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Clin Med I > Tinea & Scabies > Flashcards

Tinea & Scabies Flashcards

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1
Q

Etiology of Tinea Capitis

A

Refers to head

Caused by a variety of fungal species

Trichophyton species (T. tonsurans)
Microsporum species (M. canis)
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2
Q

Epidemiology of Tinea Capitis

A

Age: Children

Ethnicity: African Americans

Decreased personal hygiene, low socioeconomic status, overcrowding

Asymptomatic carriers

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3
Q

Clinical Presentation of Tinea Capitis

A
  • Scaly patches with alopecia (hair loss)
  • Patches of alopecia with black dots
  • Widespread scaling with subtle hair loss
  • Kerion (a boggy edematous painful plaque)
  • Favus (multiple cup-shaped yellow crusts / scutula)
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4
Q

Associated Signs of Tinea Capitis

A

Cervical adenopathy

Dermatophytid reaction (similar to eczema)

Erythema Nodosum (rare): reddish, painful, tender lumps or nodules most commonly located in the front of the legs below the knees

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5
Q

Diagnosis of Tinea Capitis

A

Physical exam

KOH prep

Wood’s Lamp

Culture

Dermascope

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6
Q

Treatment of Tinea Capitis

A

Treated with systemic antifungal therapy (oral meds)

Griseofulvin x 6-12 weeks
- Tx of choice for Microsporum or empiric tx

Terbinafine x 2-4 weeks
- Tx of choice if suspect Trichophyton

Itraconazole (4-6 weeks) and fluconazole (3-6 weeks) or pulse therapy (8-12 weeks)

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7
Q

Etiology of Tinea Corporis

A

Refers to body

Caused by different species of fungus

T. rubrum
E. floccosum
T. interdigitale
M. canis
T. tonsurans
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8
Q

Epidemiology of Tinea Corporis

A

Occurs more frequently in:

Caregivers with children with tinea capitis

Athletes with skin to skin contact (tinea corporis gladiatorum)

Immunocompromised

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9
Q

Presentation of Tinea Corporis

A

Pruritic (itchy), Annular (round), Erythematous (skin redness) plaque

Central clearing

Raised, advancing border

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10
Q

Diagnosis of Tinea Corporis

A

History and physical exam

KOH prep to confirm

Culture

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11
Q

Treatment of Tinea Corporis

A

Usually treated with topical medications

Topical antifungals:

  • Clotrimazole, ketoconazole, etc.
  • at least two weeks duration

Consider systemic tx in special circumstances (itraconazole, terbinafine, fluconazole):

  • Immunocompromised
  • Failed topical tx
  • Tinea corporis gladiatorum (no participation for 10-15 days)
  • Duration varies with drug choice (1-4 weeks)
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12
Q

Improper Treatment of Tinea Corporis

A

Tinea Incognito

Mojocchi’s Granuloma

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13
Q

Etiology of Tinea Cruris

A

Refers to the crotch/genitals

Fungal infection that begins in the inguinal fold

T. rubrum
E. floccosum
T. interdigitale
T. verrucosum

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14
Q

Epidemiology of Tinea Cruris

A

Male gender

Sweaty/humid

Occlusive clothing

Obesity/skin folds

Athlete’s foot

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15
Q

Clinical Presentation of Tinea Cruris

A

Well-marginated, scaly, annular plaque with raised border

Extends from the inguinal fold to inner thigh

Scrotum typically spared

Pruritus and pain

Can be chronic and progressive

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16
Q

Diagnosis of Tinea Cruris

A

History and physical exam

KOH prep to confirm

Culture

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17
Q

Treatment of Tinea Cruris

A

Topical antifungals (clotrimazole)

Resistant cases: oral itraconazole

Treatment accompanying or associated with tinea pedis and/or onychomycosis

Daily drying powder

Lifestyle considerations: avoid tight clothing, weight loss

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18
Q

Etiology of Tinea Pedis

A

Athlete’s foot

Typically caused by the same species as tinea cruris

T. rubrum
T. interdigitale
E. floccosum

Chronic vs. Acute

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19
Q

Epidemiology of Tinea Pedis

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A

Most common dermatophytosis in the world

Risk factors:

  • occlusive footwear
  • communal baths/showers/pools
20
Q

Clinical Presentation of Tinea Pedis

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A

Acute:

  • presents as a self-limited, intermittent, and recurrent infection
  • itchy/painful vesicles or bulla following sweating
  • secondary staph infections are common

Chronic:

  • presents as a slowly progressive infection that persists indefinitely
  • erosions/scales between toes (esp. 3rd and 4th)
  • interdigital fissures
  • “moccasin ringworm”: sharp demarcation with accumulated scale in the skin creases
  • may present with tinea manuum (two feet, one hand)
21
Q

Diagnosis of Tinea Pedis

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A

History and physical exam

KOH prep to confirm

Culture

Gram stain if bacterial infection suspected

22
Q

Treatment of Tinea Pedis

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A

Treated similarly to corporis/cruris but typically requires longer treatment

Topical antifungal cream (clotrimazole) x 4 weeks

Oral meds for chronic/extensive disease (itraconazole, terbinafine, fluconazole)

Burow’s wet dressings for vesiculation or maceration, 20 minutes BID-TID

Treat secondary infections

Lifestyle considerations: foot powder, treatment of shoes, proper footwear

23
Q

Etiology of Onychomycosis

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A

Infection of the nail by fungus, yeast, or non-dermatophyte molds

T. rubrum
T. mentagrophytes

Candida Albicans (yeast)

