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Fungal Skin Infections
Prof Werner Sinclair
Dept of Dermatology
University of the Free State
Fungi That Infect The Skin
Dermatophytes
Yeasts: Candida
Pityrosporum (Mallesazia)
Moulds: Scopulariopsis
Scytalidium
etc.
Deep Fungi: Sporothrix schenkii
Cryptococcus neoformans
Histoplasma capsulatum
Dermatophyte Infections
Keratolytic fungi
Trichophyton, Epidermophyton, Microsporum spp
Named according to skin area involved
Diagnosis of Tinea
Clinical
KOH microscopy
Culture
Treatment of Tinea Infections
Topical: Imidazole preparations
Terbinafine
Systemic: Griseofulvin
Terbinafine
Ketoconazole
Itraconazole
Tinea Corporis
Classical ringworm
Annular lesions
Secondary rings
Edge: Raised, red, scaly, pustular, vesicular
Tinea incognito
Diagnosis
Treatment
Tinea Capitis
Children / Immunocompromised adults
Scaling
Hair loss / broken off hairs
Pustules
Swelling, redness (kerion)
Diagnosis
Treatment: Always systemic!!!
Griseofulvin 15mg/kg/day
Tinea Cruris
Any skin fold: Groin, axilla, submammary
May be annular, not necessarily
Little scaling
Can be very subtle
Treatment
Tinea Pedis
Asymmetrical foot involvement
Four forms: interdigital
vesicular
moccasin
annular plaque
Epidemiology
Treatment
Tinea Unguium
Random, asymmetric nail involvement
Hands and/or feet
Onycholysis
Subungual hyperkeratosis
Nail plate thickened, brittle, yellow
Secondary Pseudomonas
Treatment: Look for matrix involvement (lunula)
Hands: 2 months, feet 3 months
Preventative measures
Candida Infections
Skin folds: Angular stomatitis
Genitals (Penis, scrotum, vulva)
Submammary
Axillae
Interdigital
Diaper rash
Nails
Mucous membranes: Oral
Vagina, penis
Esophagus
CANDIDIASE
Angular Stomatitis
“Perleche”
Older people
Atrophied gingival ridges
Ill-fitting / worn dentures
Candida colonizes the dentures
Treatment
Sterilize dentures
Stomatitis
Tongue and rest of oral mucosa
White deposition, can be scraped off
Also red, smooth form
HIV, antibiotics, diabetics, babies
Diagnosis
Treatment
Candidiasis
Candidiasis
Candida Intertrigo
All skin fold infections, including genitals
Very pruritic, red, scaling edge, satellite lesions
Usually symmetrical
Remember involvement of scrotum and penis
Diagnosis
Treatment
CANDIDIASE
CANDIDIASE
CANDIDIASE
CANDIDIASE
Candida Diaper Rash
Usually secondary to PIND
Sometimes primary, antibiotics
Intertrigo, but more extensive
Treatment: Topical + Nystatin drops
Candida Nail Infection
Random, asymmetrical involvement
Chronic paronychia
Nails hard, brown, slightly irregular
HIV, diabetics, wet work, soap, frequent hand
washing
Treatment
Advice
CANDIDIASE
Pityrosporum ovale
Also known as Mallesazia furfur
Causes tinea (pityriasis) versicolor
Also major role in seborrheic dermatitis
Not contagious
Treatment
Prophylaxis
Recommended