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Questions and Answers
What is the most common type of Tinea Manuum?
What is the most common type of Tinea Manuum?
Tinea Pedis is the most common fungal infection worldwide.
Tinea Pedis is the most common fungal infection worldwide.
True
Name one method of prevention for Tinea Pedis.
Name one method of prevention for Tinea Pedis.
Keeping toes dry
The chronic intertriginous type of Tinea Pedis commonly affects the __________ toe webs.
The chronic intertriginous type of Tinea Pedis commonly affects the __________ toe webs.
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Match the types of Tinea Pedis with their descriptions:
Match the types of Tinea Pedis with their descriptions:
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Which of the following is a characteristic of Tinea Cruris?
Which of the following is a characteristic of Tinea Cruris?
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Nummular eczema is a type of Tinea.
Nummular eczema is a type of Tinea.
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What demographic is most commonly affected by Tinea Pedis?
What demographic is most commonly affected by Tinea Pedis?
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Which of the following is NOT a predisposing factor for fungal infections?
Which of the following is NOT a predisposing factor for fungal infections?
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Tinea Pedis is also known as Athlete's foot.
Tinea Pedis is also known as Athlete's foot.
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Name one genera of fungi that is associated with superficial fungal infections.
Name one genera of fungi that is associated with superficial fungal infections.
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Tinea __________ is commonly known as ringworm of the scalp.
Tinea __________ is commonly known as ringworm of the scalp.
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Match the type of Tinea with its description:
Match the type of Tinea with its description:
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Which variety of Tinea Capitis is characterized by a painful, boggy swelling?
Which variety of Tinea Capitis is characterized by a painful, boggy swelling?
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Tinea Corporis lesions typically have a clear center with hyperpigmentation.
Tinea Corporis lesions typically have a clear center with hyperpigmentation.
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What is the common symptom of Tinea Faciei?
What is the common symptom of Tinea Faciei?
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The type of Tinea that begins early in life with a yellow cup-shaped crust is called Tinea __________.
The type of Tinea that begins early in life with a yellow cup-shaped crust is called Tinea __________.
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Which type of Onychomycosis is the most common?
Which type of Onychomycosis is the most common?
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What is the most common population at risk for Tinea Capitis?
What is the most common population at risk for Tinea Capitis?
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Proximal Subungual Onychomycosis is the most common type of fungal nail infection.
Proximal Subungual Onychomycosis is the most common type of fungal nail infection.
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What is the primary etiology of Distal and lateral subungual Onychomycosis?
What is the primary etiology of Distal and lateral subungual Onychomycosis?
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Onychomycosis is responsible for ____% of all nail diseases.
Onychomycosis is responsible for ____% of all nail diseases.
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Which treatment is NOT recommended for Onychomycosis?
Which treatment is NOT recommended for Onychomycosis?
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Match the following clinical types of Onychomycosis with their descriptions:
Match the following clinical types of Onychomycosis with their descriptions:
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White Superficial Onychomycosis can be easily scraped away.
White Superficial Onychomycosis can be easily scraped away.
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How long should treatment for toenail Onychomycosis generally continue?
How long should treatment for toenail Onychomycosis generally continue?
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Which of the following is a causative organism of candidiasis?
Which of the following is a causative organism of candidiasis?
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Oral thrush typically appears as a green, moss-like layer on the tongue.
Oral thrush typically appears as a green, moss-like layer on the tongue.
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What is the primary symptom of vulvovaginitis caused by candidiasis?
What is the primary symptom of vulvovaginitis caused by candidiasis?
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_________ is the etiologic agent of pityriasis versicolor.
_________ is the etiologic agent of pityriasis versicolor.
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Which examination method shows yellow fluorescence for diagnosing pityriasis versicolor?
Which examination method shows yellow fluorescence for diagnosing pityriasis versicolor?
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Match the type of candidiasis with its description:
Match the type of candidiasis with its description:
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Griseofulvin is effective in treating pityriasis versicolor.
Griseofulvin is effective in treating pityriasis versicolor.
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What treatment options are recommended for candidiasis?
What treatment options are recommended for candidiasis?
