fungal infections of skin [compatibility mode]

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Fungal Infections of Skin [Compatibility Mode]

Management of

Common Common

Fungal Skin Infections

Superficial fungal infections of

the skin are one of the most

common dermatologic

conditions seen in clinical conditions seen in clinical

practice.

Fungi: Common Groups

1. Dermatophytes: Superficial Ring

worm type

2. Candida Albacans: Yeast infection2. Candida Albacans: Yeast infection

3. Pityrosporium: Yeast, present in

normal flora of skin, esp. scalp &

trunk.

CLASSIFICATION OF

FUNGAL INFECTION

1.Superficial

2.Cutaneous

3.Subcutaneous3.Subcutaneous

4.Systemic

5.Opportunistic

1. Superficial mycoses- Pityriasis versicolor pigmented lesion

on torso (trunk of the human body). ( Dubo? )

- Tinea nigra gray to black macular lesion

on palms.

- Black piedra dark gritty deposits on hair.

- White piedra soft whitish granules along

hair shaft.

- All diagnosed by microscopy and easily

treated by topical preparation.

2. Cutaneous infections

Infections of skin and its appendages (nails, hair)

20 Spp. of dermatophytes cause 20 Spp. of dermatophytes cause ringworm.

3. Subcutaneous mycoses

-Subcutaneous infections, over 35 spp.

Produce chronic inflammatory disease

of subcutaneous tissue & lymphatics, of subcutaneous tissue & lymphatics,

e.g. sporotrichosis (Ulcerated lesion at

site of inculasion followed by multiple

nodules)

4. Systemic fungal infections

- Uncommon: if Natural immunity is high

- Physiologic barriers include:

- Skin and mucus membranes

- Tissue temperature: fungi grow better at- Tissue temperature: fungi grow better at

less than 37C

5. Opportunistic Mycoses

- Do not normally cause disease in healthy people.

- Cause disease in immuno-compromised people.

- Weakened immune function may occure due to:

Inherited immunodeficiency disease Inherited immunodeficiency disease

Drugs that suppress immune system:

cancer chemotherapy, corticosteroids, drugs

to prevent organ transplant Rejection.

Radiation therapy

Infection (HIV)

Cancer, diabetes, advanced age and mal-nutrition.

Most common opportunistic mycotic

infections: (commonly seen in PLWHA)

1. Candidiasis

2. Aspergillosis2. Aspergillosis

3. Cryptococcosis

4. Zygomycosis/mucormycosis

5. Pneumocystis carinii

Superficial Fungal

Infections

Tinea infections Tinea infections

TINEA Infection

T.Corporis- ringworm of body

T.Cruris- groin T.Cruris- groin

T.Pedis- foot

T.Unguium- nail

T.Capitis scalp

T.Corporis (ring of the body)

Superficial skin infection

Itchy

Annular patch (ring shaped) Annular patch (ring shaped)

Well defined edge

Scaling more obvious at

edges(central clearing)

Tinea Corporis

Tinea corporis body ringworm

Tinea corporis

Tinea Corporis Tinea of the face

Psoriasis Tinea corporis(Scaly lesion)Psoriasis (for differential diagnosis)

Tinea corporis(Scaly lesion)

TineaManum (hand) Tinea Corporis

Often assoc with T.pedis Jock itch

TINEA CRURIS (groin)

Jock itch Tight hot sweaty groin

e.g. athletes, obese Infection of groin,

genitalia, perinium

Tinea Cruris Jock Itch

Tinea Pedis

Athletes Foot Infection

Tinea PedisClinical features

Dermatitis

Peeling Peeling

Maceration

Fissuring

Sites

Toe clefts

Tinea Unguium Nail Infection

Tinea Unguium (nail)

1. Disto-lateral

subungual

onychomycosis

1

onychomycosis

2. Superficial white

onychomycosis

3. Total dystrophic

onychomycosis

2

3

Regimes-Tinea Unguium

TERBINAFINE

Terbinafine250mg od

ITRACONAZOLE ITRACONAZOLE

Pulse rx Itraconazole - 1wk/mth 200mg bid

Itraconazole 200mg od

FLUCANAZOLE

Fluconazole 150mg once weekly

T.Pedis

TINEA CAPITIS - KERION

Ringworm of the scalp

TINEA CAPITIS Black dot

Tinea Capitis

Tinea Capitis

Gray Patch

Rx-Tinea Capitis

MUST use oral Rx- prolonged course

Griseofulvin-20mg/kg/od x 6-8/52 Griseofulvin-20mg/kg/od x 6-8/52

Terbinafine-250mg od x 4/52

Flucanazole-50mg-150mg/wk x 4-6/52

Rx-Tinea Capitis

Adjunctive Measures

Shampoo- antifungal/ antiseptic/antidandruff

Antibiotics

NO STEROIDS

Other Fungal InfectionsOther Fungal Infections

Tinea Manuum

Dry hyperkeratotic

Palmer aspect

Dorsal aspect

Tinea Barbae

Tinea Faciei

Infection of the

skin of the face

excluded excluded

moustache &beard

areas

Peri-oral dermatophytosis

Investigation:

- Microscopy of scrapings

KOH preparation and looking KOH preparation and looking for the fungal elements from skin scraping, nail or hair.

