Tinea barbae is a rare dermatophytic infection that is limited to the bearded areas of the face

and neck. Generally tinea barbae is infrequent, but it is more common in areas where weather
conditions are tropical, characterized by high temperature and humidity.
Tinea barbae is caused by zoophilic and antropophilic fungi . Zoophilic dermatophytes
Trichophyton mentagrophytes var. granulosum and Trichophyton verrucosum are most often
responsible for inflammatory kerion-like plaques and infection caused by them is more
severe.
They infect the stratum corneum of the epidermis, hair, and nails. Several enzymes, including
keratinases, are released by dermatophytes, which help them invade the epidermis. The
mechanism that causes tinea barbae is similar to that of tinea capitis. In both diseases, hair
and hair follicles are invaded by fungi, producing an inflammatory response.

Clinical features
Infection often begins on the neck or chin, but the clinical manifestations of tinea barbae
depend upon the causative pathogen. Sometimes this dermatophytosis can develop without
characteristic lesions, but always with pruritus. There is a wide range of symptoms. Two
main clinical variants are distinguished.
Tinea caused by zoophilic dermatophytes is more severe, because the inflammatory reaction
due to these fungi is stronger . Chin, cheeks and neck are often affected. It typically forms an
inflamed nodule/ nodules with multiple pustules and draining sinuses on its surface. Hairs are
loose or broken; exudate, pus and crusts cover the skin surface (kerion Celsi).
Accompanying regional lymphadenopathy may be evident; fever and malaise is not rare.
Noninflammatory type caused by antropophilic dermatophytes begins as flat, erythematous
patches with a raised border. Scaly patches may be studded with papules, pustules or crusts.
Hairs are broken close to the skin, they may plug the hair follicle. Cutaneous patches may be
single or multiple and may be annular in shape . Patches can remain stabile for years or may
enlarge . Sometimes, especially when follicular pustules have developed and hair loss is
observed, the clinical morphology resembles bacterial folliculitis. Pustular lesions with hair
loss characterize a chronic variant of this fungal infection that resembles sycosis (pustular
folliculitis of the beard). Accordingly, it is called sycosiform tinea barbae.

Diagnosis
Mycologic investigation is the basis for diagnosis. Mycological examination includes direct
microscopy and culture. Collected material usually consists of depilated hairs and pustular
masses. When the plaques are superficial and without pustules the best examination material
are scrapings from its border. The specimen is examined with a light microscope and
depending upon the causal fungi this examination shows typical hyphae and/or arthroconidia.
Cultures take approximately 3-4 weeks and are typically performed on Saburaud agar with
cycloheximide and chloramphenicol added to inhibit the growth of bacteria and non-
dermatophytic fungi.
Treatment
Treatment of tinea barbae is similar to that of tinea capitis. Oral antimycotic therapy is
required and in the majority of cases combined treatment with systemic and topical
antimycotics is recommended. As topical agents usually two antifungal groups are used:
azoles and allylamines. include terbinafine, itraconazole and griseofulvin. When hairs are
involved, shaving or depilation should be taken into the consideration. Warm compresses
used to remove crusts and debris may usually be applied. Moreover, treatment of other fungal
infections, such as tinea pedis and onychomycosis, is essential, because of a possible
autoinoculations.
Tinea Unguium
Tinea unguium, often referred to as onychomycosis, is an infection of nail tissue of the hands
or the feet. T rubrum and Trichophyton interdigitale are the common dermatophytes known
to cause tinea unguium. Nondermatophytes account for the remainder of infections, notably
yeasts from Candidaspecies, as well as molds from Fusarium and Acremoniumspecies. Risk
factors for onychomycosis include older age, swimming, trauma to the nail, diabetes,
immunosuppression, or living with someone with onychomycosis

There are three forms of onychomycosis: distal subungual, superficial white, and proximal
subungual. Distal subungual onychomycosis is the most common form, with the big toe
usually the first nail to be affected. This form involves the end third of the nail farthest away
from the cuticle and begins with a whitish, yellowish, or brownish discoloration of the nail.
The discoloration eventually spreads to the entire nail and extends slowly to the cuticle. The
discoloration is due in part to keratinous debris between the nail and the nail bed. A patient
may present initially with hyperkeratosis of the nail bed, which may lead
to onycholysis (separation of the nail from underlying tissue). Onycholysis causes pain, which
may prevent the patient from being able to perform typical activities of daily
living. Superficial white onychomycosis infects the entire top surface of the nail and has a
flaky appearance. Proximal subungual onychomycosis, which is relatively rare, occurs mostly
in immunocompromised patients; it presents with a seemingly deeper infection that occurs
under the nail near the cuticle and extends distally. Unless treated properly, onychomycosis
persists indefinitely.

