are the common types of ringworm. Symptoms of tinea may manifest about 4 to 10 days after contact with the fungus. Mostly tinea infections are circular, ring-shaped, with itching and edges are slightly raised.These lesions or patches may be slightly red and often have a scaly border. In tinea capitis itching, dandruff, and hair loss are the common symptoms. Visual examination of the affected area is the common diagnosis process which can be confirmed by taking skin scrapings at the site of the infection for skin biopsy or fungal culture. Tinea infection can be diagnosed bypotassium hydroxide (KOH) examination. In KOH examination usually scrape of a small area of infected skin is placed in potassium hydroxide which destroys the normal cells and leaves the fungal cells untouched.[7]
Notable difference between different types of tineas
| Tinea corporis | Tinea pedis | Tinea cruris | Tinea capitis | Tinea unguium | |
| Location | Ringworm on body | Foot | Genitals, inner thighs and buttocks. | Scalp | Nail |
| Symptoms | Red circular rash, itching, edges are slightly raised | Scaly red rash, typically begins in between the toes, Itching worst after taking off shoes and socks, blisters or ulcers may appear. | reddened half-moon shaped eruption, flaky eruption, itching | Scaly, gray or reddened areas, brittle or fragile hair, painful areas on the scalp. | white or yellow streaks on the nail, scaling of the nail, crumbling corner, distorted nail, thickened nail |
| Causative fungus | Trichophyton mentagrophytes and Micosporumcanis | Epidermophytonfloccosum, Trichophyton rubrumand T. mentagrophytes. | Trichophyton mentagrophytes and Micosporumcanis | Trichophyton mentagrophytes and Micosporumcanis | Trichophyton mentagrophytes and Micosporumcanis |
General management and preventive measures
Fungal infection can be managed by maintaining general hygiene like washing hands with soap and running water after playing with or petting animal, avoiding sharing towels, hats, hairbrushes, and clothing,maintaining good personal hygiene around other people and avoiding scratching the affected areas. After getting wet, drying skin properly especially between the toes and where there are skin folds, such as in the groin and armpits would also be helpful.
Homeopathic management
There are several homeopathic medicines being used for treatment of tinea infection but polycreteshomeopathic medicines are found to be more effective to prevent it’s recurrence. Burnett says that it is a constitutional complaint. It is generated by the together-being of number of young people in close spaces. That it is so to speak ‘subtuberculosis’.” He also says that mycosis (fungal infection) is merely the concomitant external manifestation of the disease, not disease itself.
Commonly used drugs:
| Remedies | Indication |
| Arsenicum album | Skin eruption with burning sensation, anxiety and restlessness. Suitable for fastidious individual. Great exhaustion after the slightest exertion. Burning sensation relief by warm application. Itching worse at night especially midnight. Great thirst; drinks much, but little at a time.Great anguish and restlessness. Changes place continually.Ulcers with offensive discharge.Periodicity is well marked. |
| Belladonna | Dr. William Boericke says Belladonna always is associated with hot, red skin, flushed face, itching come and go suddenly. Melancholy with grief and discouragement; nervous anxiety and restlessness; dread of all exertion and motion. Eruption spread suddenly and violently. |
| Croton tiglium | Intense itching; but scratching is painful.Pustular eruption, especially on face and genitals, with fearful itching, followed by painful burning. Itching is worse from during summer; touch, night and morning, washing.Intense itching of genitals of both sexes. Eruption so sensitive and sore is unable to scratch. |
| Bovista | Has a marked effect on the skin, producing eruption like eczema. Itching on getting warm. Eruption moist form thick crusts. Herpetic eruptions.Persons who suffer from tettery eruptions, dry or moist.Intolerable itching at tip of coccyx; must scratch till parts become raw and sore. |
| Dulcamara | Tinea infection brought on or aggravated by exposure to cold, damp, rainy weather, or sudden changes in hot weather. Increased secretions of mucous membranes. Patients living or working in a damp, cold basement. Thick, brown-yellow crusts, bleeding when scratched. |
| Graphites | Eruptions, oozing out a sticky exudation. Rawness in bends of limbs, groins, neck, behind ears. Every little injury suppurates. Glutinous discharge from eruption. |
| Sepia | Herpes circinatus in isolated spots. Itching; not relieved by scratching; worse in bends of elbows and knees. Ringwormlike eruption every spring. Sweat on feet, worse on toes; intolerable odour. Itching of skin; of various parts; of external genitalia; is ameliorated by scratching; and is apt to change to burning. Itching is worse in afternoon or evening; from cold air or dry east wind, Better, by exercise, pressure, warmth of bed, hot applications. |
| Calcareacarbonica
|
Patients have fear of contagious disease, delusion of incurable disease, obstinate metal personality; laziness, etc. are the common mental general of Calcareacarbonica patient. Herpes circinatus worse towards morning, in bed. Chaps, or rhagades, especially in those who work in water.Ringworm eruptions moist, scurfy. Icy coldness in, and on the head, much perspiration, wets the pillow.Aversion to meat, boiled things, craving for indigestible things-chalk, coal, pencils; also for eggs, salt and sweets. |
| Natrum muriaticum | Psychic causes of disease, ill effects of grief, fright, anger, etc. Herpes cincinnatus; pemphigus, blisters starting up on burning spots, with clear, watery contents; watery blebs. Tetter in bends of joints, oozing of an acrid fluid; crusts with deep cracks, scaly eruptions on flexor surfaces; scabs on head and in axillae.Unquenchable thirst. Sweats while eating. Craving for salt. |
| Tellurium Metallicum | Itching of hands and feet. Herpetic spots; ringworm. Ring-shape lesions, offensive odors from affected parts.Worse, while at rest at night, cold weather, from friction, coughing, laughing, and lying on painful side, touch. |
Mother tinctures for internal usage
Allium ursinum: It is reported to be useful in rhinitis. It has antibacterial and antifungal[8] properties, as well as antioxidant properties that protect against free radicals.
