Diagnostic Considerations

Consider the following:

Hyperpigmentation due to pinta
Chemical stains
Junctional nevi, postinflammatory pigmentation, melanoma, and melanosis of syphilis and pinta^[25]
Superficial phaeohyphomycosis: Even in an immunocompetent individual, clinical and microscopic patterns may be similar to tinea nigra, but with the culture showing Aureobasidium melanogenum.^[26]
Tattooing from dirt or other substances^[27]

Lichen planus may rarely be evident as asymptomatic black patches on both palms, simulating tinea nigra.^[28]

The recognition of tinea nigra is crucial to prevent any unnecessary diagnostic procedures for the evaluation of pigmented lesions. Tinea nigra may easily be confused with a junctional nevus or acral lentiginous melanoma,^[29]which would require excisional biopsy. Furthermore, suspicion of a melanoma may cause unnecessary anxiety in a patient. A simple microscopic examination of the skin scrapings of the affected area readily aids the distinction between tinea nigra and other serious medical disorders that result in pigmentary changes.

Differential Diagnoses

Workup

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Media Gallery

Tinea nigra, evident as a painless cluster of brown-to-black macules. Courtesy of Dr. Peter Santalucia.
Tinea nigra, showing hyperkeratosis and mild acanthosis. A scant amount of perivascular lymphocytic infiltrate may be found in the papillary and subpapillary layers of the dermis (hematoxylin and eosin stain). Courtesy of Thomas N. Helm, MD.
Tinea nigra, with histologic section demonstrating periodic acid-Schiff–positive septate hyphae within the stratum corneum. Courtesy of Thomas N. Helm, MD.
Micrograph of the Hortaea werneckii fungus, which is a causative agent of tinea nigra. Courtesy of CDC Public Health Information Library (PHIL) and Wikimedia Commons.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Vinay Arya, MD, to the development and writing of this article.

Tinea Nigra Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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