Management

General Measures

Non-specific Keratolytics

-eg Whitfields ointment

Specific Antifungal Rx

Griseofulvin

Azoles-

-Imidazole eg ketoconazole (liver toxicity: oral prep)

topical prepstopical preps

-Triazole eg itraconazole,fluconazole

Allylamines eg terbinafine, naftifine

TOPICAL Rx

Localized disease of skin

extend rx for 3-5/7 after apparent cure

1% clotrimazole less effective

Sprays & solutions

tinea pedis /hairy areas

Limited nail disease

Batrafen nail lacquer

ORAL Rx Extensive disease

Nail disease

Tinea Capitis

FDA approved drugs for empirical therapy

Drug Dosing regimen used in controlled trials

Ampho B 0.6 1.0 mg/kg/day (IV)

__________________________________________________

Liposomal 3 mg/kg/day (IV)

Ampho B

For Systemic Fungal Infections

Ampho B

________________________________________________

Itraconazole 400 mg/day/or two days then 200 mg/d for

5-12 days (IV), followed by oral solution

400 mg/day for 14 days

__________________________________________________

Caspofungin 70 mg day 1, then 50 mg/daily

In BPKIHS D-OPDCOMMON FUNGAL PROBLEMS: All types

Rx: prescribed:

1. Hygiene teaching.

2. Antifungal: 2. Antifungal:

a. Topical: Ketaconazole, Clotrimazole,

Butrinazole

b. Oral: Fluconazole, Ketaconazole, itrazole

Thank YouThank You

7. Yeasts Pityrosporum.

Candida.

Ordinarily commensals.

Can become pathogens under favourable conditions.

Pityriasis Versicolor

Asymptomatic

scaly maculeshypopigmented

Chest, back, face

P.Versicolor Hyperpigmented

Like Dubi

Pityriasis Versicolor

8. Tinea Versicolor

(In Head)(In Head)

Dandruff

Tinea Versicolor

Skin infection caused by a yeast

Warm and humid environment

Tinea Versicolor S/S

- oval or irregularly shaped spots

- pale, dark , or pink in color

- sharp border- sharp border

- itching, worsens with heating and

sweating

Tx

- Topical antifungal medications

Management Many Rx

No Rx eradicates yeast permanently

NONSPECIFIC

Keratolytics Keratolytics

whitfield onit, sulphur

Antiseptics

selenium sulphide, Na thiosulphate

Antifungal Rx

Azoles-oral/topical

Ketoconazole 200mg od x7

Itraconazole 200mg od x 7 Itraconazole 200mg od x 7

Fluconazole 300mg-400mg stat

Terbinafine tabs for P.V

9. Candidiasis

o Candida sp- commensal of GIT

o Precipitating Factors

EndocrinopathyEndocrinopathy

Immunosuppression

Fe/Zn deficiency

Oral antibiotic Rx

o Oropharyngeal candidiasis is marker for AIDS

Candidiasis

Oropharnygeal

Candidal intertrigo-breasts, groin

Chronic Paronychia - nail fold infection Chronic Paronychia - nail fold infection

Vaginitis/balanitis

Risk Factors for Candidiasis:

Post-operative status

Cytotoxic cancer chemotherapy

Antibiotic therapy Antibiotic therapy

Burns

Drug abuse

GI damage

Candidal Intertrigo

Moist folds

Erythematous patch Erythematous patch

with satellite lesions

Management

Rx underlying disorder

Reduce moisture-

Wt loss, cotton underwear

Absorbent/antifungal powder eg Zeasorb AF

Rx partner in recurrent genital candidiasis Rx partner in recurrent genital candidiasis

Rx-Nystatin

Azoles

Oral antifungal (itraconazole): immune suppressed

10. Chronic Paronychia

Infection of nail fold

Wet alkaline work

Excess manicuring

Damage to cuticle Damage to cuticle

Swelling of nail fold

(bolstering)

Nail dystrophy

Chronic Paronychia

Keep hands dry /Wear gloves

Long term Rx

Oral Azoles