fungal infections for physians

Digafe Tsegaye MD + Dermato-venerologist

Hon. Assistant professor at MMS

Superficial

Deep

Superficial fungal infections

Defintion : limited to the stratum corneum, hair and nails

Etiology Dermatophytes Yeast

Malssezia furfur Candida albicans

Dermatophytes Three genera

Epidermophyton Trichophyton Microsporum

Modes of transmission Anthropophilic ( human to human)

Zoophilic ( from animal to human)

Geophilic (fom soil to human) The latter two trigerres inflammatory response.

Dermatophytosis Tinea capitis T.facium T.corporis T.cruris Tinea barbae T.ungium T.Mannus T.pedis

T.capitis

Is infection of the hair over the scalp caused by dermatophtes.

It is a disease of children b/n age group of2 yrs upto puberty

Should be always treated by systemic antifungal ; either griseofulvin or fluconazole

Types of tinea -capitis

Non-inflammatory t.capitis Gray-patch ,seborrehic ,black dot

Inflammatory t.capitis Favus ,keroine

Gray patch type of tinea capitis

Gray patch type of tinea capitis

Tinea corporis involving the scalp

Seborrehic type

Black Dot type Hair break at the level of the scalp

Favus yellow cap shaped crusts termed scutula, which surround the infected hair follicles.

Deep ,boggy and pustular lesions (keroin) :cervical LAP

Treatment

Griseofulvin 15-20 mg/kg at night for 6-8 weeks ; taken with fatty meal.

Fluconazole 4-6 mg /kg for one month

T.pedis

Chronic intertriginous type Chronic hyperkeratotic type

(mucosain) Ulcerative type Vesiculo bullous type

Interdigital type

Interdigital type

Mucosain type

Two feet one hand syndrome

Vesiculobullous type

Ulcerative type

Treatment

Topical antifungals like ketoconazole cream bid for 4 weeks

Wash the feet daily with soap Change the soaks daily

Tinea corporis

Annular plaque with central healing ->t.corporis

Ketoconazole cream or clotrimazole cream apply bid for 1 month.

Tinea corporis

Ring shaped leisons with central healing and peripheral activity .notice the vesicles at th edge

t.corporis

T.Cruris (jock itch ) Always unilateral Well defines edge Scaly border Scrotum is rarely

involved Rx: keep the area

dry ;light clothing Topical or

systemic antifungal

t.cruris Rx : Systemic

antifungal ( griseofulvin) 500 mg night for one month

Always unilateral Well defines edge Scaly border Scrotum is rarely

involved Rx: keep the area

dry ;light clothing Topical or

systemic antifungal

Distal lateral subungal Onychomycosis

Cause

Major ones are Dermatophtes (T.rubrum)

Also candida ,molds(aspegillus

RxFluconazole 200mg -400mg/week for 24 weeks or Griseofulvin 500mg po night for 6 months

Proximal subungal onychomycosis (associated with HIV ) Cause

Major ones are

Dermatophtes (T.rubrum)

Also candida ,molds(aspegillus

Superficial whitish onychomycosis

Cause

Major ones are Dermatophtes (T.rubrum)

Also candida ,molds(aspegillus

Total dystrophic onychomycosis

Cause

Major ones are Dermatophtes (T.rubrum)

Also candida ,molds(aspegillus

Rx ; no Rx

Treatment Fluconazloe 200-400mg weekly for 12 -

24 weeks Itraconazloe

100mg/d for 1 week each month for two months ( two pulse therapy ): for finger nails

Three pulses for toe nails 1 pulse : 100mg/d for 1 week Terbinafine 250 mg for 2 months finger

nails : three months for toe nails

Candidal infection

Oral candidiasis Vulvo-vaginal candidiasis Intertrigo Paronychia Candidal onycomycosis

Oral candidiasis

intertrigo intertrigo

intertrigo

Pseudo memraneous type oral candidiasis

Atrophic type of OC

Candidal leukoplakia

Angular chelitis

Angular cheliosis

C.paronychia

balanitis

Vulvo-vaginitis

Treatment of candidiasis Topical Imidazole creams , gel ,

suppository Clotrimazole:500mg stat/

200mg x 3d / 100mg x 6d / 10% vaginal cream 5g stat

Nystatin 4g cream x 14d / 1-2 pessaries x 14d

Systemic Fluconazole 150mg PO

stat Itraconazole 200mg PO

BID 1 day Weekly dose of

Fluconazole PO 100mg , Clotrimazole PV 500mg, or Itraconazole PO 400mg monthly for six months is required for recurrent VVC.

Treating asymptomatic sexual partner is not needed

Tinea(pityriasis) versicolor A common, benign,

superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and the back.

M furfur : dimorphic Diagnosis :

Wood's lamp :- coppery-orange fluorescence of tinea versicolor

potassium hydroxide under microscope : spaghetti and meatballs

topical ketoconazole/selenium sulfide