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What is the primary etiology of Proximal Subungual Onychomycosis?
What is the primary etiology of Proximal Subungual Onychomycosis?
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Distal and lateral subungual Onychomycosis accounts for 90% of all fungal nail infections.
Distal and lateral subungual Onychomycosis accounts for 90% of all fungal nail infections.
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What is a clinical sign of Proximal Subungual Onychomycosis?
What is a clinical sign of Proximal Subungual Onychomycosis?
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Onychomycosis is responsible for ___% of all nail diseases.
Onychomycosis is responsible for ___% of all nail diseases.
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Match the following treatment options with their types:
Match the following treatment options with their types:
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How long should treatment for fingernail Onychomycosis be continued?
How long should treatment for fingernail Onychomycosis be continued?
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White Superficial Onychomycosis is characterized by well-circumscribed patches that cannot be scraped away.
White Superficial Onychomycosis is characterized by well-circumscribed patches that cannot be scraped away.
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What is the least common variant of Onychomycosis?
What is the least common variant of Onychomycosis?
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Which of these organisms is NOT a causative agent of candidiasis?
Which of these organisms is NOT a causative agent of candidiasis?
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Vulvovaginitis caused by candidiasis is characterized by a thin, watery discharge.
Vulvovaginitis caused by candidiasis is characterized by a thin, watery discharge.
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What is a common site of infection for oral thrush in immunocompromised patients?
What is a common site of infection for oral thrush in immunocompromised patients?
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Chronic paronychia involves swelling of the nail fold along with __________ and discharge of pus.
Chronic paronychia involves swelling of the nail fold along with __________ and discharge of pus.
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Match the type of candidiasis with its description:
Match the type of candidiasis with its description:
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What is the primary treatment for pityriasis versicolor?
What is the primary treatment for pityriasis versicolor?
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Angular cheilitis is soreness located at the college of the mouth.
Angular cheilitis is soreness located at the college of the mouth.
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What is the method of examination that shows yellow fluorescence for diagnosing pityriasis versicolor?
What is the method of examination that shows yellow fluorescence for diagnosing pityriasis versicolor?
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Which type of Tinea Pedis is characterized by fissuring, scaling, or maceration of the toes?
Which type of Tinea Pedis is characterized by fissuring, scaling, or maceration of the toes?
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Tinea Cruris is the medical term for a dermatophytic infection affecting the groins.
Tinea Cruris is the medical term for a dermatophytic infection affecting the groins.
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Name one of the two main clinical forms of Tinea Manuum.
Name one of the two main clinical forms of Tinea Manuum.
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Tinea _________ is commonly known as Athlete's foot.
Tinea _________ is commonly known as Athlete's foot.
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Match the following types of Tinea Pedis with their descriptions:
Match the following types of Tinea Pedis with their descriptions:
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Which of the following best describes the inflammation associated with Tinea Cruris?
Which of the following best describes the inflammation associated with Tinea Cruris?
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Wearing closed shoes can help prevent Tinea Pedis.
Wearing closed shoes can help prevent Tinea Pedis.
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What is the most common demographic affected by Tinea Pedis?
What is the most common demographic affected by Tinea Pedis?
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Which of the following is a predisposing factor for fungal infections?
Which of the following is a predisposing factor for fungal infections?
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Tinea Barbae is commonly seen in adult females.
Tinea Barbae is commonly seen in adult females.
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What is the common name for Tinea Corporis?
What is the common name for Tinea Corporis?
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Tinea __________ is characterized by yellow, cup-shaped crusts called scutulum.
Tinea __________ is characterized by yellow, cup-shaped crusts called scutulum.
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Match the type of Tinea with its description:
Match the type of Tinea with its description:
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What variety of Tinea Capitis is marked by a painful, boggy swelling?
What variety of Tinea Capitis is marked by a painful, boggy swelling?
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Black Dot is a non-inflammatory type of Tinea Capitis.
Black Dot is a non-inflammatory type of Tinea Capitis.
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In which demographic is Tinea Capitis most commonly seen?
In which demographic is Tinea Capitis most commonly seen?
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HIV and diabetes are examples of __________ factors that can predispose individuals to fungal infections.
