Fungal Skin Infections Overview

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Questions and Answers

What type of fungi is characterized as unicellular and thrives at 37°C?

  • Mold
  • Dimorphic fungi
  • Dermatophytes
  • Yeast (correct)

Which of the following describes the general transmission route of zoophilic dermatophytes?

  • Primarily from animals to humans (correct)
  • From humans to animals
  • From soil to humans
  • From plants to humans

What distinguishes dermatophytes from the other types of fungi mentioned?

  • They only affect animals.
  • They are unicellular fungi.
  • They can produce spores in soil.
  • They infect keratinized structures. (correct)

Which of the following is NOT a type of tinea caused by dermatophytes?

<p>Tinea auris (D)</p> Signup and view all the answers

What is the characteristic appearance of a lesion in tinea corporis?

<p>Central clearing with raised edges (A)</p> Signup and view all the answers

Which clinical variant of tinea corporis is usually associated with contact sports?

<p>Tinea gladiatorum (C)</p> Signup and view all the answers

What effect do topical steroids have on tinea incognito lesions?

<p>They change the morphology of the lesions. (C)</p> Signup and view all the answers

Which of the following dermatophytes is commonly associated with infections following contact with infected kittens?

<p>Microsporum canis (C)</p> Signup and view all the answers

What is the primary site of infection for tinea cruris?

<p>Groin (A)</p> Signup and view all the answers

Which of the following is a characteristic symptom of kerion?

<p>Boggy swelling on the scalp (C)</p> Signup and view all the answers

Tinea capitis can have non-inflammatory variants. Which of the following describes the grey patch variant?

<p>Multiple round patches with scaly white scalp (D)</p> Signup and view all the answers

Which predisposing factor is particularly associated with tinea cruris?

<p>Moist weather (C)</p> Signup and view all the answers

What is the primary cause of dermatophytid reactions?

<p>Systemic response to fungal antigens (C)</p> Signup and view all the answers

What is a common symptom of tinea pedis?

<p>Scaling and maceration between the toes (C)</p> Signup and view all the answers

What type of fungi primarily causes tinea cruris?

<p>Anthropophilic fungi (C)</p> Signup and view all the answers

Which type of tinea is primarily associated with exposure to animals?

<p>Tinea barbae (D)</p> Signup and view all the answers

What is a common presentation of hyperkeratotic tinea pedis?

<p>Scaling of the planter surface and sides of feet (A)</p> Signup and view all the answers

Which type of tinea unguium is typically associated with crumbling of the nail's free edge?

<p>Distal and lateral subungual onychomycosis (B)</p> Signup and view all the answers

What complication can arise from fierce animal ringworm of the scalp?

<p>Permanent scarring alopecia (B)</p> Signup and view all the answers

What is a characteristic method for diagnosing fungal infections of the scalp?

<p>Wood’s light examination revealing green fluorescence (A)</p> Signup and view all the answers

What factor contributes to the transmission of tinea pedis?

<p>Desquamated skin scales in carpets and matting (D)</p> Signup and view all the answers

Which of these is NOT typically a differential diagnosis for tinea pedis?

<p>Alopecia areata (B)</p> Signup and view all the answers

Which is a common treatment for localized tinea infections?

<p>Imidazole preparations (D)</p> Signup and view all the answers

What symptom is associated with vesiculobullous tinea pedis caused by T. mentagrophytes?

<p>Pruritic tense vesicles and bullae (D)</p> Signup and view all the answers

What is the primary characteristic of candidiasis in mucous membranes?

<p>Fungal infection leading to lesions (C)</p> Signup and view all the answers

What does a KOH mount reveal in cases of candidiasis?

<p>Budding yeast and pseudohyphae (B)</p> Signup and view all the answers

Which of the following is NOT a common site for cutaneous candidiasis?

<p>Forehead (A)</p> Signup and view all the answers

What is one effective treatment for oral candidiasis?

