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Fungal infections of skin [compatibility mode]

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Fungal infections of skin [compatibility mode]

  1. 1. Management of CommonFungal Skin Infections
  2. 2. • Superficial fungal infections of the skin are one of the most common dermatologic conditions seen in clinical practice.
  3. 3. Fungi: Common Groups1. Dermatophytes: Superficial Ring worm type2. Candida Albacans: Yeast infection3. Pityrosporium: Yeast, present in normal flora of skin, esp. scalp & trunk.
  4. 4. CLASSIFICATION OF FUNGAL INFECTION1.Superficial2.Cutaneous3.Subcutaneous4.Systemic5.Opportunistic
  5. 5. 1. Superficial mycoses - Pityriasis versicolor – pigmented lesion on torso (trunk of the human body). ( Dubo? ) - Tinea nigra – gray to black macular lesion on palms. - Black piedra – dark gritty deposits on hair. - White piedra – soft whitish granules along hair shaft. - All diagnosed by microscopy and easily treated by topical preparation.
  6. 6. 2. Cutaneous infections• Infections of skin and its appendages (nails, hair)• 20 Spp. of dermatophytes cause ringworm.
  7. 7. 3. Subcutaneous mycoses -Subcutaneous infections, over 35 spp. Produce chronic inflammatory disease of subcutaneous tissue & lymphatics, e.g. sporotrichosis (Ulcerated lesion at site of inculasion followed by multiple nodules)
  8. 8. 4. Systemic fungal infections - Uncommon: if Natural immunity is high - Physiologic barriers include: - Skin and mucus membranes - Tissue temperature: fungi grow better at less than 37°C
  9. 9. 5. Opportunistic Mycoses - Do not normally cause disease in healthy people.- Cause disease in immuno-compromised people.- Weakened immune function may occure due to: ▪ Inherited immunodeficiency disease ▪ Drugs that suppress immune system: cancer chemotherapy, corticosteroids, drugs to prevent organ transplant Rejection. ▪ Radiation therapy ▪ Infection (HIV) ▪ Cancer, diabetes, advanced age and mal-nutrition.
  10. 10. Most common opportunistic mycoticinfections: (commonly seen in PLWHA) 1. Candidiasis 2. Aspergillosis 3. Cryptococcosis 4. Zygomycosis/mucormycosis 5. Pneumocystis carinii
  11. 11. Superficial Fungal Infections• Tinea infections
  12. 12. TINEA Infection• T.Corporis- ringworm of body• T.Cruris- groin• T.Pedis- foot• T.Unguium- nail• T.Capitis scalp
  13. 13. T.Corporis (ring of the body) • Superficial skin infection • Itchy • Annular patch (ring shaped) • Well defined edge • Scaling more obvious at edges(central clearing)
  14. 14. Tinea Corporis
  15. 15. Tinea corporis – body ringworm
  16. 16. Tinea corporis Tinea Corporis Tinea of the face Psoriasis Tinea corporis(Scaly lesion) (for differential diagnosis)TineaManum (hand) Tinea Corporis
  17. 17. TINEA CRURIS (groin)• Often assoc with T.pedis• “Jock itch”• Tight hot sweaty groin e.g. athletes, obese• Infection of groin, genitalia, perinium
  18. 18. Tinea Cruris – Jock Itch
  19. 19. Tinea Pedis –Athlete’s Foot Infection
  20. 20. Tinea Pedis Clinical features• Dermatitis• Peeling• Maceration• Fissuring Sites Toe clefts
  21. 21. Tinea Unguium – Nail Infection
  22. 22. Tinea Unguium (nail)1. Disto-lateral 1 subungual onychomycosis2. Superficial white 2 onychomycosis3. Total dystrophic 3 onychomycosis
  23. 23. Regimes-Tinea Unguium• TERBINAFINE – Terbinafine250mg od• ITRACONAZOLE – Pulse rx Itraconazole - 1wk/mth 200mg bid – Itraconazole 200mg od• FLUCANAZOLE – Fluconazole 150mg once weekly
  24. 24. T.Pedis
  25. 25. TINEA CAPITIS - KERION Ringworm of the scalp
  26. 26. TINEA CAPITIS – Black dot
  27. 27. Tinea Capitis
  28. 28. Tinea Capitis Gray Patch
  29. 29. Rx-Tinea Capitis• MUST use oral Rx- prolonged course –Griseofulvin-20mg/kg/od x 6-8/52 Terbinafine-250mg od x 4/52 –Flucanazole-50mg-150mg/wk x 4-6/52
  30. 30. Rx-Tinea Capitis Adjunctive Measures• Shampoo- antifungal/ antiseptic/antidandruff• Antibiotics• NO STEROIDS
  31. 31. Other Fungal Infections
  32. 32. Tinea ManuumDry hyperkeratotic Palmer aspect Dorsal aspect
  33. 33. Tinea Barbae
  34. 34. Tinea Faciei• Infection of the skin of the face excluded moustache &beard areas
  35. 35. Peri-oral dermatophytosis
  36. 36. Investigation: - Microscopy of scrapingsKOH preparation and lookingfor the fungal elements fromskin scraping, nail or hair.
