FUNGAL

INFECTIONS OF THE SKIN

DERMATOMYCOSES

DERMATO MEANS

SKIN
MYCOSES MEANS

FUNGUS

It comprises about

30%of skin diseases

seen by the general

practitioner

From the dermatological point of view, they are classified into:

Superficial Dermatomycoses
(tinea)

Deep Dermatomycoses

Superficial mycoses invade skin surface i.e epidermis and epidermal appendages especially hairs and nails

Classification

Regional:

T.CAPITIS:

-FAVUS -RING WORM

RINGWORM:

-PUSTULAR FOLLICULITIS
-KERION CELZI

INFLAMMATORY

NON-INFLAMMATORY

1-GRAY PATCH.

2-BLACK DOT R.W.

T.CORPORIS:
-T.CIRCINATA. -T.CRURIS. -T.VERSICOLOUR

-T.MANUS. -T.PEDIS. -ONYCHOMYCOSES

(T.UNGIUM).

Tinea Capitis

Fungus infection of the scalp

Ring Worm Favus

Ring Worm
Gray Patch

Is the commonest variety of mycotic scalp affections.

incubation period is 1- 4 weeks.

Usually affects children at school age

spreads in epidemics

especially in family
and school children

usually caused by Microsporon Auduini

Grey Patch

Symptoms
Apart from hair affection, the patient complains of hair fall

Clinical picture well circumscribed scaly macular lesion on the scalp

Unaccompanied

by any local symptoms

Hairs are shortly cut. Covering scales are small, dry, slate colored

Slightly adherent to the surface of the scalp but easily detached on scraping

Grey Patch

This patch is followed by the appearance of other patches,

we get multiple patches dispersed on the scalp of the same clinical picture

T.Capitis Multiple Scaly type

Multiple Patches

Multiple Scaly Type

Mode of infection

Direct
By contact with infected person.

Indirect
By contact with material soiled with the organisms e.g. head caps, bed sheets

Diagnosis
Scales and hairs are of fungal elements

examined for detection

by

KOH or

Lactophenol
preparation

Culture can be used in difficult cases.

Sampling For Fungal Detection

KOH preparation showing spores in the hair shaft

Differential Diagnosis

From other scaly lesions on the scalp

Psoriasis. L.E. Lichen planopilaris Favus. Lichen accuminatus (PRP)

Prognosis
Self-limited at puberty

Microscopic Examination
of Hair in Ring Worm

1-In gray patch

variety it shows microsporon hair

Fungal elements surround the hair in an irregular mosaic form.

2-In black dot

variety the hair matrix is filled with mycotic elements forming a sac form.

3- In kerion Celzi:

hair is surrounded
by regularly arranged

elements like a column

4-In Favus:
Fungal elements are arranged parallel to long axis of the hair

Black dot R.W

This variety is characterized by the development of

scaly macular lesion on the scalp of children with well defined border.

Black Dot R.W

Black-Dot Type

Black-Dot R.W.

On removal of these epidermis is slightly

inflamed

scales the underlying

On close examination we find the hair follicle ostia are blocked with black dots black dots

which are the remains of the broken hair at the surface of the scalp

usually caused by Trichophyton Violaceum and T. Tonsurans.

Black Dot R.W.

Black-Dot R.W.

Inflammatory
types of R.W

Usually affect
children but may

affect adults

besides scalp affection the beard area may

be affected.

The extent of inflammation varies according to the invading fungus.

It might be: Mild

slight erythema of the skin in the affected by discharge

patch which is covered

Hairs are stuck

together broken, and

you can see short as well as long hairs

Pustular folliculitis

Severe
marked edema, redness and tumefaction of the affected hair

leading to the

formation of a boggy soft swelling

On pressure pus comes out from the hair follicle

Each hair is
surrounded by a pool of pus and is easily detached

Kerion

Kerion

Kerion Celzi

Kerion

Celzi

Kerion

Kerion

This inflammatory swelling is called

Kerion Celzi
It usually heals by scar formation

It is usually caused by:

Microsporon Canis

Favus

one of the most common mycotic scalp affections

caused by Trichophyton
Schoenleini

Age: all ages, more

common in children ,

but

it does not

show self healing at puberty

Extends throughout life leading to

cicatrical alopecia

alopecia

cicatrical

Favus

Contagiosity

not as high as in R.W.,

sporadic cases can be detected among children

It can also affect glabrous skin and nails

Favus Of The Scalp

Post Favic

Alopecia

Clinical Picture
development of

characterized by the

Scotulum

Which is the initial lesion of

Favus

Scotulum

It is a crust like lesion, yellowish in color, with a concavo-convex surfaces.

with its convexity at the scalp making for itself an erosion or depression in the epidermis.

This leads to firm

adherence to the

scalp,

on detachement
sero-sanginous
discharge appears

The

scotulum is

friable, cup shaped, with a characteristic mousy odor

polygonal in outline measuring about

few mms. to one cm in diameter

If moistened with alcohol the color

becomes

deeper

The hair in the affected area in the scalp is but show changes in picture and color.

usually of normal length

Favic Hair

Hair becomes thin, dry, friable, grayish in appearance , lusterless and dull gray in color

the scalp appears as if dusted with powder

Microscopic Examination

The

scotulum is

shown to be a pure culture of the invading fungus

under the microscope fungal elements are invading the hair with no elements outside.

