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08/12/2011 Fungal Skin Infections Prof Werner Sinclair Dept of Dermatology University of the Free State Outcomes for this Lecture After this lecture the student should be able to: Name the types of fungi that can infect the Describe the methods to diagnose cutaneous fungal infections Discuss the epidemiology of fungal infections Recognise and describe the clinical presentations of the following cutaneous fungal infections: Dermatophyte infections: Tinea corporis Tinea capitis Tinea cruris Tinea unguium Tinea mannuum Tinea pedis (also the different types) Cutaneous Candidiasis: Oral Angular stomatitis Intertrigo Chronic paronychia Diaper rash Genital (Vulvitis and balanitis) Pityriasis versicolor Name the risk factors for the development of cutaneous candidiasis Discuss in broad terms the management of the different fungal infections Be aware of the systemic fungal infections like Sporotrichosis, Cryptococcosis and Histoplasmosis 1 08/12/2011 Fungi That Infect The Skin Dermatophytes Yeasts: Candida Pityrosporum (Mallesazia) Moulds: Scopulariopsis Scytalidium etc. “Deep” Fungi: Sporothrix schenkii Cryptococcus neoformans Histoplasma capsulatum Dermatophyte Infections Keratolytic fungi Trichophyton, Epidermophyton, Microsporum spp Named according to skin area involved 2 08/12/2011 Diagnosis of Tinea Clinical KOH microscopy Culture Treatment of Tinea Infections Topical: Imidazole preparations Terbinafine Systemic: Griseofulvin Terbinafine Ketoconazole Itraconazole 3 08/12/2011 Tinea Corporis Classical ringworm Annular lesions Secondary rings Edge: Raised, red, scaly, pustular, vesicular Tinea incognito Diagnosis Treatment Tinea Capitis Children / Immunocompromised adults Scaling Hair loss / broken off hairs Pustules Swelling, redness (kerion) Diagnosis Treatment: Always systemic!!! Griseofulvin 15mg/kg/day 4 08/12/2011 Tinea Cruris Any skin fold: Groin, axilla, submammary May be annular, not necessarily Little scaling Can be very subtle Treatment Tinea Pedis Asymmetrical foot involvement Four forms: interdigital vesicular moccasin annular plaque Epidemiology Treatment 5 08/12/2011 Tinea Unguium Random, asymmetric nail involvement Hands and/or feet Onycholysis Subungual hyperkeratosis Nail plate thickened, brittle, yellow Secondary Pseudomonas Treatment: Look for matrix involvement (lunula) Hands: 2 months, feet 3 months Preventative measures Candida Infections Skin folds: Angular stomatitis Genitals (Penis, scrotum, vulva) Submammary Axillae Interdigital Diaper rash Nails Mucous membranes: Oral Vagina, penis Esophagus 6 08/12/2011 Angular Stomatitis “Perleche” Older people Atrophied gingival ridges Ill-fitting / worn dentures Candida colonizes the dentures Treatment Sterilize dentures Stomatitis Tongue and rest of oral mucosa White deposition, can be scraped off Also red, smooth form HIV, antibiotics, diabetics, babies Diagnosis Treatment 7 08/12/2011 Candida Intertrigo All skin fold infections, including genitals Very pruritic, red, scaling edge, satellite lesions Usually symmetrical Remember involvement of scrotum and penis Diagnosis Treatment Candida Diaper Rash Usually secondary to PIND Sometimes primary, antibiotics Intertrigo, but more extensive Treatment: Topical + Nystatin drops 8 08/12/2011 Candida Nail Infection Random, asymmetrical involvement Chronic paronychia Nails hard, brown, slightly irregular HIV, diabetics, wet work, soap, frequent hand washing Treatment Advice Malassezia furfur Causes tinea (pityriasis) versicolor Also major role in seborrheic dermatitis Not contagious Treatment Prophylaxis 9
