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Race
Tinea capitis more common in black children
Corporal tinea less common in black adults
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Classification
Epidermomycosis (tinea facialis, tinea corporis,
tinea cruris, tinea manus, tinea pedis
Onychomycosis (dermatophytes, yeasts, molds)
Trichomycosis (Majocchis granuloma, tinea
barbae, tinea capitis
Tinea Pedis
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Transmission
Barefoot walking on contaminated surfaces
Ulcerative type
Extension of inter-digital type
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Physical exam
Accentuation of palmar creases
Fissures
Well-demarcated borders with central clearing
Superimposed lichen simplex chronicus
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Physical exam
Usually associated with tinea pedis / onychomycosis
Geographic patches / plaques
All ages
Common in animal workers
T rubrum most commonly
Associated with tinea pedis
Physical exam
Small to large sharply marginated plaques with or without
pustules or vesicles.
Peripheral expansion with central clearing
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Children
T tonsurans in children with tinea capitis
T mentagrophytes and T rubrum most common
Related to animal exposure
Physical Exam:
well-delineated patch with central clearing
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Tinea Barbae
beard
Majocchis granuloma
Trunk / extremities
Tinea barbae
beard
Majocchis granuloma
Trunk / extremities
Endothrix
Trichophyton species (tonsurans, violaceum in Europe
and Asia)
Favus:
Endothrix with air spaces within hair shaft
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Inflammatory
T. tonsurans, M. canis
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Labs
KOH / Dermatopathology
Culture: only presumptive, need corresponding clinical
Interdigital
Initial pustule becomes eroded possible fissuring
Surrounded by thick white skin (macerated appearing)
May be associated with paronychia / onychia
Diaper dermatitis
Erythema and edema with pustules and erosion late
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Treatment
Castellanis paint
Topical anti-fungals (Nystatin, Imidazole cream)
Oral anti-fungals (Fluconazole, Itraconazole)
Ddx:
Thrush: LP, hairy leukoplakia
Atrophic: LP
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Genital Candidiasis
Ddx
Women: Trichomoniasis, bacterial vaginosis, LP,
et A
Men: Inverse psoriasis, eczema
LS
Trunk
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Labs
KOH
Dermatopathology
Woods lamp (blue green)
Management
Selenium sulfide shampoo
Ketoconazole shampoo / Azole creams
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Epidemiology
Young and middle aged adults
90% males
Rural agricultural workers
Natural history
Weeks to years incubation
Expand for decades
Painless
No systemic symptoms
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Botryomycosis
Caused by bacteria (not true mycetoma)
Staph aureus often implicated
Actinomycetoma
Caused by actinomycetales organisms
Actinomyces
Nocardia
Others: Actinomadura, Streptomyces
Course is relentless
Management:
Surgery
Antimicrobial therapy 9mos-1year
Chromomycosis
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Transmission
Inoculation with soil contaminated FB (thorn/splinter)
Sporotrichosis
Management
Heat
Surgery
Systemic antifingals (amphotericin B)
Oral antifungals (itraconazole)
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Epidemiology
Males > workers
Florists, Ag. workers, farmers, landscapers
Transmission
Inoculation by soil contaminated foreign body (rose)
Rarely inhalation may lead to systemic Dss
Scratches from cats, armadillo (Uruguay)
Pathogenesis
After inoculation: grows locally and extends through
lymphatics, distant (hematogenous) extension does
not occur from inoculation sporotrichosis
Incubation 3 weeks begin as painless nodule
Labs:
KOH
Grams stain
Dermatopathology
culture
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Management
Oral Itraconazole
Systemic Amphotericin B
Disseminated Coccidioidomycosis
S CA
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