DERMATOPHYTE INFECTIONS

EPIDEMIOLOGY DEFINITION PATHOGENESIS DIAGNOSTICS

• Factors affecting • Derived from greek • Three steps • Host Response • Usually clinical
incidence or prevalence
words derm (skin) and • Adherence • Innate/Non Specific • KOH (Potassium
• Low socio-economic phytes (plant)
• Fungal spores Immunity Hydroxide) Test
status
• 3 Genera adhere to keratin of • First line of • Appearance of septate
• Geo-ecological (those • Trichophyton: affects skin ➝ germinate
defense
hyphae with parallel
who live in the tropics)
skin, hair, and nails
• Invasion • Epithelial or skin walls throughout the
• ↑ no. of at risk • Inhibits macrophage • Trauma and barrier, entire length or
populations
destruction and maceration antimicrobial spores

• Health Information phagocytosis

secondary to peptides, • Fungal Culture
System (HIS): database • Reduce toll like humidity facilitates competing • Rarely done due to
from PDS Accredited receptors in penetration
bacterial flora
long turn-around time

Training Institutions
keratinocytes ➝ less • Facilitated by • Cell Mediated • Periodic Acid-Schiff
• Most common diseases
secretion of pro- enzyme Immunity Stain (PAS)
• Fungal infections are inflammatory armamentarium • Depends on intact • Very sensitive but
top 5
cytokines ➝ (keratinases, lipases, Th1 response costly and fungal
• Dermatophytosis of infection is not cured
ceramidases) of (delayed species is not
the skin • Epidermophyton: fungus
hypersensitivity identified

• Top 2: 2016 and affects skin and nails

• Fungal cell wall reaction)
• Usually uses nail
2017
• Microsporum: affects inhibits cell • Lack of evidence for clippings

• Top 3: 2019 skin and hair

proliferation and cell- genetic predisposition • Skin biopsy (rarely done)

• Whether foreign or local
data, fungal skin
diseases cause
significant morbidity
host; less inflammation
• World-wide prevalence
around 25%
• Habitat Classification mediated immunity • Wood Lamp (for
• Anthropophilic: ectothrix or microsporum
adapted to human and trichophyton
infections only)
• Zoophilic: animal to
OTHER INFORMATION
human transmission;
intense inflammation

• Clinical features depend on organism and host immunity

• Geophilic: soil to
• Usually Annular or ringworm morphology
human transmission;
• Central clearing with erythematous, raised outer border

intense inflammation
• Due to advancing border of fungal infection with central clearing by immune
system

• Naming: tinea + location of infection

• Course of disease depends on integrity of the immune system and comorbidities

Diagrammatic Illustration of Dermatophyte Invasion Diagram of Spore Adhesion

Successful host response depends on the combination of

innate and adaptive immunity

TREATMENT
• Most commonly used: topical
azoles or allylamines

 DERMATOPHYTE INFECTIONS

INFECTION DEFINITION DIAGNOSIS TREATMENT LESION

DISTOLATERAL

• Fungal nail infection

• 50% of all causes of

nail dystrophy
• Risk factors: Age, male
sex, nail trauma, PVD, • Oral anti-fungals
and immunosuppression
• Topical anti-fungals
• ↑ prevalence: tight • If the patient has other
fitting shoes, use of diseases

communal locker • Off label treatments

PROXIMAL
rooms
• KOH of subungual • 4% thymol in ethanol

• Commonly begins as debris

• Camphor

Tinea pedis • Culture of nail clippings

• Thymol preparations
ONCHOMYCOSIS • 3 Types • Most specific
(Vick’s vaporub)

• Distolateral • PAS staining of nail • Mechanical interventions

Subungual   clippings
• Curettage

Onychomycosis • Most sensitive • Avulsion

(DLSO) - most • Nail abrasion

common
• Laser
WHITE SUPERFICIAL
• Proximal Subungual • Chemical removal of
Onychomycosis nail with 40% urea

(PSO) - marker for HIV

disease
• White Superficial
Onychomycosis
(WSO)
 • Zoonotic fungi

• Superficial type
• Systemic anti-fungals SUPERFICIAL

• Incidence has

• KOH
with oral steroids
TINEA BARBAE decreased due to
• Culture • To decrease
improved sanitation
INFLAMMATORY

inflammation
• Common in farm
workers

• Seen on hair and scalp

• Affects mostly in
children

• Common in African
descent, low
socioeconomic status,
• Oral anti-fungal (for hair NON-INFLAMMATORY

overcrowding, poor
bearing areas) with short
hygiene

course oral steroids for BLACK DOT

• Infected hair that is inflammatory type

shed harbors infectious

• Household:

organisms for 1 year

• KOH
• Selenium sulfide

• Black dot type is caused

TINEA CAPITIS • Culture
• Ketoconazole
by anthropophilic
• Wood Lamp shampoo

endothrix organism

• Povidone iodine wash

• Inflammatory type is
• Zinc pyrithione
caused by Microsporum INFLAMMATORY
shampoos (3x/week)

canis
• Decrease shedding
• Causes alopecia
of spores
• (+) Post cervical
lymph nodes
• Distinguishing factor
from other
inflammatory scalp
disorders
 ANNULAR

• Etiology: Trichophyton

rubrum
CONCENTRIC

• Fungal infection of
glabrous (hairless) skin
except palms, soles and
groin

• Topical anti-fungal
• Transmission: direct
• If isolated area only

contact from infected • KOH

TINEA CORPORIS • Oral anti-fungal

humans and animals; • Culture PSORIASIFORM
• If extensive
fomites or
involvement
autoinoculation from
reservoirs

• Other factors: occlusive

clothing, warm humid

climate

MAJOCCHI’S GRANULOMA

• Common in athletes

• Topical anti-fungal

TINEA CRURIS • Transmission: direct

• If isolated area only

contact with infected • KOH

also known as
• Oral anti-fungal

skin, fomites
• Culture
Jock Itch • If extensive
• Other  factors: involvement
occlusion and humidity
 INTERDIGITAL
T.Pedis

• High prevalence: CHRONIC HYPERKERATOTIC/MOCASSIN

occlusive footwear,
increased worldwide
travel, use of • Mild cases

communal baths, • Topical anti-fungals

showers, pool and • Vesiculobullous type

immune status • Short course oral

TINEA PEDIS/MANUUM • KOH
steroids
Most common • Culture
• Treat accordingly if with
dermatophyte infection • Biopsy secondary bacterial
infection

• Acetoacetic soaks VESICULOBULLOUS

• 1/4 cup vinegar in a

pan of warm water
T.Manuum

• “One hand two feet

syndrome”
• Scaling of palm with
accentuation on
palmar creases

• Transmission: direct
contact with infected
person, animal or soil,
or autoinocultaion

• Caused by prolonged
use of topical steroids

• Steroids suppress the

TINEA INCOGNITO
local immune response
and allows the fungus
to grow easily