Chapter 160 - Superficial fungal Infection part II Flashcards
Local delayed type hypersensitivity response to Trichyophyton test and systemically absorbed fungal antigen
Dermatophytid reaction
Criteria for id reaction
- Dermatophytosis on another part of the body
- Absence of fungal elements from id reaction
- Resolution of id eruption with clearing if primary dermatophyte infection
50% of all cases of onychodystrophy and 15% in children
Onychomycosis
20% of dermatophyte infections among children
Onychomycosis
Patients with CD4 count less than ___ tends to have more widespread and involve all 20 nails type of onychomycosis
400 cells/ul
40% of onychomycosis have concomitant skin infections, 30% of which is ___
Tinea pedis
Dermatophyte infection of the nail
Tinea unguium
Fungal infection of the nail caused by dermatophytes, nondermatophyte, mold, yeasts
Onychomycosis
Most common form of onychomycosis
Distolateral subungual type
Marker of HIV disease
Proximal subungual type
White superficial type is usually caused by
T. Interdigitalis
On HPx of onychomycosis, hyphae are seen between the nail lamina parallel to surface with predilection for (3)
Ventral nail
Stratum corneum of nail bed
Oral antifungal is required for onychomycosis involving the __
Matrix
Oral antifungal for onychomycosis ((3)
Terbinafine 250mg/day for 6-12 weeks
Itraconazole 200mg/day for 2-3 mos
Or 400mg/ mo for 2-3 mos
Fluconazole 150-300mg/week for 3-12 mos
In vitro fungicidal activity found in Eucalyptus citriodora (4)
Thymol
Camphor
Menthol
Oil
Asymptomatic superficial fungal infection of hair shaft
Piedra
Or
trichomycosis nodularia
Black piedra is caused by ___ and affects scalp hair
Piedra hortae
Matching type
- Scalp
- Axillary
- Genital
A. T. Asahi
B. T Inkin
C. T. Ovoides
C
A
B
White piedra affects face, axilla, genitals more than scalp.
True or False
Tru
Matching type
- Broken hairs
- Pseudoparenchyma
- Inhibited by cycloheximide
A. Black piedra
B. White piedra
A
A
B
Diff of trichomycosis nodularis vs trichomycosis axillaris
Trichomycosis axillaris are smaller and fluoresce under a Wood lamp
Curative for piedra
Shaving
Common mode of transmission of tinea barbae
Exposure to cattle, horses, or dogs
Matching type
- Involves the beard area
- T. Violaceum
- T. Verrucosum
- T. Interdigitale
- Scarring alopecia
- MC clinical presentation
A. Superficial
B. Inflammatory
C. Both
D. None
C A B B B B
In tinea barbae, always rule out (2)
Herpes simplex
Halogenoderma
Treatment for tinea barbae
Systemic corticosteroids for 1 week \+ Terbinafine 250mg/day x 2-4 weeks Itraconazole 200mg/day x 2-4 weeks Fluconazole 200mg/day x 4-6 weeks Griseofulvin 1g/day x 6 weeks
Tinea capitis is most commonly observed in children between the ages of ___ due to fungistatic effect of ___
3 to 14 years old
FA in the sebum
Common cause of tinea corporis in adults? In children?
T. Rubrum (adults)
M. Canis (children)
MC cause of tinea incognito
Tinea rubrum
Tinea capitis describes dermatophyte infection of hair and scalp caused by Trichophyton and Microsporum except
T. Concentricum
Even after shedding, hairs may harbor infectious organisms for more than ___
1 year
Matching type
- M. Audouinii
- T. Violaceum
- T. Tonsurans
- M. Canis
- M. ferrugineum
- T schoenleinii
A. Noninflammatory
B. Black dot
C. Inflammatory
D. Favus
A B B C A D
Noninflammatory type or gray patch type of tinea capitis often occurs on ___ with ___ alopecia
Occiput
Nonscarring
Inflammatory type of tinea capitis results in (2)
Scarring alopecia
Posterior cervical lymphadenopathy
Clinical pearl in diff tinea capitis from other inflamm disorders involving the scalp
Posterior cervical lymphadenopathy
Tinea capitis often involves __ hairs
Mid to late anagen hairs
Arthroconidia are usually noted in infected hairs of favus.
True or False
False, not noted
Topical therapy alone is sufficient for management of tinea capitis.
True or False
False, not sufficient
For tinea capitis, the ff should be ruled out (2)
DLE, syphilis
Thrice weekly use of (2) by all household members also reduces transmission by decreasing shedding of spores
Ketoconazole 2% shampoo
Selenium sulfide 2.5%
DOC for tinea capitis (M. Canis)
Griseofulvin 20-25mkday for 6-8 weeks (micro)
DOC for tinea capitis (T. Tonsurans)
Terbinafine x 2-4 weeks
<20kg: 62.5mg/day
20-40kg: 125mg/day
>40kg: 250mg/day
Dermatophytosis of glabrous skin except palms, soles, and the groin
Tinea corporis
Tinea corporis gladiatorum is caused by
T. Tonsurans
Superficial and subcutaneous dermatophytic infection involving deeper portions of hair follicles
Majocchi granuloma
Majocchi granuloma is most commonly caused (3)
T. Rubrum
T. Interdigitale
M. Canis
Etiologic agent of tinea imbricata
Tinea concentricum
Second most common dermatophytosis worldwide
Tinea cruris
Tinea crusis is ___ times more common in men and adults
3
Tinea cruris with involvement of genitocrural crease and medial upper thigh
E. Floccosum
Tinea cruris with extension to pubic, perianal, buttock, and lower abdominal areas
T. Rubrum
Chronic dermatophyte infection of scalp that rarely involves glabrous skin and or nails characterized by thick yellow crusts (scutula) within the hair follicles that lead to scarring alopecia
Tinea favosa
Most common cause of human favus
T. Schoenleinii
Tinea nigra is caused by superficial dermatomycosis caused by dematiaceous darkly pigmented
Hortaea werneckii
Tinea nigra has ___ predilection
Female
Asymtomatic mottled brown to greenish black macule or patch with minimal to no scale on palms and soles and darkest at advancing border
Tinea nigra
Treatment of tinea nigra
Keratolytic (Whitfield ointment, 2% SSA)
Tincture of iodine
Topical antifungal
Most common dermatophytosis worldwide
Tinea manuum and tinea pedis
Fine dry scaling of palm accentuated in the creases
Tinea manuum
Most common presentation of tinea pedis
Interdigital type, between lateral 3rd and 4th, 4th and 5th toes
Most common pathogen of moccasin type of tinea pedis
T. Rubrum
Vesiculobullous type of tinea pedis is caused by
T. Interdigitale
Responsible for malodor of athlete’s foot
Pseudomonas
Proteus
Highest rate of positive findings of KOH in tinea pedis
Blister roof of vesicles or bulla
Treatment for mild interdigital tinea pedis
Terbinafine cream applied BID for 1 week