Superficial Fungal Infections Flashcards Preview

Rheum/Musculoskeletal/Derm Week 3 > Superficial Fungal Infections > Flashcards

Flashcards in Superficial Fungal Infections Deck (69):

What is Tinea capitis?

ringworm of the scalp that is very common in 3-7 yos 


What are the main causes of Tinea Capitis?

-90% by Trichophyton tonsurans

-Microsporum canis 


How is tinear capitis contracted?

Via humans, animals, fomites (shared brushes, combs, hats) or sometimes oil that results typically in a asymptomatic carrigae phase initially


What are the primary risk factors for tinea capitis?

-large family size

-crowded living conditions

-low socioeconomic status


Tinea capitis presentations (seb derm more like in AA kids)

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This occurs because the bugs can get into the hair shafts and cause them to break off

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Tinea capitis presentations (you cannot diagnose this with a woodflam lamp anymore!)

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 Keroid is caused by marked inflammation that can cause permanent scarring and hair loss in these situations. For these you can consider sysemic steroids for decreased pain and inflammation

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T or F. LAD is common with tinea capitis

T. Especially in the posterior cervical and sub-occipital regions (correlates well with + fungal cultures in setting of scaling and alopecia)


How can tinea capitis be confirmed?

gold standard is FUNGAL CULTURE (very important to confirm)

-use a moistened cotton tip to rub vigorously over the affected area and then use a standard bacterial culture

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What is this?

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Seborrheic Dermatits (in the DDx with tinea captitis)- this is usually more chronic and unusual after infancy and before puberty (infants with cradle cap (waxy yellow scale) or teen or adults with dandruff)


What dis stuff?

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Psoriasis (on the DDx for tinea)- usually will see more erythema plaques with silvery scales and favors postauricular and posterior hairline


What is this?

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Alopecia areata- on the DDx for tinea capitis except no broken hairs, LAD, erythema


How is tinea capitis treated?

Requires SYSTEMIC antifungal to penetrate hair follicle and griseofulvin is the gold standard (microsize or ultramicrosize)

Microsize used most often: 20mg/kg/d for at least 8 weeks

NOTE: M. canis infections may require higher doses and longer course for clearance 


Advice on Tx for tinea capitis

Give with fatty food for absorption and may divide bid if large volume needed for bigger kids


AEs of Griseofulvin?

mostly well-tolerated but may see HA, GI pain, photosensitivity or drug rxns 


Adjuvant Tx for tinea?

Add an antifungal shampoo 2-3 times a week (Ketoconazole 2% or selenium sulfide) to aid in removal or scales and eradicate spores (consider all members of house use)

Fomite education (dont share combs, etc.)

-Terbinafine can be used if 4+ yo


T or F. M. canis does not respond well to Terbinafine

T. Need to know what you're treating


AEs of Terbinafine?

hepatotoxicity and rare heme effects (get a baseline ALT/AST and CBC monitoring if immunodeficient)


What is tinea corporis?

Superficial fungal infection of skin due to contact with infected person or animal


What are the main causes of tinea corporis in young children?

M. canis > M. audouinii, T > mentagrophytes


What are the main causes of tinea corporis in older childrena/adults?

T. rubrum, T. verrucosum, T. menatgrophytes (young child with T. rubrum likely has a parent with tinea pedis and/or onychomycosis)


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What is a Majocchi's granuloma?

Chronic tinea corporis infection may cause penetration into the hair follicles resulting in erythematous plaques or patches with nodules

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What is this?

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Nummular (solid redness; annular- red border) Atopic Dermatitis- this is on the DDx for tinea corporis but nummular and very pruritic

needs steroids to treat


What dis?

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Psoriasis- on the DDx for tinea corporis BUT more of a dull pink colour, nummular and distribution is different


What is this?

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Granuloma annulare- very similar to tinea corporis- never scaly, with a raised 'rubbery' rim and tend to show up on the dorsal ahnds, wrists, feet, and ankles


How is tinea corporis used?

Topical for superificial/localzied for at least 2-4 weeks and treat affected area and and extra rim of normal skin. If no improvement, and culture positive, proceed to oral therapy. Consider systemic therpay for disseminated/Majocchi's and tinea faciei


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What is Tinea Manuum?

tinea of the hands that is most common in men (rare in children)


What are the major causes of Tinea Manuum?

T. rubrum, T. mentagrophytes, and E. floccosum



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KOH (branched septated hyphae) and follow up with a fungal culture


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What is tinea cruris?