Azadirachtaindica: In the recent study it is found that Azadirachtaindica has medicinal properties like anthelminthic, antifungal, antidiabetic, antibacterial, antiviral, etc due to presence of nimbin, nimbinin, and nimbidin.[9]It is also useful in skin diseases and leprosy.
Berberisaquifolium: Recent studies have also showed its antifungal, antiradical and antioxidant activities.[10]
Curcuma longa: Research favourably speak for cough, dysponoea, antifungal, CNS depressant and cholesterol lowering properties and anti-rheumatic.
Echinacea angustifolia: Research establishes it as immune stimulant against both virus and bacteria, is antifungal, anti-inflammatory, detoxifying, wound healing drug. This is a remarkable medicine as a “corrector of blood dyscrasia”.
Cassia fistula: Many recent studies have confirmed its anti-inflammatory activity, wound healing activity, antifungal activity, etc[11].Excessive perspiration; offensive all over the body.
Droserarotundifolia: Prickling, burning, stinging, itching, gnawing in skin. Violent itching while undressing; when scratching, skin readily peels off.
Remedies for local application
Fraseracaroliniensis: Research on its alkaloids reveals properties to reduce blood pressure, sedative, anti-fungal.Externally the tincture is antifungal.
Cassia sophera: Externally it may be useful in ringworm because of its chrysophanic acid contents.
References
[1]ShyamVerma and R Madhu. The Great Indian Epidemic of Superficial Dermatophytosis: An Appraisal. Indian J Dermatol. 2017 May-Jun; 62(3): 227–236.
[2]Guidelines on the Treatment of Skin and Oral HIV-Associated Conditions in Children and Adults. Geneva: World Health Organization; 2014.National Center for Biotechnology Information, U.S. National Library of Medicine.
[3]Annual Prevalence Report, Birmingham Research Unit; Royal College of General Practitioners, 2007
[4]Martinez DA, Oliver BG, Graser Y, et al; Comparative genome analysis of Trichophyton rubrum and related dermatophytes reveals candidate genes involved in infection.MBio. 2012 Sep 43(5):e00259-12. doi: 10.1128/mBio.00259-12. Print 2012.
[5]“Ringworm Risk & Prevention”. CDC. December 6, 2015. Archived from the original on 7 September 2016.Retrieved 5 September 2016.
[6]Domino, Frank J.; Baldor, Robert A.; Golding, Jeremy (2013).The 5-Minute Clinical Consult 2014.Lippincott Williams & Wilkins.p. 1226.ISBN 9781451188509.Archived from the original on 2016-09-15.
[7]https://www.healthline.com/health/ringworm#diagnosis, Mailing Address 40 West 25th Street, 5th Floor New York, NY 10010
[8]Marcel Pârvu, Alina E. Pârvu, LaurianVlase, OanaRosca-Casian and OvidiuPârvu, Antifungal properties of Allium ursinum L. ethanol extract, Journal of Medicinal Plants Research Vol. 5(10), pp. 2041-2046, 18 May, 2011
[9]Glossary of Indian Medicinal Plants, C.S.I.R., Publication and Information Directorate, Council for Scientific and Industrial Research, New Delhi, 1992.
[10]Anna Volleková, Daniela Košt’álová2,Viktor Kettmann, Jaroslav Tóth, Antifungal activity of Mahoniaaquifolium extract and its major protoberberine alkaloids, Phytotherapy Research, volume 17, Issue 7, pages 834–837, August 2003
[11]Mohd.Danish, et al., Cassia fistula Linn. (Amulthus)- An Important Medicinal Plant: A Review of Its Traditional Uses, Phytochemistry and Pharmacological Properties, J. Nat. Prod. Plant Resour., 2011, 1 (1): 101-118