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Infectious Disease > Diagnosis and Treatment of cutaneous fungal infections > Flashcards

Diagnosis and Treatment of cutaneous fungal infections Flashcards

1
Q

What is a common superficial skin infection that may become chronic?

A

Tinea versicolor

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2
Q

What is tinea versicolor?

A

Superficial yeast infection caused by Pityrosporum ovale aka Malassezia furur

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3
Q

Where is Malassezia normally found?

What does it do on our skin?

A

is normally found on human skin

Organism oxidizes fatty acids in the skin and inhibits tyrosinase in the melanocytes leading to loss of pigmentation

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4
Q

Pathogenesis of tinea versicolor?

A

Transformation of Malassezia from yeast cells to a pathogenic mycelial form is associated with the development of clinical disease

Not related to poor hygiene

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5
Q

Risk factors for tinea versicolor?
5

What age group is it most common in?

A

Most common in teens (>15) and young adults

Risk factors:

  1. heat,
  2. humidity,
  3. excessive sweating,
  4. use of topical skin oils,
  5. HIV infection
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6
Q

Tinea versicolor is characterized by what?

A

by hypopigmented lesions on the trunk that are asymptomatic

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7
Q

Clinical presentation of tinea versicolor?

Describe the lesions?
6

A
  1. Asymptomatic (sometimes can be pruritic)
  2. Velvety tan, pink or white macules
  3. Hypopigmented areas that do not tan with the rest of the skin
  4. 4-5 mm or confluent
  5. Trunk, upper arms, neck and groin
  6. Lesions may scale if scraped
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8
Q

Laboratory tests for tinea versicolor and what do they reveal?

Diagnosis?
3

A

Skin scrapings seen on KOH prep show budding spores and large hyphae “spaghetti and meatballs” (but a clinical diagnosis really)

Fungal culture not helpful

DDX:

  1. vitiligo,
  2. seborrheic dermatitis,
  3. pityriasis alba
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9
Q

Treatment fo choice for tinea versicolor?

To prevent reocurrence?

A

Selenium sulfide lotion or shampoo 2.5% (Rx) once daily for 7 days

maintenance therapy twice a month

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10
Q

Treatment options for tinea versicolor?

4

A

Ketoconazole (shampoo)
Selenium sulfide (lotion)
Intraconazole (PO)
Fluconazole (PO)

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11
Q

How long may it take for hypopigmented areas to return to normal?

A

COuld take months

80% of cases are recurrent

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12
Q

3 species of fungi that cause human infection (dermatophytes)?

A

Trichophyton

Microsporum

Epidermophyton

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13
Q

Dermatophytes grows where?

3

A 
grow in the 
1. skin, 
2. hair and 
3. nails 
leading to localized symptoms
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14
Q

What do dermatophytes digest?

What does this cause? 3

A

Dermatophytes digest keratin

Scaling
Nails thicken and crumble
Hair loss

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15
Q

Risk factors for tinea infectious

4

A
  1. warm, moist, occluded environments,
  2. family history,
  3. compromised immune system,
  4. alteration in normal flora
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16
Q

How is dermatophytes spread?

3

A

Humans, animals, inanimate objects

17
Q

Where are Tinea infections located and what fungal species cause it?
5

A

Located in the stratum corneum

Caused by dermatophytes

  1. Trichophyton rubrum
  2. Trichophyton tonsurans
  3. Trichophyton mentagrophytes
  4. Mircrosporum canis
  5. Epidermophyton floccosum
18
Q

Tinea is classified by it’s anatomic location:

Tinea corporis?

Tinea cruris?

Tinea pedis?

Tinea capitis?

Tinea unguium?

A

Body “ring worm”

Groin “jock itch”

Feet “athlete’s foot”

Scalp

Nails

19
Q

Symptoms generally include what? 3

What could accompany these symptoms? 2

A
  1. pruritus,
  2. burning and
  3. stinging.