HIV and diabetes are examples of __________ factors that can predispose individuals to fungal infections.
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Match the Tinea description with correct type:
Match the Tinea description with correct type:
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Study Notes
Fungal Infections
- Fungal infections are common, affecting 20-25% of the world population.
- Predisposing factors include tropical climates, manual labor, low socioeconomic status, profuse sweating, friction with clothes, malnutrition, and immunosuppression.
- Fungal infections can be classified as superficial or deep.
Superficial Infections
- Superficial fungal infections are caused by dermatophytes, specifically Microsporum, Trichophyton, and Epidermophyton.
- Superficial fungal infections can affect different parts of the body:
-
Tinea Capitis (Scalp Ringworm): Invasion of the hair shaft by dermatophytes, mainly seen in children.
- There are 4 varieties:
- Gray Patch (Ectothrix): non-inflammatory, caused by Microsporum spp, characterized by patches of partial hair loss with dull, grey, easily pluckable hairs.
- Black Dot (Endothrix): characterized by brittle hair shafts, broken-off hairs with black dots, minimal inflammation, and green fluorescence under Wood's Lamp examination.
- Kerion: inflammatory, painful, boggy swelling with purulent discharge, vesicles, pustules, thick crusting, matting of hair, lymphadenopathy, secondary bacterial infection, and scarring.
- Favus: inflammatory, begins early in life, characterized by yellow, cup-shaped crusts (scutula), mousy odor, matted hair, and extensive patchy hair loss with cicatricial alopecia.
- There are 4 varieties:
- Tinea Barbae (Barber's Itch): Ringworm of the beard and moustache area, mainly affecting adult males.
- Tinea Faciei: Dermatophyte infection of the non-bearded area of the face, characterized by burning, itching, photosensitivity, erythematous scaly patches, raised borders, and hypopigmented or brown central areas.
- Tinea Corporis: Dermatophyte infection of the skin excluding the scalp, beard, face, hands, feet, and groin.
-
Tinea Manuum (Ringworm of the Palms): Common in adults, particularly males, with two main types:
- Non-inflammatory squamous form: most common, characterized by hyperkeratosis of palms and fingers, accentuation of flexural creases, and association with hyperhidrosis.
- Inflammatory vesicular/dyshidrotic/eczematous form: uncommon in temperate climates, characterized by vesicles mainly on the palms, itchiness, and spontaneous healing.
-
Tinea Pedis (Athlete's Foot): Dermatophyte infection of the feet, most common fungal infection worldwide, affecting 30-70% of the population in developed countries.
- Four types:
- Chronic intertriginous: most common, characterized by fissuring, scaling, and maceration between the 3rd and 4th toes.
- Chronic papulosquamous: inflammatory, patchy scaling over the soles.
- Vesicular/vesiculobullous: small vesicles/vesiculopustules on the instep and mid anterior plantar surface with scaling.
- Acute ulcerative: maceration, weeping, and ulceration of the soles with secondary infections possible.
- Four types:
- Tinea Cruris (Dhobi's Itch, Jock Itch): Dermatophytic infection of the groins, characterized by itching, sharply demarcated erythematous annular skin rash extending from the groins to the thighs.
-
Onychomycosis: Infection of the nail caused by fungus, common infection affecting 20% of all nail diseases, characterized by dirty, dull, dry, pitted, ridged, split, discolored, thick, uneven nails with subungual hyperkeratosis.
- Four types:
- Distal and lateral subungual onychomycosis: most common, starts distally and moves proximally.
- Proximal subungual onychomycosis: least common, characterized by whitish-brownish area on the proximal part of the nail, can be an early indicator of HIV infection.
- White superficial onychomycosis: 2nd most common, characterized by well-circumscribed powdery white patches on the nail plate.
- Total dystrophic onychomycosis: characterized by complete destruction of the nail plate.
- Four types:
-
Tinea Capitis (Scalp Ringworm): Invasion of the hair shaft by dermatophytes, mainly seen in children.
Treatment of Dermatophyte Infections
- Topical Treatment: Bifonazole, Oxiconazole, Clotrimazole, Miconazole, Butenafine, Terbinafine, available in lotions, creams, powders, and gels.
