Fungal Infections of The Skin: by Bekele T. (BSC, MSC) 1

FUNGAL INFECTIONS
OF THE SKIN
BY Bekele T.(BSc,MSc) 1
Dematophytosis
Superficial infections of keratinized tissue
caused byorganisms of three genera of fungi
known as the dermatophyte; Microsporum,
Trichophyton, and Epidermophyton
They are named based on the site of infection
Tinea Capitis
Very common invasion of hair shafts by a
dermatophyte fungus
Etiology varies from country to country. Mostly
Trichophyton spp
Transmission occurs from person to person,
animal to person, or via fomites
Poverty, debilitating chronic illness and
malnutrition are risk factors
Tinea Capitis
It could be inflammatory or non inflammatory
based on species involved.
Affects toddlers and school age children,
sometimes as epidemics. Rare after 16 years.
Different clinical varieties occur.
Tinea Capitis
Grey Patch:
patches of scalp alopecia with scale.
Small patches coalesce, forming larger
patches. Inflammatory response minimal
but massive scaling
Tinea Capitis
Black Dot:
Broken-off hairs near surface give
appearance of dots. Tends to be
diffuse and poorly circumscribed.
Resembles seborrheic dermatitis.
Tinea Capitis
Kerion:
Characterized by boggy,
purulent, inflamed nodules and
plaques extremely painful;
drains pus from multiple
openings, like honeycomb
Tinea Capitis
Favus:
Thick yellow adherent crusts
(scutula) composed of skin
debris and hyphae that are
pierced by remaining hair
shafts. Fetid odor.
Tinea Capitis
Treatment is with griseofulvin 15 to
20mg/kg/d at least for six weeks.
Better absorption with fatty food.
Topical agents are ineffective.
All contacts and family members
should be examined and treated.
Chronic untreated kerion and favus,
can result in permanent scarring
alopecia BY Bekele T.(BSc,MSc) 26
Tinea Corporis
Dermatophyte infections of the trunk,
legs, and arms, ex-cluding the feet,
hands, and groin.
Occurs in all ages as single
(occasionally multiple) circular
arcuate lesions with active raised
margin and a tendency to clear
centrally.
Mostly asymptomatic
Tinea Corporis
Granulomatous reactions (Majocchis
Granuloma) and bullae formation
with pruritis may occur.
Tinea Corporis
White fields ointment, topical
azoles(1% Clotrimazole,
2%Ketoconazole) treats localized
cases effectively.
Should be given continuously till the
lesion clears completely, at least three
weeks.
Systemic antifungals for extensive
cases.
Tinea Manuum
Chronic dermatophytosis of the
hand(s), often unilateral, most
commonly on the dominant hand,
and usually associated with tinea
pedis.
Tinea Manuum
Chronic dermatophytosis of the
hand(s), often unilateral, most
commonly on the dominant hand,
and usually associated with tinea
pedis.
Tinea Manuum
After treatment, recurs unless
dermato-phytosis of fingernails, feet,
and toenails is eradicated. Fissures
and erosions pro-vide portal of entry
for bacterial infections.
Tinea Cruris
Subacute or chronic dermatophytosis
of the groin, pubic regions, and
thighs.
Also called as Jock Itch.
Warm, humid environment; tight
clothing worn by men, obesity and
topical steroid application are
aggravating factors.
Most have tinea pedis.
Tinea Cruris
Prevention is important.
Antifungal powder or soap is
frequently used.
Often recurrent in which prolonged
systemic antifungals are required.
Tinea Facialis
Dermatophytosis of the glabrous
facial skin, characterized by a well-
circumscribed erythematous patch,
and is more commonly misdiagnosed
than any other dermatophytosis.
Tinea Facialis
Topical antifungals with eradication
of dermatophytosis from other sites
is the treatment.
Tinea Pedis
Dermatophytic infection of the feet,
characterized by erythema, chronic
diffuse desquamation, and/or bulla
formation.
More common in males than females.
Hot, humid weather; occlusive
footwear; excessive sweating are
predisposing factors
Tinea Pedis
Transmission occurs with walking
barefooted on contaminated floor,
sharing of sandals.
Often asymptomatic.
Pruritis and pain with secondary
infection may occur.
Different clinical varieties exist
Tinea Pedis
Transmission occurs with walking
barefooted on contaminated floor,
sharing of sandals.
Often asymptomatic.