All are within the hair

Hairs are few in number and not completely destroyed

Fungal elements are

arranged parallel to the long axis of the hair

Tinea Corporis

This includes the following:

T T T T

. . . .

Circinata . Cruris . Manus & Pedis Versicolour .

Tinea Circinata

Occurs anywhere on the body surface especially on exposed parts

in the form of one or multiple circinate macular lesions

lesion is made of well defined erythematous scaly patches

spreading eccentrically forming a circinate appearance

i.e healing in the at the border.

center and activity

Circinata

Tenia

T.Circinata

T.Circinata

Multiple Patches

The activity appears in the form of erythema vesicles and papules.

center may show

hyper-pigmentation

and covered with branny scales

The patient complains

of

itching and disfigurement

T.C.

T.circinata

Differential Diagnosis

From other circinate eruptions:

Superficial:

Pityriasis Rosea . Psoriasis . Lichen planus . Seborrhoeic dermatitis Erythema multiforme. Impetigo .

Deep:
Syphilis. Leprosy.

T.B. Leishmaniasis.
Sarcoidosis.

Tenia Cruris

A circinate macular lesion occupying the inner surface of the upper parts of both thighs

Usually accompanied with T. pedis.

Other flexures may share in the affection

It is usually a symmetrical affection

It might extend both anteriorly to the pubic area, scrotum,

and posteriorly to the perineum and gluteal folds

The lesion is brownish red in color with well defined border and circinate configuration

Surface shows minute scaliness and tendency for healing with spreading margin

T.cruris

Tenia Cruris

Differential Diagnosis

Erythematous scaly conditions affecting the flexures :

intertrigo

 Intertrigo Erythrasma Psoriasis

Tinea Versicolour

a very common superficial fungus infection of the skin

affecting both sexes and commonly seen at puberty

It is caused by

Microsporoon FurFur

Mild asymptomatic dysfiguring macular eruption affecting the vest area

short jacket with long sleeves

Sites Of T.V.C

Macules are oval,rounded or patchy, brownish or coffe et lait in colour

varying from

light to deep brown

The lesions are well defined and covered by fine branny adherent scales.

.T.V.C

T.V.C.

T.V.C. On The Chest

T.V.C. on the Back

Colour changes in different sites in the

same patient and

among different individuals

Colour change is ascribed to the following factors:

Contrast between

colour of the lesion and normal skin colour of the patient.

Site of the lesion whether on an exposed site or a hidden site.

Hygiene of the patient as frequent baths removes the scaly layer on the lesion

that prevents the reach of UV to the skin underneath.

Tenia Manus & Pedis

Superficial fungus infection of both hands and feet.

It may take one of the following clinical pictures

1-Erythematous scaly or circinate type. 2-Eczematous or vesiculobullous type

Both types occur on the dorsal aspect of

the hands and feet

Erythematous Scaly Type

3-Hyperkeratotic type:

on the palmar and plantar aspects

Hyperkeratotic Type

Hyperkeratotic T.pedis

4-Commonest
type is the interdigital type

Clinical picture of

the standard type:

Affects the interdigital spaces between toes and fingers

The skin becomes whitish, sodden, macerated and the depth of the cleft is fissured

Interdigital Type

On removal of the macerated keratinous

material

the

underlying skin

is erythematous, moist , and may be eroded

It is very common among athelets and called atheletic foot

Onychomycosis

fungus infection
of the nails

caused by many species of fungi

The affected nail is dry, brittle, lusterless and the surface is pitted and grooved.

Nails may be separated

from the nail bed

Onychomycosis

Differential Diagnosis

Moniliasis

nails retain its luster, thick accompanied by paronychia

Fungal

Monilial

 Chronic

eczema Lichen planus Psoriasis. Syphilis. Lichen accuminatus.

Treatment of Mycoses

General Treatment

Griseofulvine
An oral antibiotic fungicidal agent derived from penicillin species.

It is given in a tablet form each tablet contains 250 mgm of ordinary griseofulvine

The

same therapeutic effect is obtained by 125 mgm of fine particle F.P. Griseofulvin

Dose :
From 10-25 mg/kg body wt. in divided doses.

It may be given in a single weekly dose calculated by

1/3 of body weight in tablets/ week not exceeding 20 tablets per week

effective against

all superficial fung

except

.V . C. Erythrasma. Moniliasis.

Contraindications

Pregnancy, liver, kidney or heart disease.

Side effects :
- Nausea - Vomiting

- Headache

Duration of Treatment:

T.corporis 3-4 weeks T.capitis 5-7 weeks T.Pedis 7-9 weeks

onychomycosis
Nails 3-4 months Toes 5-6 months

Other systemic antifungals are now in common use.

They should be used with caution as some of them have serious side effects as:

which is a potent hepatotoxic drug

Ketoconazole

Terbenafine
and

Itraconazole
are used safely
in indicated cases

But they are expensive and limited to worthy cases.

For Tinea Versi Color Fluconazole capsules 150 mgm once weekly for 4 weeks may be given in resistent cases

Local Treatment

local fungicidals
Tr.Iodine,Tolnaftate Clotrimazole, Undecylinic acid derivatives

Whitfield ointment

Salicylic acid 3 Benzoic acid 6 lanovaseline 100

we use modified forms of Whitfield ointment because the original formula is very irritant but very effective.

fungal infections, we use

eczematised

In cases of

Preparations containing

fungicidal agent

plus
hydrocortisone or
another steroid

or the preparation called

Castellani
paint which must be prepared fresh

GOOD LUCK