- Systemic Treatment: Griseofulvin, Fluconazole, Terbinafine, Itraconazole.
-
Duration of Treatment:
- Tinea capitis: 6 weeks
- Tinea faciei: 4 weeks
- Tinea cruris: 2-4 weeks
- Tinea corporis: 4-6 weeks
- Tinea manuum/pedis: 6-8 weeks
Treatment of Onychomycosis
- Topical Treatment: 8% Ciclopirox olamine lotions, Amorolfine lacquer.
- Systemic Treatment: Same treatment as for dermatophyte infections for 3 months (fingernails) or 6 months (toenails), Pulse Therapy with Terbinafine or Itraconazole can be considered.
Treatment Principles for Fungal infections
- Dermatophytosis takes 3-4 weeks to resolve with complete treatment, including one week beyond apparent cure.
- Good hygiene, proper clothing, and treatment of predisposing factors are crucial.
- Onychomycosis requires 3-6 months of treatment with 4 weeks beyond apparent cure.
Candidiasis
- Causative organism: Candida albicans, Candida tropicalis, Candida pseudotropicalis.
- Sites of affection: mucous membranes, skin, nails.
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Mucosal Candidiasis:
- Oral Thrush: creamy, curd-like white pseudomembrane on an erythematous base in immunocompetent patients, affecting cheeks, gums or palate; in immunocompromised patients, it can affect the tongue and extend to the pharynx or esophagus.
- Angular Cheilitis (Angular Stomatitis/Perleche): soreness at the angles of the mouth.
- Vulvovaginitis (Vulvovaginal Thrush): itching, soreness, thick creamy white discharge.
- Balanoposthitis: tiny papules on the glans penis after intercourse evolving into white pustules or vesicles, radial fissures on glans penis in diabetics, vulvovaginitis in conjugal partner.
- Flexural Candidiasis (Intertrigo): Erythema and maceration in folds, axilla, groins, webspaces, and napkin rash (pustules with irregular borders and satellite lesions).
-
Candidiasis of Nail:
- Chronic Paronychia: swelling of the nail fold with pain and discharge of pus.
- Onychomycosis: Destruction of the nail plate.
Treatment of Candidiasis:
- Treat predisposing factors, including poor hygiene, diabetes, AIDS, and conjugal infections.
- Topical Treatment: Clotrimazole, Miconazole, Ciclopirox olamine.
- Oral Treatment: Itraconazole, Fluconazole.
Pityriasis Versicolor
- Etiologic agent: Malassezia furfur.
- Common among youth with genetic predisposition and familial occurrence.
- Characterized by multiple, discrete, fawn, brown, grey, or hypopigmented macules, pinhead-sized to large sheets of discolouration.
- Typically affecting seborrheic areas, upper half of the body: trunk, arms, neck, abdomen.
Investigations for Pityriasis Versicolor:
- Wood's Lamp examination: Yellow fluorescence.
- KOH preparation: spaghetti and meatball appearance (coarse mycelium, fragmented to short filaments with spherical, thick-walled yeasts).
Treatment of Pityriasis Versicolor:
- Topical Treatment: Clotrimazole, Miconazole, Bifonazole, Oxiconazole, Butenafine, Terbinafine, Selenium sulfide, Sodium thiosulphate.
- Oral Treatment: Fluconazole (single dose). Griseofulvin is not effective.
Fungal Infections
- Fungal infections are a common type of infection, affecting 20-25% of the world's population.
- Predisposing factors for fungal infections include tropical climates, manual labor populations, low socioeconomic status, profuse sweating, friction with clothes, synthetic innerwear, malnourishment, and immunosuppression.
- Immunosuppression can be caused by HIV, congenital immunodeficiencies, corticosteroid use, immunosuppressive drugs, and diabetes.
Superficial Cutaneous Fungal Infections
- Superficial cutaneous fungal infections are caused by three genera: Microsporum, Trichophyton, and Epidermophyton.
- These infections can be categorized by location on the body:
- Tinea Capitis (Scalp Ringworm): Invades the hair shaft, primarily affecting children, with boys demonstrating a higher prevalence than girls.