Pruritis and pain with secondary
infection may occur.
Different clinical varieties exist
Tinea Pedis
Interdigital Type:
Most common type; frequently over-
looked. Maceration, peeling, fissuring
of toe webs. Underlying skin red with
or with out weeping. Most commonly
between fourth and fifth finger
Tinea Pedis
Moccasin Type:
More common in atopic
individuals.Well-demarcated
erythema with minute papules on
margin, fine white scaling, and
hyperkeratosis (confined to heels,
soles, lateral borders of feet)
Tinea Pedis
Inflammatory/Bullous Type:
Least common type; usually caused
by T. mentagrophytes. Vesicles or
bullae filled with clear fluid. Pus
usually indicates secondary S. aureus
infection. May be associated with
dermatophytid.
Tinea Pedis
Ulcerative Type:
Extension of interdigital tinea pedis
onto dorsal and plantar foot . Usually
complicated by bacterial infection.
Tinea Pedis
Dermatophytid:
Presents as a vesicular eruption of
the fingers/toes and/or palmar
aspects of the hands secondary to
inflammatory tinea pedis
Tinea Pedis
Prevention is important:
Burows wet dressings;
Castellanis paint,
Aluminum chloride hexahydrate 20%
b.i.d. to reduce sweating.
Use private shower shoes at public
facilities
Tinea Pedis
Topical Antifungal: Apply to all
affected sites for 2 to 4 weeks
Systemic agents are indicated for
extensive infection or for failures of
topical treatment or for those with
tinea unguium and moccasin-type
tinea
ONYCHOMYCOSIS
An infection of the finger or toenail
caused by a wide variety of fungi,
yeasts, and molds.
Tinea unguium is a subtype of
onychomycosis caused by the
dermatophyte group of fungi.
It could be primary or secondary
ONYCHOMYCOSIS
Toenails are involved much more
commonly than fingernails.
The first and fifth toenails are infected
most frequently.
Involvement of the fingernails is
usually unilateral.
When fingernails are involved, pattern
is usually two feet and one hand
ONYCHOMYCOSIS
Discoloration and dystrophy of the
affected nail/s with or with out skin
involvement occurs.
Diagnosis is confirmed by KOH mount
or fungal culture.
ONYCHOMYCOSIS
Topical agents (available as lotions)
are usually not effective except for
early cases after prolonged use
(months).
Griseofulvin or azoles administered for
months is needed.
Relapse is common
Toe nails are not usually treated.
Cutaneous Candidiasis
Superficial infection occurring on
moist cutaneous sites; many patients
have predisposing factors that alter
local immunity such as increased
moisture at the site of infection.
Caused by Candida albicans.
Uncommonly, other Candida species
It is due to overgrowth of the normal
flora.
In males with balanitis, Candida may
be transmitted from female sexual
partner.
Soreness and pain are common.
Occurs where occlusion and
maceration create warm, moist
microecology.
It may present as diaper dermatitis or
intertrigo (inflammation of two
opposing surfaces), Balanitis, Vulvitis,
or, Candida paronychia .
Erosion and confuelent erythematous
papules with satellite lesions are seen.
KOH examination shows
pseudohyphae.
Angular cheilitis BY Bekele T.(BSc,MSc) 100
Keep intertreginous areas dry.
Apply body powder with or without
antifungals after bath.
Castellanis paint.
Nystatin or imidazole creams applied
b.i.d. till all the lesions disappeared.
Systemic azoles also effective.
Griseofulvin not effective.
Mucosal Candidiasis
(Moniliasis)
Candida infection occurring on the
mucosa of the upper aerodigestive
tract and vulvovagina mainly as itchy
curd/cheese like deposits
Immunosupression (Diabtes, AIDS,
etc) is a risk factor for oropharyngeal
candidiasis, but not for vaginal
candidiasis.

Mucosal Candidiasis
Classification
SUPERFICIAL MUCOSAL CANDIDIASIS
Vaginal and Vulvovaginal Candidiasis
Oropharyngeal Candidiasis
Erythematous (atrophic) candidiasis
Pseudomembranous candidiasis (thrush)
Candidal leukoplakia (hyperplastic
candidiasis)
Angular cheilosis
DEEP MUCOSAL CANDIDIASIS
Mucosal Candidiasis
Treatment is with systemic or topical
azoles.
Nystatin is very effective for
orophryngeal candidiasis
Chronic supressive doses are needed
for recurrent cases.

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