12.4 Fungal Skin Infections and Skin Infestations

Question 1

Dermatophytosis (Ringworm)

Answer 1

• Lives in stratum corneum, hair and nails
• Lives on dead keratin layer of skin

Names
- Tinea capitis (scalp)
- Tinea corporis (body)
- Tinea cruris (jock itch)
- Tinea pedis (athletes foot)
- Tinea unguium (nails)

Treatment
- Oral/Topical Antifungals

Question 2

Candidiasis

Answer 2

• Grows in moist areas (mouth or diaper)
• Mouth is called oral thrush

S/S
- Inflamed areas with white exudate, peeling off, easy bleeding.
- Pruritis and can cause diaper dermatitis

Diagnosed from appearance or scrape test

Treatment
- Oral Thrush - Nystatin Oral Solution
- Diaper Candidiasis - Antifungal creams, topical application (IV and PO for bad cases)

Question 3

Enterobiasis (Pinworms)

Answer 3

• Parasitic Infection (Most Common)
• Spread in daycare centers, classrooms, crowded places that have a lot of hand to mouth actions and interactions with others. Can also occur playing in dirt that gets under fingernails and transmitted to mouth.

S/S
- Eggs are ingested/inhaled, hatch in intestines. Eggs get laid outside the anus that causes extreme rectal itching.
- Eggs live on other surfaces for 2-3 weeks

Diagnosis
- Tape Test (put a piece of tape over the anus to see if eggs stick to the tape)

Treatment
- Pyrantel Pamoate (STAINS STOOL WITH BRIGHT RED COLOR)

Question 4

Scabies

Answer 4

• Impregnated females burrow into stratum corneum of epidermis (not living tissue) and lay eggs and discard feces.
• Transmitted by PROLONGED CLOSE PERSONAL CONTACT

S/S
- Inflammation from eggs/feces that cause intense pruritis and excoriation
- Seen in webs of fingers
- Mites (black/grey dots) with threat-like burrow

Treatment
- Permethrin Cream
- Oral Ivermectin
- Treatment must be repeated after 1-2 weeks.
- Can take 30-60 days after infestation to develop symptoms. (ALL PEOPLE WHO HAVE HAD PERSONAL CONTACT SHOULD GET TESTED FOR SCABIES)

Education
- Rash will take 2-3 weeks to go away.
- Moisturizers, ointments, topical corticosteroids, and antihistamines can manage symptoms
- TREAT ALL FAMILY MEMBERS (MEDICATIONS MUST BE FOLLOWED CAREFULLY)

Question 5

Pediculosis Capitis (LICE)

Answer 5

• Blood sucking organisms that eat 5 times a day.
• Can live 48 hours away from host (1 month lifespan)

S/S
- Nits hatch from eggs on scalp and the bugs/saliva cause extreme itching

Treatment
- Permethrin
- Ivermectin
- Nit Comb

Complications
- Secondary bacterial infection causing localized lymph node enlargement

Education
- HIGHLY CONTAGIOUS
- MUST CLEAN ENVIRONMENT (ALL BEDDING AND CLOTHING MUST BE WASHED WITH VERY HOT WATER
- HAIR MUST BE RETREATED WITH PEDICULOCYTE SHAMPOO ONCE AND AGAIN IN 7-10 DAYS
- Items that cannot be washed or dried in high heat must be placed into a plastic bag, sealed, and left for 2-3 weeks to make sure all the bugs die.

Question 6

Lice Manifestations

Answer 6

• Smooth, teardrop-shaped masses
• Masses adhere to hair shafts
• Silvery-white or dark brown hair
• Measures 0.5-0.8mm in size
• Common in occipital and postauricular scalp.