Candidiasis

Question 1

Define

Answer 1

Fungal infection of the body and groin

Body= Tinea corporis or ringworm

Groin= Tinea cruris

These are caused by dermatophytes, most commonly:
* Trichophytum rubrum
* Trichophytum interdigitale
* Rarely: Epidermophyton floccosum

Groin infection is usually caused by autoinoculation from dermatophyte infection of the hands, feet or nails

Transmitted by:
* Direct contact with an infected person
* Direct contact with an infected animal
* Indirect contact with fomites (objects/ materials with infection)
* Contact with soil

Question 2

Define tinea capitis

Answer 2

Fungal infection of the scalp (Known as Tina capitis, or scalp ringworm)

This is infection of the scalp hair follicles and surrounding skin caused by dermatophytes, commonly:

1. Trichophyton tonsurans
2. T. violacaeum
3. In Europe and rural parts of UK, usually caused by zoonotic dermatophyte: Microsporum canis- usually affects household pets

Transmission:

• Contact with an infected child, either directly or via fomites
• Fungal spores or infected hairs are transferred by contact or by airborn dissemination onto the epidermis between hair follicles
• The spores germinate, producing chains of hyphae, which grow down into the hair shaft and penetrate the hair

Most prevalent 3-7 yrs

USUALLY TRASNFERRED FROM KITTEN - SO CHECK IN Hx

Question 3

Symptoms

Answer 3

Tinea corporis

• ‘Ring’ worm describes the often ringed (annular) appearance of skin lesions
• Single or multiple red or pink, flat or slightly raised annular patches
• Sizes vary (1-5cm) and enlarge outwards
• Lesions have an active red, scaly advancing edge and a clear central area (central clearing)
• Asymmetrical in distribution
• May be larger and coalescence of lesions

Tinea cruris
* Most commonly affecting inguinal folds and proximal medial thighs
* Perianal skin, buttocks and above the waistline may be affected
* Lesions are red/ red-brown, flat or slightly raised with active borders (pustular or vesicles with lesions)
* Uniform scale WITHOUT central clearing and typical scaly edge may be lost in moist flexures

Tinea capitis

• Scaling and itch of scalp- generalised and diffuse
• Single or multiple circular patches of hair loss (alopecia)
• Usually asymmetrical (if multiple)
• Dry scaling
• May be a ‘black dot’ appearance of scalp- broken-off swollen hair stubs within the follicles
  Inflammatory involvement can present
• rythema, scattered pustules, crusting
• Painful, pustular boggy masses, which have a thick crust (kerion)
• Permanent alopecia and scarring of hair follicles
• Lymphadenopathy which may be painful

Question 4

Investigations

Answer 4

Microscopic examination of skin scrapings for fungal hyphae

Skin swab for bacterial and fungal microscopy (if skin pustular and macerated)

Hair sampling

Culture of organisms- definitive identification

Question 5

Management

Answer 5

TINEA CORPORIS + CRURIS

• Advice on self-care measures
• Loose-fitting clothes (cotton or material designed to keep moisture away from skin)
• Maintain good hygiene- washing affected areas daily
• After washing, dry thoroughly, especially in skin folds
• Avoid scratching affected skin
• Do not share towels and wash them frequently
• Wash clothes and bed linen to eradicate fungal spores
• Do NOT need to be excluded from school

Tinea Faciei, Tinea Corporis, Tinea Cruris or Tinea Pedis

1. Mild -> topical antifungals (e.g. terbinafine cream, clotrimazole)
2. Moderate -> hydrocortisone 1% cream (Apply for maximum 7 days and do NOT use alone on skin lesions)
3. Severe -> oral antifungals (1st line: oral terbinafine; 2nd line: oral itraconazole)
4. Tinea Capitis -> oral antifungal (e.g. griseofulvin or terbinafine) For 4-6 wks

If there is a suspected kerion (swelling and alopecia of scalp) - URGENT referral to dermatology specialist

If household pet is suspected of being source of infection, assess and treat by vet

Question 6

Complications

Answer 6

Tinea corporis + cruris
* Secondary bacterial infection
* Fungal infection of the hand
* Tinea incognito (extensive spread of infection and change in morphology of lesions)

Tinea capitis
* Secondary bacterial infection
* Scarring alopecia
* Skin pigmentation changes
* A dermatophytid reaction
* Erythema nodosum

Prognosis

Infection often relapses after successful treatment in susceptible people and may become a chronic problem

Tinea capitis: hair usually regrows fully after effective PO antifungal treatment for Trichophyton tonsurans, scarring of the scalp is rare