Cutaneous fungal Infections

Question 1

Which 3 types of fungi commonly cause skin infection?

Answer 1

Dermatophytes: Tinea (Ringworm)
Yeasts: Candida albicans
Moulds: Aspergillus

Question 2

2 common features of fungal skin infection presentation

Answer 2

Itchy

Unilateral/ asymmetrical

Question 3

3 features of Tinea Pedis

Answer 3

Most common dermatophyte infection
Moist scaling + fissuring in toe-webs
Spreads to sole + dorsum of foot

Question 4

How is dermatophyte infection most commonly acquired?

Answer 4

Contact with keratin debris carrying fungal hyphae

Question 5

3 features of Tinea Cruris

Answer 5

M > F
Scaly erythematous margin spreads down medial thighs, may extend back to perineum + bum
Source often feet

Question 6

2 features of Tinea Corporis

Answer 6

Clearly defined raised, scaly edge

Annular lesions on trunk + limbs

Question 7

Presentation of Tinea Manuum

Answer 7

Palm: mild scaling erythema
Dorsum: inflammatory change with well defined edge

Question 8

3 features of Tinea Unguium

Answer 8

Common + associated with athletes foot
Starts distally with yellow streaks in nail plate
Whole nail thickens, discolours, friable

Question 9

4 features of Tinea Capitis

Answer 9

Kids > Adults
>,1 patches of partial hair loss
Scaly + hair broken off just above surface
+/- Inflammation/ pustule formation

Question 10

3 features of Kerion

Answer 10

Severe inflammatory scalp ringworm
Pustules + Abscesses
Often fungus of Cattle ringworm

Question 11

3 features of Cattle ringworm

Answer 11

Affects face + forearms
Marked inflammatory reaction
Young farmers/ kids visiting farms at risk

Question 12

3 features of Tinea Incognito

Answer 12

Fungal infection appearance altered by inappropriate tx with topical steroids
Top. steroids suppress inflammatory response to fungus
Scaly erythematous margin disappears leaving ill-defined patchy scaling erythema studded with pustules

Question 13

Ix for suspected dermatophyte infection

Answer 13

Skin scrapings, nail clippings + plucked hair

Question 14

Tx for dermatophyte infection

Answer 14

Small: Terbinafine TOP

Extensive/ Nails: Terbinafine PO

Question 15

Tx for tines capitis

Answer 15

1: Griseofulvin PO (Safe for kids)
2: Terbinafine/ Itraconazole PO

Question 16

Aetiology of Candida albicans infection

Answer 16

Normal commensal
Pathogenic when favourable conditions to multiplication arise e.g. Immune suppression, Steroids, Broad spectrum Abx, DM, apposition of skin to warm moist environment

Question 17

Ix for candidiasis

Answer 17

Swab + culture

Question 18

2 features of buccal mucosal candidiasis

Answer 18

White, curd-like plaques adhere to buccal mucosa

Scraped off to reveal inflamed + friable epithelium

Question 19

Tx for buccal mucosal candidiasis

Answer 19

Miconazole gel
Fluconazole PO (Severe)

Question 20

What inflammation process at the corners of the mouth may be caused by Candida?

Answer 20

Angular chelitis

Question 21

Tx for Candidal angular chelitis

Answer 21

Miconazole TOP / Nystatin
Fluconazole PO (Severe)

Question 22

What is chronic Candidal paronychia? Who does it predominantly occur in?

Answer 22

Inflammatory process affecting proximal nail fold + nail matrix
Those whose hands are repeatedly immersed in water

Question 23

3 features of chronic Candidal paronychia

Answer 23

Thickening + erythema of proximal nail fold- Bolstering
Loss of cuticle- access of irritant substances
Associated nail dystrophy

Question 24

Tx for chronic Candidal paronychia

Answer 24

Keep hands dry as poss

Miconazole TOP

Question 25

Presentation of balanitis

Answer 25

Small white patches/ eroded areas on foreskin/ glans

Question 26

3 risk factors for balanitis

Answer 26

Poor penile hygeine DM Sexual partner with candida vulvovaginitis

Question 27

Presentation of vulvovagintis

Answer 27

Creamy discharge | Itchy erythema of vulva

Question 28

3 risk factors for vulvovaginitis

Answer 28

Pregnancy OCP DM

Question 29

Tx for balanitis

Answer 29

Ketoconazole/ Miconazole TOP

Question 30

Tx for vulvovaginitis

Answer 30

1. Fluconazole PO | 2. Clotrimazole PV

Question 31

Intertrigo

Answer 31

Maceration which occurs when 2 skin surfaces are in apposition Groins, Axillae, Submammary regions, beneath abdominal fat apron RF: Obesity + poor hygeine

Question 32

What suggests candida super infection in Intertrigo?

Answer 32

Creamy 'satellite' pustules at margins of affected areas | Easily rupture leaving collarette of scale + scalloped edge

Question 33

Tx for Intertrigo

Answer 33

Terbinafine/ Imidazole TOP Hydrocortisone TOP Hygiene

Question 34

2 features of Pityriasis versicolor

Answer 34

``` YA most commonly Malassezia yeasts (commensals in pilosebaceous follicles) ```

Question 35

Presentation of Pityriasis versicolor

Answer 35

Asymptomatic Fair: Light-brown macules with fine surface scale, trunk + upper arms Dark: Patchy hypopigmentation

Question 36

Ix for Pityriasis versicolor

Answer 36

Skin scrapings + microscopy

Question 37

Tx for Pityriasis versicolor

Answer 37

Limited: Clotrimazole cream Extensive: Ketoconazole shampoo