15- Fungi And Yeasts (Superficial)

Question 1

Black dot ringworm, seborrheic like scaling and inflammatory kerion

This organism in tinea capitis produces spores WITHIN the hair shaft

Do not produce fluorescence in Wood’s lamp

Answer 1

Trichophyton tonsurans

Question 2

Organism in tinea capitis that produce spores OUTSIDE the hair shaft

Fluoresce under Wood’s lamp
Scaly, erythematous papules with loose and broken off hairs

Answer 2

Microsporum canis

Question 3

Deep tender boggy plaques exuding pus in tinea capitis

Scarring, permanent alopecia

Answer 3

Kerion celsii

Question 4

Appears chiefly on scalp but may affect glabrous skin and nails

Scalp- concave yellow sulfur crusts around loose wiry hairs

Atrophic scarring- glossy smooth white patch
Glabrous skin- cup shaped crusts with mousy odor

Answer 4

Favus

Question 5

Cup shaped crusts usually pierced by a hair on skin with a distinctive mousy odor in tinea infection

Answer 5

Scutulae

Question 6

Infected tinea hairs will fluoresce what color in Wood’s light?

Answer 6

Bright green or yellow green

Trichophyton- does not fluoresce

Question 7

Treatment for tinea capitis in children

Answer 7

Griseofulvin 10mg/kg/day

2-4 months

Question 8

Treatment for trichophyton infections in tinea

Answer 8

Terbinafine 3-6mg/kg/day x 1-4 weeks

Adjunct: selenium sulfide shampoo or ketoconazole shampoo 5 mins 3x a week

Question 9

Tinea barbae is different from staphylococcal folliculitis (sycosis vulgaris) by

Answer 9

Sparing of upper lip

Unilateral involvement

Question 10

Circular, sharply circumscribed, slightly erythematous, dry, scaly hypopigmented patches
Progressive central clearing

Found in the body except in face, scalp, beard, hands, feet and groin

Answer 10

Tinea corporis

Question 11

Treatment for tinea corporis

Answer 11

Topical- miconazole, clotrimazole BID X 2-4 weeks

ketoconazole, terbinafine- OD
Terbinafine- 1 week

Systemic- trichophyton: griseofulvin, terbinafine, fluconazole

Question 12

Deep pustular tinea circinata resembling a carbuncle or kerion on glabrous skin

Follicles distended with purulent material

Most often on shin or wrist

Answer 12

Fungal folliculitis

Majocchi granuloma

Question 13

Tinea incognito is an atypical lesion that are widespread and may lack an advancing scaly border

It is usually caused by

Answer 13

Treatment with topical corticosteroid or calcineurin inhibitors

Question 14

Infection of the nail plate by a fungus is called

Answer 14

Onychomycosis

Tinea unguium

Question 15

Onychomycosis caused by what organism?

Starts at distal corner of the nail and involves the junction of the nail and bed
Yellow discoloration, spreads proximally
Nail becomes brittle

Answer 15

T. rubrum

Question 16

Treatment of onychomycosis

Answer 16

Terbinafine 250mg/day x 6-8 weeks

Toenails- 12-16 weeks

Itraconazole, fluconazole

Question 17

Side effect that should be noted when using itraconazole and terbinafine, ketoconazole

Answer 17

Hepatotoxicity

Question 18

Grayish white membranous plaques found on the surface of the mucous membrane

Base is moist reddish and macerated

Often first manifestation of AIDS

Answer 18

Oral candidiasis (thrush)

Question 19

Treatment for oral thrush

Answer 19

Fluconazole 150mg single dose

Question 20

Maceration and transverse fissuring of the oral commissures

Bilateral involvement

Answer 20

Perlèche (angular cheilitis)

Question 21

Pruritic intertriginous eruptions between folds

Pink to red moist patches surrounded by a colarette scale

Answer 21

Candidal intertrigo

Question 22

Candidal intertrigo treatment

Answer 22

Topical anticandidal ( clotrimazole, ketoconazole, miconazole, nystatin, terbinafine)

+ topical midstrength steroid

Question 23

Treatment for diaper candidiasis

Answer 23

Topical anticandidal agents

Zinc oxide- barrier against urine

Question 24

Infection with Candida limited to mucosal surfaces, skin and nails

Onset before 6 years old
Hyperkeratotic, horn like or granulomatous lesions

Answer 24

Chronic mucocutaneous candidiasis

Question 25

Gold standard for systemic candidiasis treatment

Answer 25

Amphotericin B

Question 26

Common in tropics Brown or black spots on palms and soles, may be mistaken for nevi Common in the tropics Pigment confined to stratum corneum and scrapes of easily

Answer 26

Tinea nigra

Question 27

Dark pinhead to pebble sized formations on the hairs of scalp, brows, lashes or beard Distributed irregularly on the hair shaft

Answer 27

Black piedra

Question 28

Yellow or beige colored soft slimy sheath coating the hair shaft caused by trichosporon

Answer 28

White piedra

Question 29

Treatment for piedra

Answer 29

Cutting/ shaving hair Black- oral and topical terbinafine White- oral itraconazole, topical imidazoles

Question 30

Hypo or hyperpigmented coalescing scaly macules on the trunk and upper arms Favors oily areas of the skin, occurs during summer Mild itching and inflammation around patches

Answer 30

Tinea versicolor

Question 31

Treatment for tinea versicolor

Answer 31

Selenium sulfide lotion 10mins daily x 1 week Zinc pyrithione soap Ketoconazole Oral itraconazole 200mg OD X 7 days