- Tinea Barbae (Barber's Itch): Affects the beard and moustache area in adult males, characterized by inflammatory papulopustules.
- Tinea Faciei: Dermatophyte infection of the non-bearded area of the face, often presents with burning, itching, and photosensitivity.
- Tinea Corporis: Infection of the skin excluding the scalp, beard, face, hands, feet, and groin. Presents with annular or polycyclic lesions, often with raised borders.
- Tinea Manuum (Ringworm of the Hand): Primarily affects adults, most commonly presenting as a non-inflammatory squamous form with hyperkeratosis and accentuation of flexural creases.
- Tinea Pedis (Athlete's Foot): The most common fungal infection worldwide, particularly affecting adult males. Presents with varying clinical types including intertriginous, papulosquamous, vesicular, and acute ulcerative variants.
- Tinea Cruris (Dhobi's Itch, Jock Itch): Dermatophytic infection of the groins, characterized by itching, a sharply demarcated erythematous rash, and variable scaling.
- Onychomycosis (Nail Fungus): Infection of the nails, frequently occurring in 20% of all nail diseases. Presents with various clinical types including distal and lateral subungual, proximal subungual, white superficial, and total dystrophic.
Tinea Capitis (Scalp Ringworm)
- Tinea Capitis can present with varying lesions, ranging from subtle grey broken hairs with minimal scaling to severe, painful inflammatory masses.
- Partial hair loss is common across all types.
- There are four varieties of Tinea Capitis:
- Gray Patch (Ectothrix): Non-inflammatory type caused by Microsporum species, characterized by patches of partial hair loss and easily pluckable, dull grey hairs.
- Black Dot (Endothrix): Endothrix organisms cause brittle hair shafts, leading to black dots from broken off hairs. Inflammation is minimal, and a Wood's Lamp examination will reveal green fluorescence.
- Kerion: Inflammatory type with painful, boggy swelling, purulent discharge, vesicles, pustules, thick crusting, matted hair, lymphadenopathy, and secondary bacterial infection. Heals with scarring.
- Favus: Inflammatory type that begins early in life. Characterized by yellow, cup-shaped crusts (scutula), mousy odor, matted hair, and extensive patchy hair loss with cicatricial alopecia.
Tinea Barbae (Barber's Itch)
- Affects the beard and moustache area, primarily affecting adult males.
- The fungus invades coarse hairs, causing inflammatory papulopustules, seropurulent discharge, and easy hair epilation.
- It can be difficult to differentiate from bacterial folliculitis, requiring confirmation through KOH mount.
Tinea Faciei
- Dermatophyte infection of the non-bearded area of the face.
- Presents with burning, itching, and photosensitivity.
- Lesions appear as erythematous, scaly patches with raised borders and a central area of hypopigmentation or brown discoloration.
- Often seen in immunocompromised patients.
Tinea Corporis
- Infection of the skin excluding the scalp, beard, face, hands, feet, and groin.
- The fungus enters the stratum corneum and spreads centrifugally.
- Presents with annular or polycyclic lesions, often with raised borders and a clear, hyperpigmented center.
- Concentric rings may be visible.
Tinea Manuum (Ringworm of the Hand )
- Primarily affects adults, most commonly presenting as a non-inflammatory squamous form:
- Hyperkeratosis of palms and fingers
- Accentuation of flexural creases
- Association with hyperhidrosis
- An inflammatory vesicular/dyshidrotic/eczematous form is uncommon in temperate climates, presenting with vesicles on the palms.
Tinea Pedis (Athlete's Foot)
- The most common fungal infection worldwide, particularly affecting adult males.
- Associated with wearing shoes and maceration.
- Presents with four clinically accepted variants:
- Chronic intertriginous type: Fissuring, scaling, or maceration, commonly found in the lateral 3rd and 4th toe webs.
- Chronic papulosquamous type: Inflammation and patchy "mocassin-like" scaling over the soles.
- Vesicular or vesiculobullous type: Small vesicles/vesiculopustules on the instep and mid-anterior plantar surface, often associated with scaling.
- Acute ulcerative variant: Maceration, weeping, and ulceration of the soles, often complicated by secondary infections.