Nondermatophyte molds

24
Q

Risk Factors for Onychomycosis

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A

Advanced age

Tinea pedis

Genetics

Immunodeficiency

Household infection

25
Distal Subungual Onychomycosis
- Most common subtype by far - Typically starts with great toe, but all can be affected - White/brown/yellow discoloration starts at distal corner and spreads towards the cuticle - Distal end of the nail breaks, exposing the nail bed
26
Proximal Subungual Onychomycosis
- Starts near the cuticle and progresses distally - Relatively uncommon presentation - Usually seen in severely immunocompromised population (AIDS)
27
White Superficial Onychomycosis
- Starts with dull white spots on the surface of the nail plate - Spreads centrifugally until entire nail is involved - Lesions can be scraped for lab sample
28
Fingernail Onychomycosis
Commonly caused by yeast (Candida Albicans) Thickening of nail with yellow/brown discoloration May cause chronic paronychia (An infection of the tissue folds around the nails)
29
Diagnosis of Onychomycosis
KOH prep of nail scrapings Culture Histopathology (biopsy)
30
Treatment of Onychomycosis
No obligatory, but should be considered if the patient: - Has a history of cellulitis - Diabetic - Desires cosmetic improvement - Complains of discomfort/pain Dermatophyte onychomycosis: - Oral terbinafine (6 weeks for fingernails, 12 weeks for toenails) - Alternative options: fluconazole, intraconazole Nondermatophyte onychomycosis: - Oral intraconazole (6 weeks for fingernails, 12 weeks for toenails)
31
Etiology of Candida Intertrigo
Any infectious or noninfectious inflammatory condition of two closely opposed (intertriginous) skin surfaces Often due to Candida species
32
Risk Factors of Candida Intertrigo
Moisture (humidity, incontinence) Skin friction (obesity, sumo wrestling) Immunocompromised
33
Clinical Presentation of Candida Intertrigo
Typically affects the groin, mammary/abd folds, web spaces, and axilla Erythematous, macerated (soggy or softened) plaques and erosions Satellite papules/pustules Fine peripheral scaling
34
Diagnosis of Candida Intertrigo
History and physical exam KOH prep Culture
35
Treatment of Candida Intertrigo
Preventative measures: - drying agents - weight loss - address underlying medical conditions Topical medications x 2-4 weeks - Nystatin - Azoles Systemic medications in resistant/severe cases - Fluconazole x 2-6 weeks
36
Etiology of Tinea Versicolor
Fungal infection of the skin Caused by Malassezia sp. Normal fungal skin flora that becomes pathologic when it transforms into the mycelial form
37
Epidemiology of Tinea Versicolor
Tropical climate Adolescents/young adults Risk Factors: - Hyperhidrosis, Genetics, immunosuppression, not contagious
38
Clinical Presentation of Tinea Versicolor
Varies with skin tone/location (can be hypo/hyper pigmented, erythematous) - Macules (flat lesions), patches, plaques on trunk/UE - Can coalesce - Often have fine scale Typically asymptomatic but can be mildly pruritic
39
Diagnosis of Tinea Versicolor
History and physical exam KOH prep Wood's Lamp: yellow to yellow-green fluorescence in 1/3
40
Treatment of Tinea Versicolor
Usually treated with topical antifungal medications Topical treatments: - Azole antifungals (clotrimazole) x 2 weeks - Selenium sulfide (lotion, shampoo, foam) x 1 weeks - Zinc Pyrithione shampoos x 2 weeks Systemic: - reserved for extensive disease or failed topical therapy - Not used in children - Oral azole antifungals (itraconazole x 5-7 days) pigment changes can persist for months after successful tx recurrence common, consider prophylaxis
41
Scabies Etiology
A parasitic infection Caused by Sarcoptes scabiei mite: - host harbors 3-50 female mites - female mite excavates a burrow in the stratum corneum in which she lays 2-3 eggs/ days for her 30-day lifespan - eggs hatch in 10 days - can live for 3 days away from host
42
Clinical Presentation of Scabies
Initial lesion Burrow is pathognomonic (indicative of a particular disease or condition) Severe pruritus, worse at night
43
Scabies in the Immunocompromised
Crusted Scabies (Norwegian scabies) - Fissures provide avenue for bacteria which can lead to sepsis - Requires oral medications
44
Diagnosis of Scabies
Visualization of the burrow Microscopic identification of the mite, eggs, or fecal pellets (Scybala) Dermatoscope
45
Treatment of Scabies
Permethrin 5% cream - initial tx + 2nd application 10-14 days later Oral Ivermectin - single dose repeated two weeks later Patient education - treat household and close contacts simultaneously - Post scabetic itch can persist up to 2 weeks - oral anihistamines and emollients can provide symptomatic relief - wash linens in hot water and dry under high heat
46
Pubic Lice
Parasites, larger than scabies Caused by the crab louse, Phthirus pubis Most commonly affects teens and young adults Transmitted primarily via sexual contact Presents with itching in groin/axilla Diagnosed by visualizing the lice or egg (nit) Using a microscope helps Treatment is permethrin 1% cream, repeat/recheck in 10 days Treat sexual partners Have another STI about 30% of the time

Clin Med I (5 decks)

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