<p>Oral suspensions of nystatin (B)</p> Signup and view all the answers

What is the primary action of flucytosine in antifungal therapy?

<p>Disruption of nucleic acid synthesis (C)</p> Signup and view all the answers

Which of the following is a common predisposing factor for candidiasis?

<p>High humidity and occlusive clothes (C)</p> Signup and view all the answers

Which antifungal class is known for inhibiting squalene epoxidase?

<p>Allylamines (B)</p> Signup and view all the answers

What is a recommended action for patients with chronic paronychia?

<p>Keep hands warm and dry (A)</p> Signup and view all the answers

What is the most common location for lesions in Pityriasis (Tinea) Versicolor?

<p>Back and upper arms (B)</p> Signup and view all the answers

Which treatment is specifically indicated for Tinea Corporis?

<p>Griseofulvin 12.5 mg/kg (D)</p> Signup and view all the answers

What clinical feature is characteristic of Pityriasis Versicolor?

<p>Asymptomatic macules with scaling (B)</p> Signup and view all the answers

Which factor is a significant predisposing condition for candidiasis?

<p>Old age (C)</p> Signup and view all the answers

What is the appearance of Malassezia furfur observed under a KOH smear?

<p>Spaghetti and meatballs (B)</p> Signup and view all the answers

Which antifungal is NOT mentioned as effective for Pityriasis Versicolor?

<p>Fluconazole (D)</p> Signup and view all the answers

Which systemic treatment is recommended for Tinea Cruris?

<p>Terbinafine 250 mg once daily (A)</p> Signup and view all the answers

What is the most common demographic group affected by Pityriasis Versicolor?

<p>Adolescent and young adult males (B)</p> Signup and view all the answers

Flashcards

Dermatophytosis (Tinea)

Fungal infections of the skin, hair, and nails caused by dermatophytes, leading to lesions with a characteristic ring-like appearance.

Tinea Capitis (Scalp Ringworm)

A type of dermatophyte infection that affects the scalp, leading to hair loss, scaling, and inflammation. It's usually caused by Trichophyton or Microsporum.

Tinea Corporis (Body Ringworm)

A type of dermatophyte infection affecting smooth skin (excluding the scalp, face, and nails). The classic lesion is a raised ring with a clear center.

Tinea Cruris (Jock Itch )

A subtype of Tinea corporis affecting the groin area. It's often itchy and has a characteristic ring-like shape.

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Tinea Pedis (Athlete's Foot)

A type of dermatophyte infection that mainly affects the feet, causing scaling, itching, and sometimes blisters. It is also known as "Athlete's Foot."

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Tinea Barbae (Beard Ringworm)

A type of ringworm infection specifically affecting the beard area, causing itching, inflammation, and sometimes hair loss.

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Tinea Unguinm (Onychomycosis or Nail Ringworm)

The infection of the fingernails or toenails caused by dermatophytes, resulting in thickening, discoloration, and often separation of the nail from the nail bed.

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Tinea Incognito

A form of ringworm infection where the typical ring-like presentation has been altered, often due to the application of topical steroids or other medications.

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Tinea Capitis

A fungal infection of the scalp that can present in both non-inflammatory and inflammatory forms. Non-inflammatory forms include gray patches with small scales and black dots where hair breaks at the surface. Inflammatory forms include kerion, a boggy swelling, and favus, characterized by yellow cup-shaped crusts.

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Dermatophytid "id" reaction

A systemic reaction to fungal antigens, seen in cases of inflammatory tinea capitis. This reaction manifests as widespread skin eruptions on the trunk and extremities, often appearing as vesicles, papules, and pustules.

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Tinea Barbae

A zoophilic fungal infection of the face, commonly caused by contact with pets. It is characterized by scaling, annular patterns (ring-shaped), and pustule formation.

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Tinea Manuum

A fungal infection of the hands, typically caused by T. rubrum or T. mentagrophytes var. interdigitale. It commonly affects the palms and fingertips and can manifest as scaling, itching, and redness.

