According to the CDC, several fungal infections are prevalent among school-aged children, with one of the most common being tinea, which has different names depending on the affected body part. The severity of fungal infections can vary, with some causing mild irritation and others penetrating deeper layers of the skin, resulting in symptoms like itching, swelling, blistering, or scaling. Some fungal infections can even trigger reactions elsewhere on the body. School nurses must be aware of these tinea infections and their symptoms to provide appropriate interventions and prevent their spread among students.

 Tinea Capitis

Also known as scalp ringworm, tinea capitis is a common fungal infection among children ages 2 to 10, especially those in crowded settings, including schools. It is highly contagious and can spread quickly through personal contact and shared items, such as combs, brushes, blankets, and hats. The symptoms of tinea capitis can include a scaly rash on the scalp, itching, and hair loss. On assessment, redness, swelling, and pus-filled sores may be noted, along with oozing and yellowish crusts, which can be mistaken for impetigo. School nurses should encourage treatment that requires oral antifungal medication and, in some cases, medicated shampoos to prevent further transmission. Exclusion policies generally allow students with tinea capitis to return after initiating treatment.

 Tinea Pedis

Athlete's foot, or tinea pedis, is a fungal infection that affects the feet and is commonly acquired in warm, moist environments. The symptoms of tinea pedis include itching, burning, and scaling of the skin between the toes or other areas of the foot. Blisters and cracks may also form, leading to secondary bacterial infections, and on assessment, there may be a putrid odor. The infection is highly contagious and can spread easily through contact with contaminated surfaces or personal items. Treatment for tinea pedis includes keeping the affected area clean and dry, applying topical antifungal medications as prescribed, and wearing breathable shoes and socks. Students with athlete's foot infections who are otherwise well should not be excluded from school or activities.

 Tinea Cruris

When the fungal infection affects the groin or perianal area, it is known as jock itch or tinea cruris. Not easily transmissible, jock itch is more prevalent in males, and students who are overweight may be more susceptible. Symptoms include redness, itching, and rash; the affected skin may also appear scaly or have a burning sensation. Treatment for tinea cruris typically involves keeping the infected area clean and dry, using OTC antifungal creams, and avoiding tight clothing that can cause irritation. If symptoms persist or worsen, students should be referred for further evaluation.

 Tinea Corporis

The fungal infection most often referred to as ringworm is tinea corporis, a fungal infection of the trunk and limbs. It usually presents as circular or oval-shaped rashes with raised borders and clear centers. The rashes are typically itchy, red, scaly and may have blisters. In severe cases, they may become crusted or ooze fluid. Students may also be asymptomatic, and tinea corporis lesions can be easily mistaken for eczema or seborrheic dermatitis, so careful evaluation of other potentially affected body areas is critical. Treatment for ringworm can include both OTC and Rx antifungal creams, oral antifungal medication, or a combination of both. According to the AAP, students should be excluded from school until treatment has been initiated, and student-athletes with ringworm in sports with person-to-person contact should not participate for 72 hours after starting treatment unless the affected area can be covered.

 Prevention

Education and awareness campaigns to prevent fungal infections should include reminders on healthy hygiene habits, including proper bathing or showering, frequent shampooing, wearing clean underwear and socks every day, avoidance of sharing hats, hair clips, or other personal items, and wearing sandals in public locker rooms, showers, or swimming pools.

Tinea in schools is relatively common, but while these fungal infections can be uncomfortable, distressing, and unsightly, they are typically not serious and can be managed with early identification, proper care, and appropriate treatment.