6. Superficial Infections:
I. T . Capitis
II. T . Barbae
III. T . Faciei
IV. T . Corporis
V. T . Manuum
VI. T . Pedis
VII. T. Cruris
VIII. Onychomycosis
7. I Tinea Capitis ( Scalp Ringworm )
Invasion of a hair shaft by a dermatophyte fungus
Mainly in children; rare after puberty because
sebum is fungistatic
Boys > Girls
Wide spectrum of lesions: few dull grey broken off
hairs, with little scaling to severe, painful
inflammatory mass
Partial hair loss is common in all type
9. I Tinea Capitis - Grey Patch ( Ectothrix )
Non inflammatory type
Etiology: Microsporum spp
Patches of partial hair loss- often circular in
shape
Hairs – dull and grey – easily pluckable
11. I Tinea Capitis - Black Dot ( Endothrix )
Endothrix organisms
Hair shaft is brittle
Broken off hairs – black dot
Inflammation is minimal
Wood’s Lamp examination: green fluorescence
13. I Tinea Capitis - Kerion
Inflammatory type
Painful, boggy swelling
with purulent discharge
Vesicles and pustules
Thick crusting with
matting of hair
Lymphadenopathy
Secondary bacterial
infection
Heals with scarring
14. I Tinea Capitis - Favus
Inflammatory type
Begins early in life
Yellow, cup shaped
crust – scutulum
Concavity faces
upwards
Mousy odor
Hair may be matted
Extensive patchy
hairloss with cicatricial
alopecia
15. II Tinea Barbae – T.Sycosis, Barber’s Itch
Ringworm of beard & moustache area
Disease of adult males
Invasion of coarse hairs
Inflammatory papulopustules, seropurulent
discharge
Hairs- easily epilated
Simulate bacterial folliculitis
Diagnosis- confirmed by KOH mount
17. III Tinea Faciei
Dermatophyte infection on
non bearded area of face
Burning, itching &
photosensitivity
Erythematous scaly patches
Extends peripherally- raised
border
Central area-
hypopigmented or brown
Seen often in
immunocompromised
patients
18. IV Tinea Corporis
Dermatophyte infections of skin other than
those involving the scalp, beard, face, hands,
feet and groin
The fungus enters the stratum corneum and
spreads centrifugally
19. Tinea Corporis
Typical lesion- annular /
polycyclic
Borders – erythematous,
vesicular or scaly
Centre – clear,
hyperpigmentation
Concentric rings may be
seen
Sites: Waist, under breasts,
abdomen, thighs, etc.
20. Differential Diagnosis of T. Corporis
Psoriasis
Lichen Simplex Chronicus
Pityriaisis Rosea
Candidiasis
Nummular eczema
Tertiary Syphilis
Annular lesions of Leprosy
21. V Tinea Manuum
Ringworm of palmar skin
Commonly occurs in adults, in males
2 main clinical types:
(1) Non inflammatory squamous form
Most common clinical presentation
Hyperkeratosis of palms and fingers
Accentuation of flexural creases
Association – hyperhidrosis
(2) Inflammatory vesicular / dyshidrotic / eczematous form:
Uncommon in temperate climates
Vesicles occur-mainly on palms
Itchy
Heal spontaneously
22. VI Tinea Pedis ( Athlete’s Foot )
Dermatophyte infection of the feet
Most common fungal infection worldwide
30-70 % of population in developed countries
Wearing of shoes and resultant maceration
Adult males commonest
23. VI Tinea Pedis ( Athlete’s Foot )
4 clinically accepted variants:
(1) The chronic intertriginous type
commonest type
fissuring, scaling or maceration
lateral 3rd
& 4th
toe webs
(2) Chronic papulosquamous type
inflammation
patchy ‘mocassin like’ scaling over soles
(3)Vesicular or vesiculobullous type
small vesicles/ vesiculopustules- seen at instep
and mid anterior plantar surface
Associated with scaling
(4) Acute ulcerative variant
Maceration, weeping and ulceration of the soles
often complicated by secondary infections
24. VI Tinea Pedis-Prevention
Keeping toes dry
Not walking barefoot on the floors of communal changing rooms
Avoiding swimming baths.
Avoid closed shoes
Avoid nylon socks
Use of antifungal powders
25. VII Tinea Cruris ( Dhobi’s itch, Jock itch )
Dermatophytic infection of the
groins
Itching
Sharply demarcated,
erythematous advancing
annular skin rash
Extends from groins to the
thighs
Scaling is variable, and
occasionally may mask the
inflammatory changes.