  37. 37. Management• General Measures• Non-specific Keratolytics -eg Whitfield’s ointment
  38. 38. Specific Antifungal Rx• Griseofulvin• Azoles- -Imidazole eg ketoconazole (liver toxicity: oral prep) topical preps -Triazole eg itraconazole,fluconazole• Allylamines eg terbinafine, naftifine
  39. 39. TOPICAL Rx• Localized disease of skin – extend rx for 3-5/7 after apparent cure – 1% clotrimazole less effective• Sprays & solutions – tinea pedis /hairy areas• Limited nail disease – Batrafen nail lacquer
  40. 40. ORAL Rx• Extensive disease• Nail disease• Tinea Capitis
  41. 41. For Systemic Fungal InfectionsFDA approved drugs for empirical therapyDrug Dosing regimen used in controlled trialsAmpho B 0.6 – 1.0 mg/kg/day (IV)__________________________________________________Liposomal 3 mg/kg/day (IV)Ampho B________________________________________________Itraconazole 400 mg/day/or two days then 200 mg/d for 5-12 days (IV), followed by oral solution 400 mg/day for 14 days__________________________________________________Caspofungin 70 mg day 1, then 50 mg/daily
  42. 42. In BPKIHS D-OPDCOMMON FUNGAL PROBLEMS: All typesRx: prescribed:1. Hygiene teaching.2. Antifungal: a. Topical: Ketaconazole, Clotrimazole, Butrinazole b. Oral: Fluconazole, Ketaconazole, itrazole
  43. 43. Thank You
  44. 44. 7. Yeasts• Pityrosporum.• Candida.• Ordinarily commensals.• Can become pathogens under favourable conditions.
  45. 45. Pityriasis Versicolor• Asymptomatic hypopigmented scaly macules• Chest, back, face
  46. 46. P.Versicolor • HyperpigmentedLike Dubi
  47. 47. Pityriasis Versicolor
  48. 48. 8. Tinea Versicolor (In Head) Dandruff
  49. 49. Tinea VersicolorSkin infection caused by a yeastWarm and humid environment
  50. 50. Tinea VersicolorS/S- oval or irregularly shaped spots- pale, dark , or pink in color- sharp border- itching, worsens with heating andsweatingTx- Topical antifungal medications
  51. 51. Management• Many Rx• No Rx eradicates yeast permanently• NONSPECIFIC• Keratolytics – whitfield onit, sulphur• Antiseptics – selenium sulphide, Na thiosulphate
  52. 52. Antifungal RxAzoles-oral/topical• Ketoconazole 200mg od x7• Itraconazole 200mg od x 7• Fluconazole 300mg-400mg stat• Terbinafine tabs for P.V
  53. 53. 9. Candidiasiso Candida sp- commensal of GITo Precipitating Factors Endocrinopathy Immunosuppression Fe/Zn deficiency Oral antibiotic Rxo Oropharyngeal candidiasis is marker for AIDS
  54. 54. Candidiasis• Oropharnygeal• Candidal intertrigo-breasts, groin• Chronic Paronychia - nail fold infection• Vaginitis/balanitis
  55. 55. Risk Factors for Candidiasis: ▪ Post-operative status ▪ Cytotoxic cancer chemotherapy ▪ Antibiotic therapy ▪ Burns ▪ Drug abuse ▪ GI damage
  56. 56. Candidal Intertrigo• Moist folds• Erythematous patch with satellite lesions
  57. 57. Management• Rx underlying disorder• Reduce moisture- – Wt loss, cotton underwear – Absorbent/antifungal powder eg Zeasorb AF• Rx partner in recurrent genital candidiasis• Rx-Nystatin Azoles• Oral antifungal (itraconazole): immune suppressed
  58. 58. 10. Chronic Paronychia • Infection of nail fold • Wet alkaline work Excess manicuring • Damage to cuticle • Swelling of nail fold (bolstering) • Nail dystrophy
  59. 59. Chronic Paronychia• Keep hands dry /Wear gloves• Long term Rx• Oral Azoles• Antifungal solution-(high alcohol content)• +/-Broad spectrum antibiotics-cover staph
  60. 60. Rx Summary• Tinea capitis should be treated with systemic therapy.• Griseofulvin in a dose of 10-20 mg per kg for six weeks to 8weeks is the first- line treatment of Tinea capitis.• Ketoconazole 2-4mg per kg for ten days, itraconazole and terbinafine (Lamisil) are good alternatives.
  61. 61. • Griseofulvin should be taken after fatty meal.• Topical treatment can be added to decrease the transmission and accelerate resolution.• Whitefield ointment is preferred in the absence of secondary bacterial infection.• Other family members should also be examined and treated.• Small and single lesion can be treated with topical agents. Clotrimazole 1%, ketoconazole 2%, meconazole 1%. BID for two weeks
  62. 62. • Systemic: ketoconazole 2-4mg per kg of weight for 10 days. Itraconazole and fluconazole are choices if available. Griseofulvin is also effective for the treatment of Tinea corporis.• Topical anti fungal creams or ointments applied regularly for 4 - 6 wks.
  63. 63. • Systemic treatments provide better skin penetration than most topical preparations, Itraconazole, terbinafine and griseofulvin are good choices for oral therapy.• Itraconazole and terbinafine are more effective than griseofulvin. Once-weekly dosing with fluconazole is another option, especially in noncompliant patients.• Personal hygiene (foot hygiene) is highly advised.
  64. 64. Thank You