"jock itch" common in men and rare in children with risk factors including obesity, heat, and humidity and having the same causal organisms as Tinea Manuum


Actual penis and scrotum are not usually affected. Same diagnosis

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Risk factors for tinea pedis?

occlusive shoes and communal pools/showers


What is 'moccasin' pattern Tinea pedis caused by?

T. rubrum (fine dry scale over soles)

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What is 'vesiculobullous' pattern Tinea pedis caused by?

Vesicles/bullous on soles (esp. insteps) due to T. mentographytes commonly

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What is this?

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•Contact Dermatitis (on the DDx for tinea pedis)

–Dorsal feet more commonly affected



What is this?

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Dyshidrotic eczema (on the DDx for tinea pedis)- more likely on the soles or between toes characterized by “tapioca vesicles” that are VERY itchy


Describe Tinea Unguium

Nail infection common in ELDERLY males 


What are the most common causes of TInea Unguium?

T. rubrum, T. mentagrophytes, E. Floccosum but can be caused by Non-dermatophyte molds and yeasts


What are the risk factors for contracting tinea unguium?

Immunosuppression, diabetes, HIV, poor circulation, trauma, dystrophy


What are the patterns of Tinea Unguium?

–Distal subungual

–Proximal subungual

–White superficial



What is this?

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–Distal subungual pattern = most common

•Invasion of distal nail plate, onycholysis with thickening and discoloration


What pattern of tinea unguium is this?

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Proximal subungal

–Uncommon and pathognomonic for HIV positive patient


What pattern of tinea unguium is this?

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•White superficial

–White plaques on dorsal nail plate


What is this?

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Candida- notice how red the nail is around the nailbed


What is this?

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Chronic Paronychia

•Nail dystrophy caused by Candida albicans

–Confirm with stain and culture




How is Chronic Paronychia treated?

•Topical ketoconazole if mild

•Oral fluconazole if severe (»3 mos for fingernails)–Baseline CBC, LFT’s


What is this?

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Trchyonychia (aka 20 nail dystrophy)

•Ridging, grooves, pitting, discoloration, fragility



What are the causes of trachyonychia?

Can be Idiopathic, lichen planus, psoriasis, etc. 


What is this? When is it common?

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Beau's Lines- Transverse grooves or furrows that results when stress causes temporary arrest of nail matrix (very common after Hand, Foot, and Mouth disease)

•Nail may shed completely (onychomadesis)


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What is this?

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Habit Tic Deformity- Habitual picking at the cuticle


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How are nail infections treated?

Topical agents are not very effective because they dont penetrate the nail plate well or reach the nail matrix so Penlac (8% Ciclopirox lacquer) may work if superifical infection not involving lunula (has to be given for months) and urea helps soften the nail plate


Tx for nail infections?

Systemic therapy typically needed and terbinafine is the DOC (Griseofulvin not that effective and has a high recurrence rate) usually 6 weeks for fingernails and 12 weeks for toenails


Is any monitoring needed during nail infection therapy?

Yes, get a baseline CBC and LFT and repeat in 2-4 weeks typically (not 100% necessary)


How long does it take fingernails to grow out? Toenail?

Fingernail- 4 to 6 months

Toenail- 12-18 months 


What is Tinea versicolor?

aka pityriasis veriscolor (a common superficial fungal disorder of skin), caused by the dimorphic fungus Malssezia furfur (aka Pitrosporum), a normal skin flora.

Usually presents in adolescence and likely oily spots of skin 


How does this present?

Multiple scaling, oval macules, patches and thin plaques over upper trunk, proximal arms, and sometimes face and neck regions. It can be hyper- or hypopigmented due to azelaic acid production. 


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When is Tinea versicolor common?



What is Pityriasis alba?

On the DDx for tinea versicolor that is most common on the face but the discoloration is patchy and usually due to dry skin 

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What is this?

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KOH prep is usually sufficient (spaghetti and meatball appearance)


How is tinear versicolor treated?

Education is a big part because the course of this tends to be chronic and recurrences are common. 

Drugs; Topical selenium sulfide lotion/shampoo effective 


How can recurrent or severe tinea versicolor be treated?

Can go to systemic therapy- ketoconazole (work up a sweat, wait 10-12 hr to shower) or fluconazole (doesnt require a sweat) once a week

and still use topical for maintenance


Places for candidisis? Types?



•Angular Cheilitis at oral commissures due to increased moisture (e.g. elderly, lip lickers, dentures) (below)

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How can candidiasis be treated?

•Topical anti-yeast cream

•Decrease moisture