Otomycosis

(Fungal Otitis Externa)

• Otomycosis is a superficial mycotic infection of the outer ear canal
• Ethiology : Aspergillus and Candida sp.
• Predisposing Factor :
 Humid climate
 Presence of cerumen
 Instrumentation of the ear
 Immunocompromized host
 Recently increased use of topical antibiotic/steroid preparations
• Patophysiology :
The mycosis results in inflammation, superficial epithelial masses of debris containing
hyphae, suppuration and pain. In addition, symptoms of hearing loss and aural
fullness are as a result of accumulation of fungal debris in the canal.
 Otomycosis
(Fungal Otitis Externa)
• Sign and Symptom
 Usually affect one ear
 Inflammatory pruritus
 Otorrhea
 Edema
 Eritema
 Scaling
 Otalgia
 Aural fullness
 Hearing loss
 Many long, white, filamentous hyphae growing from the skin surface
• Workup :
Swab from ear canal Epithelial debris placed in 10% potassium hydroxide should reveal the
presence of hyphae and, in some instances, the fruiting structures of the aetiological agent.
 Otomycosis
(Fungal Otitis Externa)
• Differential Diagnostic
 Atopic Dermatitis
 Otitis Media
• Treatment
 Sistemic : Anti Histamin, Anti Inflamation, Antibiotic
 Ear canal debridement
 Burow's solution or 5% aluminum acetate solution should be used to
reduce the swelling and remove the debris
 Antifungal ear drops clotrimazole 1% ear drops or flumetasone pivalate
0.02% plus clioquinol 1% ear drops are commonly used.
 Tinea Capitis

• Tinea capitis is dermatophytic infection of the scalp and hair that occurs primarily
in children, mostly occur in men.
• Ethiology : Dermatophyt, especially T. rubrum, T. mentagroplrytes and M. gypseum
• Predisposing factor :
 Hot climate
 Poor sanitation
 Contact with pet like cat and dog
 Humid air
 Tinea Capitis

• Clinical manifestation
 Noninflammatory scaling patches
 Scaling and broken-off hairs
 Severe, painful inflammation with painful boggy nodules that drain pus (kerion) and result in
scarring alopecia.
• Lession :
 Gray patch ring worm : miliary papules around base hair, hair easily broken, leaving brown
alopecia.
 Black dot ring worm : fungal infection in the hair (endotrix) or outside the hair (ectotrix),
broken hair right on the surface of the skin, leaving the brown macula with a black dot, and the
surrounding hair color go dark
 Kerion : on the scalp appear small boils with squamous skin due to local inflammation, broken
hair and easily revoked.
 Tinea Favosa : red yellow spots covered by crust shaped cup (scutula). Stinking (mousy odor),
hair on it is broken and easy to pull out.
 Tinea Capitis

• Workup :
Wood Light : greenish fluorescence.
Squama breeding in the Sabouraud media
Direct microscopy of hair shaft (collect by plucking) and scalp scales collected
with a brush covered with a drop of potassium hydroxide (KOH) shows
presence of fungal hyphae.
• Differential Diagnostic
 Seborrheic dermatitis (in tinea favosa form)
 Psoriasis (in tinea favosa form)
 Alopecia areata (in black dot form)
 Tinea Capitis
• Treatment :
 Systemic : Griseofulvin 10-25 mg/KgBB; adult 500 mg/day. Ketoconazole 5-10
mg/KgBB; adults 200 mg/day for 7-14 days.
 Topical : Wash your head and hair with an antimycotic disinfecting shampoo as
salicylic acid solution, benzoic acid, and sulfur precipitate. Imidazole 1-2%
derivatives in creams or solvents can cure, as well as ketoconazole creams or
solutions 2%