If inflammatory reaction may have

  1. erythema and
  2. vesicles in addition to the symptoms listed above
20
Q

Laboratory evaluation of tinea infections?

7

A
  1. Microscopic evaluation
  2. Skin margin scraping and 3. KOH prep
  3. Fungal culture
  4. Takes 2 weeks
  5. Wood’s lamp
  6. Will identify Microsporum species
21
Q

Tinea Corpis is find where?
3

What do the lesions look like? 3

How is it transmitted? 3

How should we treat it?

A

Face, limbs, trunk

  1. Ring shaped lesion with well-demarcated margins
  2. Central clearing
  3. Scaly, erythematous border

Transmitted by contact Humans, animals, sports equipment

Treat with a topical azole antifungal (apply 1-2 x daily for 2-4 weeks) continue therapy for a week after lesions clear

22
Q

Tinea Cruris is found where? 2 spots.
Where is it not found?

Describe the lesions? 4

What is the hallmark sign?

Treatment?

A

Groin, inguinal folds
Spares the scrotum

  1. Borders distinct
  2. Lesions large,
  3. erythematous
  4. Macular with central clearing

Hallmark: pruritus with burning

Treatment: topical azole antifungal

23
Q

TInea pedis is found where? 2

Descibe the lesions?

Treatment?

A
  1. Interdigital: scaling, maceration, fissures b/w toes
  2. Plantar: diffuse scaling of the soles

Acute vesicular: vesicles and bullae on the sole of the foot, great toe and instep

Treatment: topical azole antifungal (dry spray and allowing the area to be exposed to air)- also spray shoes

24
Q

What do the lesions look like in tinea capitis?

5

A
  1. Inflamed
  2. scaly,
  3. alopecic,
  4. raised
    patches
  5. can have tender pustular nodules
25
Q

What causes the diffuse scaling in tinea capitis?

Treatment?
2

A

Diffuse scaling with round alopecic patches due to broken hair shafts

Treatment: griseofulvin for 8 weeks OR terbinafine for up to 4 weeks

(CANNOT USE TOPICAL THERAPY)

26
Q

Tinea unguium is also known as?

Where does it typically occur?

How does the infection usually occur?

Symtpoms?

Pathology?

A

Also known as onychomycosis

Typically toenails but can affect fingernails as well

Infection usually moves distal to proximal

Usually asymptomatic

Fungus is causing cells to lyse and build up

27
Q

Treatment for tinea unguium:
Fingernail?
Toe Nails?

What should we monitor? 2

What is the alternative?

A
  1. Treat with oral terbinafine (Lamisal) 250 mg po qday X 6 weeks (fingernails); 12 weeks for toenails.
  2. Monitor LFTs, CBC
  3. Alternative is itraconazole (Sporanox)
28
Q

What is a candidiasis found in the axillae, under breasts, groin, and intergluteal folds?

What is a candidiasis found on the glans penis?

What is a candidiasis found that produces follicular pustules?

What is a candidiasis found in nail folds?

What is a candidiasis found in the mouth and tongue?

What is a candidiasis found in babies?

A

Intertrigo

Balantitis

Candidal folliculitis

Candidal paronychia

Thrush

Diaper dermatitis

29
Q

Risk factors for candidiasis

7

A
  1. Infection
  2. Recent antibiotic therapy
  3. Diabetes
  4. Systemic and topical steroids
  5. Immunosuppression
  6. Warm, moist conditions
  7. Break in the skin
30
Q

Treatment of candidiasis: Thrush? 2

A

Nystatin

Clotrimazole

31
Q

Tretament of cutaneous candidiasis:
3

If failure of topical therapy?

A
  1. Powder for macerated areas (Nystatin)
  2. Topical clotrimazole (Lotrimin),
  3. ketoconazole

If failure of topical therapy
-Oral fluconazole (Diflucan)

32
Q

What are the topical azoles?

3

A

Azoles:

  1. Miconazole;
  2. Clotrimazole;
  3. Ketoconazole

Infectious Disease (29 decks)

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