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Derm > adult and pediatric cutaneous fungal infections > Flashcards

adult and pediatric cutaneous fungal infections Flashcards

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Dermatology Board Prep flashcards
1
Q

estimated population affected by dermatophytoses

A

20-25%

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2
Q

superficial cutaneous fungal infectinos are limited to the _____ as opposed to systemic fungal infections

A

epidermis

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3
Q

three groups of cutaneous fungi that cuase superficial infections

A

dematophytes

  • Malassezia* spp
  • Candida* spp
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4
Q

dermatophytes

A

Trichophyton

Microsporum

Epidermophyton

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5
Q

areas that dermatophytes infect

A

keratinized tissues:

  • stratum corneum
  • the nail
  • the hair
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6
Q

descrinbe this

A

erythema and scaling present on the plantar surface between the toes

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7
Q

Most common fungal infection seen in developed countries

A

tinea pedis

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8
Q

Tinea pedis caused by

A

Trichophytom rubrum

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9
Q

common sources of infection of tinea pedis

A

shoes provide ideal moist environment for fungal growth

public showers, gyms, swimming pools

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10
Q

clinical patterns of infection

A

interdigital

moccasin

vesiculobullous

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11
Q

most common location for tinea pedis

A

interdigital types

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12
Q
A

interdigitating tinea pedis

redness and scaling between the toes

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13
Q
A

tinea pedis: moccasin type

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14
Q

tinea pedis moccasin type

A

sharply marginated scale, distributed along lateral borders of feet, heels, and soles

vesicles and erythema may be present

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15
Q

tinea pedis moccasin type is often associated with

A

onychomycosis (nail fungal infection)

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16
Q

one hand, two feet syndrome

A

tinea pedis moccassin type shows unilateral fine scaling, particularly in the creases

and nails are often involved.

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17
Q

tinea pedis vesiculobullous type

A

grouped 2-3 mm vesicles or bullae are seen often on the arch or instep

can be itchy or painful

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18
Q

which tinea pedis is delayed hypersensitivity immune response to a dermatophyte?

A

vesiculobullous

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19
Q

what does KOH do to scales on glass slide

A

dissolves keratin

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20
Q

describe diagnostic featurs in this KOH exam

A

parallel walls throughout the entire length

septated and branching hyphae

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21
Q

how do we diagnose fungus of the hair, skin or nail?

A

KOH testing

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22
Q

topical antifungals for tinea pedis

A

imidazoles: fungistatic
allylamines: fungicidal
ciclopirox: fungicidal and fungistatic

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23
Q

imidazoles

A

fungistatic

ex. clotrimazole

miconazole

ketoconazole

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24
Q

allylamines

A

fungicidal (kills)

ex terbinafine

naftifine

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25
Q

ciclopirox

A

fungicidal and fungistatic

ex cicloprix olamine

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26
Q

complications of tinea pedis

A

lower leg cellulitis (creates portal of entry for bacteria)

tinea corporis - from autoinoculation

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27
Q

onychomycosis

A

chronic fungal infection of the nailbed, usually multiple nails

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28
Q

how can we determine between psoriatic onychomycosis or chronic fungal infection?

A

KOH test or pathology

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29
Q

effect of topics on onychomycosis

A

responds poorly

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30
Q

first line treatment for onychomycosis

A

oral terbinafine (250 mg daily) or azoles

required for at least 3 months!

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31
Q

tinea corporis

A

ringworm

dermatophytosis of the skin - usually affecting the trunk and limbs

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32
Q
A

tinea corporis ringworm

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33
Q

description of ringworm

A

sharply marginated, erythematous annuar lesion with central clearing and raised papulovesicular border with scaling

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34
Q

areas of the body tinea corporis affects

A

the trunk and limbs usually

35
Q

tinea cruris

A

jock itch - ringworm presentation in the groin

36
Q

signs and symptoms of tinea corporis

A

itching is most prominent symptom

asymmetric distribution

active border with central clearing

37
Q

Tinea corporis description

A

annular lesion with central clearing

38
Q

nomenclature

  • body
  • feet
  • scalp
  • hands
  • face
  • nails
  • obscured by topical steroid
A
  • tinea corporis
  • tinea pedis
  • tinea capitis
  • tinea manuum (hands)
  • tinea facei
  • onychomycosis (tinea in nails)
  • tinea incognito
39
Q

treatment for tinea corporis

A

similar to tinea pedis: topical antifungals for 2 weeks minimum

if severe: oral terbinafine or fluconazole 1-2 w

40
Q

tinea capitis

A

dermatophytosis of the scalp and associated hair

41
Q

demographic of tinea capitis

A

common in african american children age 4-8

42
Q

spread of tinea capitis

A

direct contact with animals, humans, fomites

43
Q

most common tinea capitis in world

most common tinea capitis in US

A
  • Microsporum canis (animal to human)*
  • Trichophyyton tonsurans (human/fomite to human)*
44
Q
A

tinea capitis with arthropsores inside the hair shafts

on KOH stain

45
Q

differential diagnosis for tinea capitis

A

seborrheic dermatitis (erythema and greasy scale but no broken hair)

psoriasis (erythematous plaques with overlying silvery scale)

atopic dermatitis (eczematous skin lesions, severe itching and occasional bnrokemn hairs from scratching)

alopecia areata (well demarcated circular patches of complete hair loss)