Treatment

It is important to recognize the presence of fungus before antifungal therapy is initiated. The
examiner must take into account the number of affected nails, as well as symmetry, pain, and
other nail characteristics.[16] Onychomycosis is most readily confirmed using a KOH
preparation for histologic examination. Treatment should be initiated upon confirmation.

Topical and systemic therapies for onychomycosis exist; however, studies indicate that
systemic therapies are more effective.[10] Topical antifungal creams do not adequately
penetrate the nail bed and are not considered appropriate. However, an antifungal topical in
the form of a nail lacquer (e.g., ciclopirox) is an option, especially in patients in whom oral
therapy is contraindicated. Evidence supports the use of oral terbinafine or itraconazole for 6
to 8 weeks for fingernail onychomycosis. Toenail onychomycosis requires a longer duration
of therapy (1216 weeks for terbinafine, or continuous daily dosing with itraconazole for 12
weeks).
Rubella is an acute, contagious viral infection. While the illness is generally mild in children,
it has serious consequences in pregnant women causing fetal death or congenital defects
known as congenital rubella syndrome (CRS).

The rubella virus is transmitted by airborne droplets when infected people sneeze or cough.
Also, if a woman is infected with rubella while she is pregnant, she can pass it to her
developing baby and cause serious harm.

A person with rubella may spread the disease to others up to one week before the rash
appears, and remain contagious up to 7 days after. However, 25% to 50% of people infected
with rubella do not develop a rash or have any symptoms.
Symptoms

In children, the disease is usually mild, with symptoms including a rash, low fever (<39C),
nausea and mild conjunctivitis. The rash, which occurs in 5080% of cases, usually starts on
the face and neck before progressing down the body, and lasts 13 days. Swollen lymph
glands behind the ears and in the neck are the most characteristic clinical feature. Infected
adults, more commonly women, may develop arthritis and painful joints that usually last
from 310 days.

Once a person is infected, the virus spreads throughout the body in about 5-7 days.
Symptoms usually appear 2 to 3 weeks after exposure. The most infectious period is usually
15 days after the appearance of the rash.

Congenital rubella syndrome

Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong
disabilities, including autism, diabetes mellitus and thyroid dysfunction many of which
require costly therapy, surgeries and other expensive care.

Vaccination
The rubella vaccine is a live attenuated strain that has been in use for more than 40 years.
A single dose gives more than 95% long-lasting immunity, which is similar to that
induced by natural infection.
Rubella vaccines are available either in monovalent formulation (vaccine directed at only
one pathogen) or more commonly in combinations with other vaccines such as with
vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and
varicella (MMRV).
Adverse reactions following vaccination are generally mild. They may include pain and
redness at the injection site, low-grade fever, rash and muscle aches. Mass immunization
campaigns in the Region of the Americas involving more than 250 million adolescents and
adults did not identify any serious adverse reactions associated with the vaccine.
 RUBELLA

Rubella - yang sering dikenal dengan istilah campak Jerman atau campak 3 hari -
adalah sebuah infeksi yang menyerang, terutama, kulit dan kelenjar getah bening. Penyakit
ini disebabkan oleh virus rubella (virus yang berbeda dari virus yang menyebabkan penyakit
campak), yang biasanya ditularkan melalui cairan yang keluar dari hidung atau tenggorokan.
Penyakit ini juga dapat ditularkan melalui aliran darah seorang wanita yang sedang hamil
kepada janin yang dikandungnya. Karena penyakit ini tergolong penyakit ringan pada anak-
anak, bahaya medis yang utama dari penyakit ini adalah infeksi pada wanita hamil, yang
dapat menyebabkan sindrom cacat bawaan pada janin tersebut.

GEJALA

Tanda-tanda dan gejala Infeksi rubella dimulai dengan adanya demam ringan selama 1
atau 2 hari (99 - 100 Derajat Fajrenheit atau 37.2 - 37.8 derajat celcius) dan kelenjar getah
bening yang membengkak dan perih, biasanya di bagian belakang leher atau di belakang
telinga. Pada hari kedua atau ketiga, bintik-bintik (ruam) muncul di wajah dan menjalar ke
arah bawah. Di saat bintik ini menjalar ke bawah, wajah kembali bersih dari bintik-bintik.
Bintik-bintik ini biasanya menjadi tanda pertama yang dikenali oleh para orang tua.

