Superficial Fungal Infections

These included the following: -

• 1. Dermatophyte infection 'ringworm'.
• 2. Candidiasis (Moniliasis) . https://t.me/
preoperativeblock/149
• 3. Pityriasis versicolor. As comments don’t appear
here use tele

Dermatophyte infection: -
3 qenera of dermatophytes cause ringworm
infection of the skin:
• 1. Trichophyton infection: affects skin, hair and
nail.
• 2. Microsoporum : skin and hair.
• 3. Epidermophyton: skin and nail.
 Mode of transmission:

1. Zoophilic : transmitted from animals to

human but not from human to human and
usually cause severe inflammatory type of
infection.
• 2. Anthrophilic: transmitted from human
to human and caused mild inflammation.
• 3. Geophilic: transmitted from soil to man.
Presentations
• Tinea pedis:
'Athletes foot’
Tinea capitis
fungal infection of the scalp. It is a disease of children and very rarely occurs in post-adolescent
adults. It may take one of the following types according to the aetiologic agents:-

• 1. Superficial scaly type: “Gray patch”

-presented as localized area of lusterless hair —> that progress to partial or complete hair loss with
underlying scale and erythema.
-The hair removal is usually painless and very easy.
2. Black dot type
-localized hair loss —> which is about 0.5 mm from the surface of the scalp —> so the
remaining part of the hair appears as black dot.
• 3. Kerion:
• 4. Favus:
 beard

T. Barbae
infection of the hairy area of the face i.e. beared area with feature similar to T. Capitis.
It is usually of the inflammatory type.
 circular

T. Corporis: - 'Tinea circinata'

-Ringworm infection of the skin of the body that affects especially the trunk and limbs.
-It arise as small erythematous scaly plaque —> that enlarge gradually to annular or ring like lesion with central clearance
and peripheral activity that is shown in the form of erythema, scale or even vesicles and pustules in severe cases.
-It may be single or multiple.
Tinea facieii
-fungal infection of the non hairy skin of the face. -
It gives appearance similar to that of T. corporis.
-It is often misdiagnosed and mistreated.
Tinea cruris
-ringworm infection of the groin
-it affects men more than women.
-The eruption is often unilateral or asymmetrical, sharply
demarcated plaque with peripheral scaling and central
clearance start in the groin and descends down ward.
Differential diagnosis
• 1. Candidiasis characterized by presence of satellite
papulopustules around the lesion.

• 2. Intertrigo
redness due to mechanical friction e.g. obese.
It usually spare the skin folds themselves.

• 3. Erythrasma
• 4. Pant dermatitis
• 5. Seborrhoeic dermatitis
• 6. Flexural psoriasis
T. manum

• T. unguium
 -This is commonly seen in T. faceii and T. cruris.

Steroid modified tinea "Tinea

incognito"

-this is due to misdiagnosis or mistreatment and use -This is followed by relapse of the condition
of potent topical steroids which lead to suppression and enlargement of the lesion with loss of the
of inflammation and great change in the features of characteristic features of the lesion once the
infection with apparent improvement of the lesion. steroids are stopped.
 Ide reaction
-wide spread itchy papulovesicular eruption that occurs as
hypersensitivity reaction to the presence of active infalmmed focus

Ide reaction
of fungal infection.
-A localized form similar to pomphylox may occur.
-Treatment of the infection usually leads to disappearance of these
lesions.

• Investigations:
• 1. scraping and KOH (10-30%)
examination
• 2. Culture: Sabouraudes media, Mycosel
agar
• 3. Wood's light examination: 365 nm
negative wood's light exam doesn't
exclude T. capitis
Treatment:
• Topical treatment :-
• 1. Keratolytics : combination of salicylic
acid 3% and benzoic acid 6% " white
field's ointment".
• 2. Tolnaftate “Tinadeerm "
• 3.1midazole group: - Coltrimazole,
miconazole, econazole.
• 4. Undecanoic acid.
• 5. Terbinafine.
Systemic treatment:
• -Indications: -
• 1. T. capitis
• 2. T. of the nail
• 3. T. incognito.
• 4. Wide spread or chronic infection that is
resistant to topical treatment
• 5. Immunocompromised patient.
• Griseofulvin: fungistatic drug dose 10
mg/Kg/day
• Ketoconazole, itraconazole, flucouazole
and Terbinafine.
Candidiasis (Moniliasis):
It is caused by candida albicans which is a classical opportunistic yeast infection that can invade the skin and
mucous membrane.

• Predisposing factors
• 1. Age: occurs mostly in extremes of life: neonates and
elderly.
• 2. Occlusion: because it increases moisture of the skin.
• 3. Obesity.
• 4. Endocrine abnormalities: diabetes,
hypothyroidism, hypoparathyroidism.
• 5. Pregnancy and contraceptive Pills.
• 6. Broad spectrum AB: tetracycline.
• 7. Immunocompression by malignancy, HIV or drugs.
• 8. Leucopenia specially neutropenia.
Presentations
• 1. Oral Candidiasis
one or more whitish adherent plaques on
the lingual or buccal mucous membrane
that are easily removed leaving a raw red
area that may bleed easily.

• 2. Angular cheilitis
Or perlechae
• 3- Genital Candidiasis
or vulvovaginitis
 -affect the intertriginous areas like groin, axillae,
under the breast, napkin area and also between the

Presentations fingers.

-Clinically there is moist glazed area of erythema

4. Candidal intertrigo
and maceration that appear in body folds with
characteristic satellite papulo-pustules around the
lesion.
 5. Paronychia
-infection of the nail folds mostly occurs in the house wives.

-It is either acute, caused by staph. infection or chronic paronychia

that is caused by Candidiasis leading to painless red swollen nail
folds with loss of nail cuticles.

• 6. Chronic mucocutaneous
candidiasis

• 7. Systemic candidiasis
occurs in patients with immuno suppression.

• Investigations: -
microscopic examination
shows budding spores.
Treatment: -

• 1. Elimination of the predisposing factor.

• 2. Topical: Nystatin, imidazole group and
Magenta paint
• 3. Systemic agents: in immune compromised
and Recurrent or systemic infection we use :
itraconazle, fluconozale, ketoconazole and
amphoterecin B.
Tinea versicolor
pityrosporum orbiculare
malassezia furfur
Investigations: -
• - Scraping of the skin and KOH immersion
showing a mixture of short branched hyphae and
spores.
• - Yellow fluorescence on wood's light exam.
• Treatment:-
• Topical:-
• 1. Imidazole group in the solution or cream forms.
• 2. Selenium sulphide (2.5 %) selsun shampoo.
• 3. Ketoconazole shampoo.
• 4. Old remedies: whitefield ointment, tolnaftate,
sulphur.
• systemic agents: ketoconazol, itraconazole may
be use in patients with widespered, recurrent or
resistant lesions or those with immuno
suppression