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Kerion

A type of inflammatory tinea capitis caused by dermatophytes of animal origin, such as T. verrucosum. It is characterized by a boggy swelling of the scalp and typically results from an inflammatory reaction to the fungus.

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Favus

A severe type of tinea capitis characterized by yellow, cup-shaped crusts called scutula. It is caused by T. schoenleinii and results in a distinctive bluish-white fluorescence under Wood's lamp.

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Interdigital Tinea pedis

A type of Tinea pedis that presents with scaling, fissuring and erythema in the web spaces between the toes, particularly the 3rd and 4th toe clefts.

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Hyperkeratotic Tinea pedis (Moccasin Type)

A type of Tinea pedis characterized by scaling on the plantar surface and sides of the feet, resembling a moccasin.

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Vesiculobullous Tinea pedis

Tinea pedis caused by T.mentagrophytes, presenting with itchy tense vesicles and bullae that affect the soles of the feet.

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Maceration in Tinea pedis

A common symptom of Tinea pedis, particularly the interdigital type, where the skin between the toes becomes soft and white due to excessive moisture.

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Distal and Lateral Subungual Onychomycosis

The end of the nail lifts up, often crumbling, usually caused by Trichophyton rubrum.

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Superficial White Onychomycosis

A type of onychomycosis characterized by flaky white patches on the top of the nail plate, commonly caused by T.mentagrophytes, Aspergillus, Fusarium, and Acremonium.

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Proximal White Subungual Onychomycosis

A type of onychomycosis affecting the proximal nail bed, often associated with HIV.

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Pityriasis Versicolor

A skin infection caused by the lipophilic yeast Malassezia furfur and Malassezia globosa. It manifests as small, asymptomatic, hypopigmented or hyperpigmented macules (spots).

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Candidiasis of skin, mucous membranes and nails

Candidiasis of the skin, mucous membranes, and nails. It's more common in infants, pregnant women, older adults, and people with impaired immune systems, hormonal imbalances, or other underlying health conditions.

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Oral Candidiasis (Thrush)

A fungal infection that affects the mouth, including the tongue, gums, and inner cheeks. It can cause white patches, soreness, and difficulty swallowing.

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Cutaneous Candidiasis

A type of candidiasis that affects the skin, mucous membranes, and nails. It can be found in areas like the groin, under breasts, and around the diaper area.

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Candidia Onychomycosis

A fungal infection that affects the nails, often causing thickening, discoloration, and separation from the nail bed.

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KOH Mount

A common test used to diagnose candidiasis. It involves using a microscope to examine a sample of skin or mucous membrane for the presence of yeast and pseudohyphae.

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Azoles

A common treatment option for candidiasis. This group of medications includes topical and oral antifungals like clotrimazole and fluconazole.

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Nystatin

A topical antifungal medication often used to treat candidiasis. It comes in various forms, including creams, ointments, and powders.

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Allylamines (Naftifine-Terbinafine)

A type of antifungal medication that works by inhibiting the synthesis of ergosterol, a vital component of fungal cell membranes.

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Flucytosine

A type of antifungal medication that works by interfering with the production of DNA and RNA in fungal cells.

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Study Notes

Fungal Skin Infections

  • Fungal skin infections, also known as superficial mycoses, affect various superficial structures including hair, nails, and the stratum corneum of the skin.
  • Fungi causing these infections are called dermatophytes.
  • Dermatophytes are classified into three categories based on their ecology:
    • Geophilic: Live in soil.
    • Zoophilic: Primarily parasitize animal bodies, but can be transmitted to humans.
    • Anthropophilic: Usually infect humans and spread between individuals.
  • Dermatophytosis (ringworm): Infection of keratinized structures (hair, nails, skin).
  • Specific types of dermatophytosis include:
    • Tinea capitis (scalp)
    • Tinea barbae (beard and mustache)
    • Tinea faciei (face)
    • Tinea corporis (body)
    • Tinea cruris (groin)
    • Tinea manuum (hands)
    • Tinea pedis (feet)
    • Tinea unguium (nails)
    • Tinea incognito (obscured by steroid treatment).
  • Tinea corporis lesions are annular, with raised edges (active border) and a clearing center, involving glabrous skin (e.g., T. rubrum, T. mentagrophytes, M. canis).
  • Clinical variants of tinea corporis include:
    • Circinate typical lesion.
    • Tinea gladiatorum (common in contact sports).
    • Tinea imbricata (characterized by concentric rings),
    • Tinea incognito (altered by steroid use).
    • Majocchi granuloma (nodular perifolliculitis).
  • Tinea cruris (jock itch): Groin infection, typically on the upper medial thigh spreading to buttock and pubic regions, rarely involving the scrotum. Common in warm, moist environments.

