Fungal: dermatophytosis, candidacies

Question 1

In which pts can fungal infection be severe?

Answer 1

Immunocompromised pts

Question 2

What are the 3 main types of fungal infection ?

Answer 2

1. Dermatophytes
   tinea / ringworm
2. Yeasts
   candidiasis / malassezia
3. Moulds
   aspergillus

Question 3

Describe and diagnose

Answer 3

Diagnosis:
Tinea corporis (tinea infection of the trunk and limbs)

Describe:
Itchy circular or annular lesions with a clearly defined, raised and scaly edge is typical

Tinea cruris (groin and natal cleft) very itchy and similar to tinea corporis

Question 4

Describe and diagnose

Answer 4

Diagnose:
Tinea pedia (atheltes foot) also Tinea unguium present (infection of nail )

Describe:
TP - moist scaling and fissuring in toewebs, spreading to the sole and dorsal aspect of the foot
TU - yellow discoloured nail, thickened and crumbly

Question 5

Describe and diagnose

Answer 5

Diagnose:
Tinea capitis (scalp ringworm)

Describe:
Patches of broken hair, scaling, inflammation

Question 6

Describe and diagnose

Answer 6

Diagnosis:
Tinea manuum

Describe:
scaling and dryness in the palmar creases

Question 7

Describe and diagnose

Answer 7

Diagnosis: Candidiasis

Describe : white plaques on mucosal areas, erythema with satellite lesions in flexures

Question 8

Describe and diagnose

Answer 8

Diagnosis: Pityriasis versicolor (infection with Malassezia furfur)

Describe: scaly pale brown patches on upper trunk that fail to tan on sun exposure, usually asymptomatic

Question 9

What steps / investigations to establish the correct diagnosis of fungal infections?

Answer 9

Skin scrapings
hair or nail clipings (dermatophytes)
skin swabs (yeasts)

Question 10

What is the management for fungal infections?

Answer 10

General:
Treat precipitating factors e.g. immunosuppressive condition, moist environment

Specific treatment:
Antifungal
Topical : Terbinafine cream (e.g. in tinea capatis)
Oral: itraconazole (severe, widespread and nail infections)

Question 11

What should you avoid in treatment of fungal infections and why?

Answer 11

Avoid topical steroids - can lead to tinea incognito

Question 12

Complication of tinea capitis?

Answer 12

Scarring
Permanent hair loss