46
Q
A

seborrheic variant of noninflammatory tinea capitis

47
Q
A

black dot variant of noninflammatory tinea capitis

48
Q

what is a kerion

A

a painful, boggy, inflammatory mass with broken hair follicles

untreated capitis can progress to a kerion

can discharge pus

49
Q
A

inflammatory tinea capitis kerion

50
Q

treatment for tinea capitis

A

Griseofulvin in the US

Terbinafine is comparable

51
Q

topical agents and tinea capitis

A

ineffective

52
Q

diaper candidiasis description

A

beefy red confluent erosinos and marginal scaling in the area (inner thigh and abdomen) covered by a diaper in an infant, folds are affected

looks for satellite papules and pustules

53
Q

pathogenesis of diaper candidiasis

A

wet and dirty diapers that are not changed regularly contribute to diaper dematitis due to urease enzymes in feces

disruptino of the epidermal barrier allows for entry of candida which is present in feces

54
Q

treatment for diaper candidiasis

A

nystatin or imidazole creams or ointments are first line

55
Q

hydrocortisone 1% cream or ointment in diaper candidiasis

A

may be used for significant inflammation but only for al imited time due to risk of skin atrophy and/or system absorption

56
Q

don’t treat diaper candidiasis with

A

combination therapies - high potency topical steroids

57
Q

oral nystatin

A

may be used if thrush is present or with frequent recurrance

58
Q

diaper rash differential

A

atopic dermatitis

infantile psoriasis

irritant diaper dermatitis

tinea cruris

59
Q

atopic dermatitis

A

red skin on an edematous surface with microvesiculation, very rare in diaper area

60
Q

infantile psoriasis

A

sharply demarcated, erythematous papules and plaques involving the folds

61
Q

irritant diaper dermatitis

A

erythma, erosion, spares skin folds, severe cases may show ulcerated papules and islands of re-epithelization

62
Q

tinea cruris in the differential

A

well demarcated red/brown/tan plaques, inguinal fold are affected, rarely involves lavia, scrotum or penis

63
Q
A

irritant dermatitis

64
Q
A

diaper candidiasis

65
Q

irritant diaper dermatitis treatment

A

improves with barrier creams - zinc oxide paste

more frequent diaper changes, looser fitting diapers

candidiasis could be a complicating factor

66
Q

candidiasis of the large skin folds

A

candidal intertrigo

67
Q

where does candidal intertrigo arise

A

groin or armpits

bewtween the buttocks

under large penduluous breasts

under overhanging abdominal folds

neck folds

68
Q

KOH exam on candidal intertrigo

A

reveals pseudohyphae

69
Q

symptom of candidal intertrigo

A

burns more than itches

70
Q

predisposing factors to candidal intertrigo

A

diabetes mellitus

hot, humid weather

limited mobility

obesity

71
Q

treatment of candidal intertrigo

A

topical antifungal agents

  • polyenes (nystatin)
  • imidazoles

allylamines are not used!

72
Q

prevention of candidal intertrigo

A

hygiene, keep dry, weight loss

73
Q

extensive or recalcitrant candidal intertrigo

A

systemic imidazoles

can combine with hydrocortisone cream to reduce symptoms rapidly, but limit to one week

74
Q
A

candidal intertrigo

75
Q
A

candidal intertrigo

76
Q

psoriasis

A

well demarcated plaque with a thick silvery scale

77
Q

common complication of tinea pedis

A

lower leg cellulitis in immunocompromised non diabetics

78
Q

_____ is especially helpful in tinea corporis diagnosis when the source of infection is not obvious

A

culture

79
Q

topical treatment used for

A

tinea pedis

tinea corporis

candidal intertrigo

80
Q

oral medications are used for

A

extensive disease, tinea capitis, onychomycosis

81
Q

always do a ________ when a child presents with a scaling rash concerning for fungal infection

A

diagnostic test - KOH prep or fungal culture

82
Q

etiology of diaper dermatitis

A

irritant, inflammatory, infectious

83
Q

seborrheic dermatitis in infants

A

usually resolves on its own with mild baby shampoos, topical ketoconazole shampoo or cream in persistent cases

84
Q

commonly involved areas of seborrheic dermatitis in infants

A

cradle cap

behind ears

neck creases

axillae

diaper area

Derm (8 decks)

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