Vesiculation is rare
26. VIII Onychomycosis
Infection of nail caused by fungus
Common infection
20 % of all nail diseases
Incidence is increasing
Dirty, dull, dry, pitted, ridged, split, discoloured,
thick, uneven, nails with subungual hyperkeratosis
28. Distal and lateral sunungual Onychomycosis
Most common type
90 % of all fungal nail
infection
Etiology: T.rubrum
Toe nails > finger nails
Infection starts in distal
nailbed or lateral nailfold,
then moves proximally
29. White Superficial Onychomycosis
2nd
most common
Well circumscribed
powdery white patches
o nail plate- easily
scraped way
Surface of nail- rough &
friable
30. Proximal Subungual Onychomycosis
Least common variant
Etiology: T.rubrum
1st
clinical sign is a
whitish-brownish area
on proximal part of nail
Early indicator of HIV
infection
31. Treatment of Dermatophyte Infections-Treatment of Dermatophyte Infections-
Topical
Bifonazole, Oxiconazole, Clotrimazole, Miconazole,
Butenafine, Terbinafine.
Vehicle: Lotions, creams, powders, gels are available.
33. Treatment of OnychomycosisTreatment of Onychomycosis
The same line of Treatment for
3 months (fingernail)
6 months (toenails)
8% Ciclopirox olamine lotions for local application
Amorolfine lacquer painted weekly
Pulse Therapy
Terbinafine: 250mg given 1BD 1week / per month
Itraconazole: 200mg given 1BD 1week/month
3 pulses for fingernails
4 pulses for toenails.
34. Treatment PrinciplesTreatment Principles
Dermatophytosis will take 3-4 weeks to resolve and patient
should be told about the need for complete treatment.
Treat 1 week beyond apparent cure.
Need for hygiene, proper clothing.
Onychomycosis requires 3-6 months of treatment. Treat 4
weeks beyond apparent cure.
Temporary relief should not be mistaken for cure
36. Candidiasis : MucosalCandidiasis : Mucosal
Oral thrush:
Creamy, curd-like, white
pseudomembrane, on
erythematous base
Sites:
Immunocompetent patient: cheeks,
gums or the palate.
Immunocompromised patients:
affection of tongue with
extension to pharynx or oesophagus
Angular cheilitis (angular stomatitis /
perleche)
Soreness at the angles of the mouth
37. Candidiasis : MucosalCandidiasis : Mucosal
Vulvovaginitis (vulvovaginal thrush)
Itching and soreness with a thick, creamy white discharge
Balanoposthitis:
Tiny papules on the glans penis after intercourse, evolve as
white pustules or vesicles and rupture.
Radial fissures on glans penis in diabetics.
Vulvovaginitis in conjugal partner
38. Candidiasis - FlexuralCandidiasis - Flexural
Intertrigo (Flexural
candidiasis):
Erythema and maceration in
the folds, axilla, groins and
webspaces.
Napkin rash:
Pustules, with an irregular
border and satellite lesions
39. Candidiasis: NailCandidiasis: Nail
Chronic Paronychia:
Swelling of the nail fold with
pain and discharge of pus.
Chronic, recurrent.
Superadded bacterial infection
Onychomycosis:
Destruction of nail plate.
40. Treatment of candidiasisTreatment of candidiasis
Treat predisposing factors like poor hygiene, diabetes,
AIDS, conjugal infection
Topical
Clotrimazole
Miconazole
Ciclopirox olamine
Oral:
Itraconazole 100-200mg
Fluconazole 150mg
41. Pityriasis versicolorPityriasis versicolor
Etiologic agent: Malassezia furfur
Common among youth
Genetic predisposition, familial
occurrence
Multiple, discrete, discoloured,
macules.
Fawn, brown, grey or hypopigmented
Pinhead sized to large sheets of
discolouration
Seborrheic areas, upper half of body:
trunk, arms, neck, abdomen.
42. P.versicolor - InvestigationsP.versicolor - Investigations
Wood’s Lamp examination:
Yellow fluorescence
KOH preparation:
Spaghetti and meatball appearance
Coarse mycelium, fragmented to short filaments 2-5
micron wide and up to 2-5 micron long, together with
spherical, thick-walled yeasts 2-8 micron in diameter,
arranged in grape like fashion.
43. Treatment P. versicolor - TopicalTreatment P. versicolor - Topical
Topical
Clotrimazole
Miconazole
Bifonazole, Oxiconazole, Butenafine,Terbinafine,
Selenium sulfide, Sodium thiosulphate
Oral
Fluconazole 400mg single dose
Griseofulvin is NOT effective.
Hypopigmentation will take weeks to fade
Scaling will disappear soon