Superficial Fungal Infection

TINEA BARBAE
• Epidemiology:
 transmission by contaminated barbers’ razors

• Clinical Features:
1. Superficial Type: less inflammatory, caused by
anthropophilics such as T. violaceum

2. Inflammatory Type: caused by T. interdigitale

(zoophilic strains) or T. verrucosum
• Differential Diagnosis :

• Management:
 oral antifungal is usually necessary in the treatment of tinea barbae.
 Systemic glucocorticoids used for the first week of therapy are helpful in cases with
severe inflammation.
 TINEA CAPITIS
• Definition:
Dermatophyte infection of hair and scalp typically caused by Trichophyton and Microsporum
species, with the exception of Trichophyton concentricum

• Epidemiology:
 Most commonly observed in children between the ages of 3 and 14 years
 Prevalence of the carrier state is approximately 4% in the United States
 Transmission is increased with decreased personal hygiene, overcrowding, and low
socioeconomic status
• Clinical Findings:
1. Noninflammatory Type:
 most commonly caused by M. audouinii or Microsporum ferrugineum
 may have circumscribed erythematous scaly patches of nonscarring alopecia with breakage
of hairs (“gray patch”)

2. “Black Dot”:
 caused by T. tonsurans and T. violaceum
 Hairs broken off at the level of the scalp leave behind grouped black-dots within patches of
polygonal-shaped alopecia with finger-like margins.
 in rare cases, kerion—an inflammatory mass studded with broken hairs and follicular
orifices oozing with pus

3. Inflammatory Type:
 Zoophilic or geophilic pathogens, such as M. canis, M. gypseum, and T. verrucosum
 Resultant inflammation ranges from follicular pustules to furunculosis
• Diagnosa:
 Wood lamp examination, a yellow-green fluorescence may be detected
 On histopathology of tinea capitis, PAS and methenamine silver stains readily reveal
hyphae around and within hair shafts

• Diffrential Diagnosa:
• Management:
 Topical and oral antifungal
 prednisone 1 to 2 mg/kg each morning during the first week of therapy.
 Adjuvant therapy:
shampoo preparat Selenium sulfide (1% and 2.5%), zinc pyrithione (1% and 2%), povidone-
iodine (2.5%), and ketoconazole (2%). Recommended 2 to 4 times weekly for 2 to 4 weeks
 TINEA CORPORIS
• Epidemiology:
 Children are more likely to contract zoophilic pathogens, especially M. canis
 “Tinea corporis gladiatorum” is caused most commonly by T. tonsurans
 increasingly observed among immunocompromised patients

• Clinical Features:
The classic presentation:
A. Annular (“Ring Worm”)
B. Polycyclic
C. Psoriasiform
Majocchi granuloma: a superficial and
subcutaneous dermatophytic infection involving
deeper portions of the hair follicles, presenting as
scaly, follicula papules and nodules that coalesce
in an annular arrangement

→caused by T. rubrum, T. interdigitale, and M.

canis
• Diffrential Diagnosa:

• Management:
 Topical antifungal (twice daily for 2-4 weeks)
 Oral antifungal (if reserved for widespread or more inflammatory eruptions)
 Topical allylamines (eg, terbinafine), imidazoles (eg, clotrimazole) for isolated plaques on
the glabrous skin
 TINEA CRURIS
• Epidemiology:
 Autoinfection from distant reservoirs of T. rubrum or T. interdigitale on the feet is common

• Clinical Features:
 Pruritus and pain when plaques are macerated or secondarily infected
 Annular erythematous plaques with a raised scaling border expanding from the inguinal on the
inner thighs and pubic region
• Differential Diagnosa:

• Management:
 Medical treatment of tinea cruris is the same as that for tinea corporis
 TINEA FAVOSA
• Definition:
 Favosa or favus (Latin for “honeycomb”) is a chronic dermatophyte infection of the scalp that
rarely involves glabrous skin and/or nails, and is characterized by thick yellow crusts
(scutula) within the hair follicles that lead to scarring alopecia

• Epidemiology:
 Usually acquired before adolescence, but may extend into adulthood
 asscociated with malnutrition and poor hygiene

• Clinical Features:
 The first 3 weeks of infection, early favus is characterized by patchy perifollicular erythema
with slight scaling and matting of the hair.
 Progressive hyphal invasion distends the follicle, producing a yellow-red follicular papule,
then a yellow concave crust (scutulum) around a single dry hair
 Over several years, the plaques advance peripherally leaving behind central, atrophic areas
of alopecia
• Clinical Features:
 The first 3 weeks of infection, early favus is characterized by patchy perifollicular
erythema with slight scaling and matting of the hair.
 Progressive hyphal invasion distends the follicle, producing a yellow-red follicular
papule, then a yellow concave crust (scutulum) around a single dry hair
 Over several years, the plaques advance peripherally leaving behind central, atrophic
areas of alopecia
• Diagnosa:
 Blue-gray fluorescence along the entire hair with Wood lamp examination.
 Microscopy with KOH preparation reveals hyphae arranged lengthwise
around and within the hair shaft, rare arthroconidia, and vacant air spaces

• Management:
 same as tinea capitis
 TINEA NIGRA
• Definition:
 Superficial dermatomycosis caused by dematiaceous, darkly
pigmented, Hortaea werneckii

• Epidemiology:
 occurs in tropical or subtropical areas
 female-to-male predilection of 3:1

• Clinical Features:
 presents typically as an asymptomatic
 Arises after trauma to the skin with subsequent inoculation, and a
typical incubation period of 2 to 7 weeks.
 mottled brown to greenish-black macule or patch with minimal to no
scale on the palms or soles
• Diffrential Diagnosa:

• Diagnosa:
 KOH examination: brown to olive-colored, thick branching hyphae, along with oval to
spindle-shaped yeast cells that occur singly or in pairs with a central transverse septum
 Cultured: initially yeast-like with a brown to shiny black color and appears as typical 2-celled
yeast forms under microscopic examination
• Management:
 topical antifungal agents.
 topical therapy with a keratolytic (Whitfield ointment, 2% salicylic acid),
 tincture of iodine
Treatment should be continued for 2 to 4 weeks after clinical resolution to
prevent relapse
 TINEA PEDIS AND
TINEA MANUUM

• Clinical Features:
 Subtypes:
A. Interdigital Type
B. Chronic Hyperkeratotic (Moccasin) Type
C. Vesiculobullous Type
D. Acute Ulcerative Type
E. Vesicular Id Reaction
• Etiology:
 by T. rubrum (most common), T. interdigitale, and E. floccosum

• Differential Diagnosis:
• Management:
 topical antifungal agents.
 Terbinafine cream applied twice daily for 1 week is effective in 66% of cases
 Patients suspected of having Gram-negative coinfections should be treated
with a topical or systemic anti-bacterial agent
Thank you