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