Dermatomycosis/Tinea - Xuan

Definition

A group of diseases caused by mycotic (fungal) infection of the skin. They are superficial but communicable and infectious.

There are tinea capitis (Tou Xuan), tinea corporis (Ti Xuan), tinea cruris (Gu Xuan), tinea mannum (Shou Xuan), tinea pedis or Hong Kong foot or athlete’s foot (Zu Xuan), tinea unguium (Jia Xuan) and tinea versicolor (Hua Ban Xuan).

Tinea Capitis

Mycosis of the skin
Hairy part of the scalp
There 3 types: tinea favosa (Huang Xuan – yellow), tinea alba (Bai Xuan – white) and tinea nigra (Hei Xuan – black), caused by different fungus, and when pus forms they become kerion (Nong Xuan – pus).
TCM – caused by Wind Damp Heat and “worms” in the skin

Tinea favosa: can cause scarring and permanent hair loss. At the beginning, there are yellowish-red dots around hair follicles. They will then enlarge, thicken to form yellow, brown or grey scab and crust. Further development will see typical scutula (Huang Xuan Jia). Round and yellow colour scabs, dish-like (higher on the edge and lower in the middle), adhered to the scalp, through the middle there are a few pieces of hair, there is a distinctive smell (like mouse urine or rotten wheat). Under the scabs, there is red and moist skin surface which is slightly concave and itchy. Dry and dull hair. Permanent hair loss due to atrophic scars and destruction of hair follicles.

Tinea alba: at the beginning there are small and red pimples at hair follicles with greyish white scales. They then develop into bigger patches with bigger greyish white scales and a clear border. Hair loses its shine and becomes bristle, and breaks at 2-3 mm from its root to leave uneven hair. Surrounding the hair there is a white sheath (which is a group of fungus). There is no or just a little inflammation in the skin, with itch, pimples and scab. No scars. Occurs in young children and can cure itself in puberty.

Tinea nigra: pea sized scaly patches but sometimes the patches can be bigger. Hair breaks early with this infection and at the opening of follicles (so the lesion has black or other darker dots).

Kerion (Nong Xuan): a group of follicles are infected to form a swelling patch and then develop into a bigger and red lump. There are a number of holes with pus discharge and pus scabs. Not to painful. Hair breaks or falls off. Scars when it heals.

Pityriasis capitis – widespread scales, no broken hair, no fungus.
Psoriasis (Yin Xie Bing – silvery scale disease) – patches with silvery white scales, dull red and clear border, hair in bunches. No fungus.
Seborrheic dermatitis – greasy scale and inflammation, itchy, also lesions outside scalp, adult.
Alopecia areata (Ban Tu – patchy hair loss): sudden hair loss in patches, no scale, no inflammation and no itch.