Ruam rubella dapat terlihat seperti kebanyakan ruam yang diakibatkan oleh virus
lain. Terlihat sebagai titik merah atau merah muda, yang dapat berbaur menyatu menjadi
sehingga terbentuk tambalan berwarna yang merata. Bintik ini dapat terasa gatal dan terjadi
hingga tiga hari. Dengan berlalunya bintik-bintik ini, kulit yang terkena kadangkala
megelupas halus.

Gejala lain dari rubella, yang sering ditemui pada remaja dan orang dewasa,
termasuk: sakit kepala, kurang nafsu makan, conjunctivitis ringan (pembengkakan pada
kelopak mata dan bola mata), hidung yang sesak dan basah, kelenjar getah bening yang
membengkak di bagian lain tubuh, serta adanya rasa sakit dan bengkak pada persendian
(terutama pada wanita muda). Banyak orang yang terkena rubella tanpa menunjukkan
adanya gejala apa-apa.

Ketika rubella terjadi pada wanita hamil, dapat terjadi sindrom rubella bawaan, yang
potensial menimbulkan kerusakan pada janin yang sedang tumbuh. Anak yang terkena
rubella sebelum dilahirkan beresiko tinggi mengalami keterlambatan pertumbuhan,
keterlambatan mental, kesalahan bentuk jantung dan mata, tuli, dan problematika hati,
limpa dan sumsum tulang.

Penularan Virus rubella menular dari satu orang ke orang lain melalui sejumlah kecil
cairan hidung dan tenggorokan. Orang yang mengidap rubella sangat berpotensi
menularkan virus tersebut dalam periode satu minggu sebelum sampai satu minggu
sesudah ruam muncul. Seseorang yang terinfeksi tetapi tidak menunjukkan gejala rubella
tetap dapat menularkan virus tersebut

Balita yang memiliki rubella bawaan dapat melepaskan virus tersebut melalui urin
dan cairan hidung dan tenggorokan selama satu tahun atau lebih dan dapat menularkan
virus terhadap orang yang belum terimunisasi.
Pencegahan
Pencegahan Rubella dapat dicegah dengan vaksin rubella. Imunisasi rubella secara
luas dan merata sangat penting untuk mengendalikan penyebaran penyakit ini, yang pada
akhirnya dapat mencegah cacat bawaan/lahir akibat sindrom rubella bawaan. Vaksin ini
biasanya diberikan kepada anak-anak berusia 12 - 15 bulan dan menjadi bagian dari
imunisasi MMR yang telah terjadwal. Dosis kedua MMR biasanya diberikan pada usia 4 - 6
tahun, dan tidak boleh lebih dari 11 - 12 tahun. Sebagaimana dengan imunisasi lainnya,
selalu ada pengecualian tertentu dan kasus-kasus khusus. Dokter anak akan memiliki
informasi yang tepat. Vaksin rubella tidak boelh diberikan kepada wanita hamil atau wanita
yang akan hamil dalam jangka waktu satu bulan sesudah pemberian vaksin. Wanita hamil
yang tidak kebal terhadap rubella harus menghindari orang yang mengidap penyakit ini
harus diberikan vaksinasi setelah melahirkan sehingga dia akan kebal terhadap penyakit ini
di kehamilan berikutnya

Masa inkubasi

Periode inkubasi rubella adalah 14 - 23 hari, dengan rata-rata inkubasi adalah 16 -

18 hari.

Jangka waktu

Ruam rubella biasanya berlangsung selama 3 hari. Pembengkakan kelenjar akan

berlangsung selama satu minggu atau lebih dan sakit persendian akan berlangsung selama
lebih dari dua minggu. Anak-anak yang terkena rubella akan pulih dalam jangka waktu satu
minggu sementara pada orang dewasa membutuhkan waktu lebih lama untuk pulih.

Penanganan
Rubella tidak dapat ditangani dengan antibiotik karena AB tidak dapat digunakan
untuk mengatasi infeksi virus Wanita hamil yang terkena rubella harus segera menghubungi
dokter spesialis.

Penanganan di rumah
Rubella biasanya penyakit yang ringan, terutama pada anak-anak dan hanya
membutuhkan penanganan kecil di rumah. Awasi suhu badan anak dan hubungi dokter jika
demamnya meninggi
Untuk mengurangi keyidaknyamanan, balita dapat diberikan acetaminophen atau
ibuprofen. Cegah penggunaan aspirin kepada anak-anak yang terkena infeksi virus karena
penggunaan aspirin pada kasus tersebut dicurigai menyebabkan terjadinya sindrom Reye,
yang dapat menyebabkan kegagalan hati dan kematian