General Knowledge of Fungi

  • Yeast are unicellular fungi, often found at 37°C (body temperature).
  • Mold fungi are multicellular, characterized by hyphae (filaments), often observed at 25°C.
  • Dimorphic fungi: Can exist as mold or yeast depending on temperature conditions (e.g., molds at 25°C and yeast forming at 37°C).

Skin Anatomy

  • Epidermis: Outermost skin layer.
  • Dermis: Inner skin layer containing blood vessels, hair follicles, sebaceous glands, and sweat glands.
  • Subcutaneous layer/Hypodermis: Layer beneath the dermis, primarily composed of fat.
  • Hair follicles, Sebaceous glands, Sweat glands: Structures within the dermis.
  • Pore: Opening of structures like hair follicles and sweat glands.
  • Hair and Nails: Keratinized structures.

Candidiasis

  • Characterized by overgrowth of Candida yeast, Candida is a commensal organism in the human body which becomes pathogenic in presence of predisposing factors.
  • Predisposing factors includes:
    • Immunosuppression.
    • Pregnancy.
    • Diabetes.
    • Use of antibiotics.
  • Sites of candidal infection:
    • Skin (intertrigo, diaper candidiasis).
    • Mucous membranes (oral thrush, vulvovaginitis).
    • Nails (paronychia, onychomycosis).
  • Different clinical manifestations include thrush, vulvovaginitis, intertrigo, paronychia.

Pityriasis versicolor

  • Chronic superficial fungal skin disease caused by lipophilic yeasts Malassezia furfur and M. globosa.
  • Lesions appear as asymptomatic, small, hypopigmented or hyperpigmented macules, typically on the back, underarms, upper arms, and chest.
  • Most common in adolescent and young adult males.
  • Associated with hot and humid climates and sweating.

Investigations for Fungal Infections

  • Microscopic examination of skin scrapings in potassium hydroxide (KOH) mount to identify fungi and hyphae.
  • Skin culture to identify the species of fungus.
  • Wood's lamp examination for characteristic fluorescence (e.g., in tinea capitis).
  • KOH exams will reveal characteristic fungus structures (e.g., budding yeast, pseudohyphae).

Treatment of Fungal Infections

  • Local: Topical antifungal creams, lotions, or shampoos. Examples are imidazoles, clotrimazole, ketoconazole, terbinafine, amorolfine and tioconazole.
  • Systemic: Oral antifungals (e.g., terbinafine, itraconazole, griseofulvin) are recommended for extensive or deep infections.
  • Anti-fungal therapy is classified according to the site of action:
    • At the nuclear level (flucytosine)
    • At the cytoplasmic membrane level (polyenes, azoles, allylamines).
    • At the cell wall level (echinocandins)
    • At the mitotic spindle level (griseofulvin).

Differential Diagnoses

  • Conditions that can mimic fungal infections need to be considered in differential diagnosis. Examples include seborrheic dermatitis, psoriasis, eczema, and other skin diseases.

Complications from Fungal Infections

  • Scarring alopecia can result from severe ringworm infections.
  • Ringworm infection can be rampant in schools and can spread rapidly between individuals.
  • Steroid use can mask the appearance of a fungal infection.

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