Tinea Cruris (Dhobi's Itch, Jock Itch):
- Dermatophytic infection of the groins.
- Characterized by itching and a sharply demarcated erythematous rash that advances in an annular pattern.
- The rash extends from the groins to the thighs.
- Scaling is variable and can mask inflammatory changes.
- Vesiculation is rare.
Onychomycosis (Nail Fungus)
- Infection of the nails, frequently occurring in 20% of all nail diseases.
- Presents with a variety of clinical types:
- Distal and lateral subungual Onychomycosis: The most common type, caused by T.rubrum, affecting toe nails more than fingernails. The infection begins in the distal nailbed or lateral nailfold and moves proximally.
- Proximal Subungual Onychomycosis: Least common variant, caused by T.rubrum. The first sign is a whitish-brownish area on the proximal part of the nail. It can be an early indicator of HIV infection.
- White Superficial Onychomycosis: Second most common type. Well-circumscribed powdery white patches on the nail plate, easily scraped away, leaving a rough and friable nail surface.
- Total Dystrophic Onychomycosis: Characterized by involvement of the entire nail.
Candidiasis
- Caused by Candida species, most commonly Candida albicans.
- Affects mucous membranes, skin, and nails.
-
Mucosal candidiasis is common in immunocompromised patients, but also affects immunocompetent individuals.
- Oral thrush: Creamy, curd-like, white pseudomembrane on an erythematous base, affecting cheeks, gums, and palate.
- Angular cheilitis: Soreness at the angles of the mouth.
- Vulvovaginitis: Itching and soreness with a thick, creamy white discharge.
- Balanoposthitis: Tiny papules on the glans penis after intercourse, evolving into white pustules or vesicles that rupture.
- Flexural candidiasis presents as erythema and maceration in skin folds, particularly in the axilla, groins, and webspaces.
- Napkin rash presents with pustules, an irregular border, and satellite lesions.
-
Nail candidiasis presents as:
- Chronic paronychia: Swelling of the nailfold with pain and discharge of pus.
- Onychomycosis: Destruction of the nail plate.
Pityriasis Versicolor
- Caused by Malassezia furfur.
- Common among youth and associated with genetic predisposition and familial occurrence.
- Presents with multiple, discrete, discolored macules that can be fawn, brown, grey, or hypopigmented.
- Lesions range in size from pinhead-sized to large sheets of discoloration.
- Affects seborrheic areas, particularly the upper half of the body, including the trunk, arms, neck, and abdomen.
Treatment
-
Topical Treatment:*
-
Dermatophyte Infections: Bifonazole, Oxiconazole, Clotrimazole, Miconazole, Butenafine, Terbinafine. Vehicles include lotions, creams, powders, and gels.
-
Onychomycosis: 8% Ciclopirox olamine lotions for local application.
-
Candidiasis: Clotrimazole, Miconazole, Ciclopirox olamine.
-
Pityriasis Versicolor: Clotrimazole, Miconazole, Bifonazole, Oxiconazole, Butenafine, Terbinafine, Selenium sulfide, Sodium thiosulphate.
-
Systemic Treatment:*
-
Dermatophyte Infections: Griseofulvin, Fluconazole, Terbinafine, Itraconazole.
-
Onychomycosis: Same medications as systemic dermatophyte treatments, for 3 months (fingernails) or 6 months (toenails).
-
Candidiasis: Itraconazole, Fluconazole.
-
Pityriasis Versicolor: Fluconazole, Griseofulvin is NOT effective.
-
Treatment Principles:*
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Dermatophytoses require 3-4 weeks of treatment, extending 1 week beyond the apparent cure.
-
Proper hygiene, clothing, and avoidance of communal changing rooms and swimming baths is recommended.
-
Onychomycosis treatment is generally for 3-6 months, extending 4 weeks beyond the apparent cure.
-
Temporary relief should not be mistaken for cure.
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Description
Explore the various types of fungal infections, including superficial and deep infections. Learn about the common causes, predisposing factors, and specific conditions such as Tinea Capitis. This quiz delves into the dermatophytes responsible for these infections and their effects on different parts of the body.