Post on 03-Jun-2015
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