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adult and pediatric cutaneous fungal infections 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
ciclopirox
fungicidal and fungistatic ex cicloprix olamine
26
complications of tinea pedis
lower leg cellulitis (creates portal of entry for bacteria) tinea corporis - from autoinoculation
27
onychomycosis
chronic fungal infection of the nailbed, usually multiple nails
28
how can we determine between psoriatic onychomycosis or chronic fungal infection?
KOH test or pathology
29
effect of topics on onychomycosis
responds poorly
30
first line treatment for onychomycosis
oral terbinafine (250 mg daily) or azoles required for at least 3 months!
31
tinea corporis
ringworm dermatophytosis of the skin - usually affecting the trunk and limbs
32
tinea corporis ringworm
33
description of ringworm
sharply marginated, erythematous annuar lesion with central clearing and raised papulovesicular border with scaling
34
areas of the body tinea corporis affects
the trunk and limbs usually
35
tinea cruris
jock itch - ringworm presentation in the groin
36
signs and symptoms of tinea corporis
itching is most prominent symptom asymmetric distribution active border with central clearing
37
Tinea corporis description
annular lesion with central clearing
38
nomenclature - body - feet - scalp - hands - face - nails - obscured by topical steroid
- tinea corporis - tinea pedis - tinea capitis - tinea manuum (hands) - tinea facei - onychomycosis (tinea in nails) - tinea incognito
39
treatment for tinea corporis
similar to tinea pedis: topical antifungals for 2 weeks minimum if severe: oral terbinafine or fluconazole 1-2 w
40
tinea capitis
dermatophytosis of the scalp and associated hair
41
demographic of tinea capitis
common in african american children age 4-8
42
spread of tinea capitis
direct contact with animals, humans, fomites
43
most common tinea capitis in world most common tinea capitis in US
* Microsporum canis (animal to human)* * Trichophyyton tonsurans (human/fomite to human)*
44
tinea capitis with arthropsores inside the hair shafts on KOH stain
45
differential diagnosis for tinea capitis
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
seborrheic variant of noninflammatory tinea capitis
47
black dot variant of noninflammatory tinea capitis
48
what is a kerion
a painful, boggy, inflammatory mass with broken hair follicles untreated capitis can progress to a kerion can discharge pus
49
inflammatory tinea capitis kerion
50
treatment for tinea capitis
Griseofulvin in the US Terbinafine is comparable
51
topical agents and tinea capitis
ineffective
52
diaper candidiasis description
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
pathogenesis of diaper candidiasis
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
treatment for diaper candidiasis
nystatin or imidazole creams or ointments are first line
55
hydrocortisone 1% cream or ointment in diaper candidiasis
may be used for significant inflammation but only for al imited time due to risk of skin atrophy and/or system absorption
56
don't treat diaper candidiasis with
combination therapies - high potency topical steroids
57
oral nystatin
may be used if thrush is present or with frequent recurrance
58
diaper rash differential
atopic dermatitis infantile psoriasis irritant diaper dermatitis tinea cruris
59
atopic dermatitis
red skin on an edematous surface with microvesiculation, very rare in diaper area
60
infantile psoriasis
sharply demarcated, erythematous papules and plaques involving the folds
61
irritant diaper dermatitis
erythma, erosion, spares skin folds, severe cases may show ulcerated papules and islands of re-epithelization
62
tinea cruris in the differential
well demarcated red/brown/tan plaques, inguinal fold are affected, rarely involves lavia, scrotum or penis
63
irritant dermatitis
64
diaper candidiasis
65
irritant diaper dermatitis treatment
improves with barrier creams - zinc oxide paste more frequent diaper changes, looser fitting diapers candidiasis could be a complicating factor
66
candidiasis of the large skin folds
candidal intertrigo
67
where does candidal intertrigo arise
groin or armpits bewtween the buttocks under large penduluous breasts under overhanging abdominal folds neck folds
68
KOH exam on candidal intertrigo
reveals pseudohyphae
69
symptom of candidal intertrigo
burns more than itches
70
predisposing factors to candidal intertrigo
diabetes mellitus hot, humid weather limited mobility obesity
71
treatment of candidal intertrigo
topical antifungal agents - polyenes (nystatin) - imidazoles allylamines are not used!
72
prevention of candidal intertrigo
hygiene, keep dry, weight loss
73
extensive or recalcitrant candidal intertrigo
systemic imidazoles can combine with hydrocortisone cream to reduce symptoms rapidly, but limit to one week
74
candidal intertrigo
75
candidal intertrigo
76
psoriasis
well demarcated plaque with a thick silvery scale
77
common complication of tinea pedis
lower leg cellulitis in immunocompromised non diabetics
78
\_\_\_\_\_ is especially helpful in tinea corporis diagnosis when the source of infection is not obvious
culture
79
topical treatment used for
tinea pedis tinea corporis candidal intertrigo
80
oral medications are used for
extensive disease, tinea capitis, onychomycosis
81
always do a ________ when a child presents with a scaling rash concerning for fungal infection
diagnostic test - KOH prep or fungal culture
82
etiology of diaper dermatitis
irritant, inflammatory, infectious
83
seborrheic dermatitis in infants
usually resolves on its own with mild baby shampoos, topical ketoconazole shampoo or cream in persistent cases
84
commonly involved areas of seborrheic dermatitis in infants
cradle cap behind ears neck creases axillae diaper area

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