Fungal infections of the skin

Question 1

How can you diagnose fungal infections?

Answer 1

1. clinical features
2. KOH exam (direct microscopy)
3. fungal culture
4. Wood’s lamp

Question 2

Describe how the KOH exam is done

Answer 2

1. Collect scale from active border scrapping with a scalpel
2. Put scale on center of glass slide
3. Put coverslip and add 1-2 drops of KOH
4. Wait ~15 minutes to dissolve
5. Microscopy

Question 3

Describe the different types + clinical description of tinea pedis

Answer 3

1. Interdigital (en sık): erythema, scaling, fissures and maceration
2. Moccasin (hiperkeratotik): diffüz hiperkeratosis, eritem, scaling and fissures on plantar surfaces
   One Hand Two Feet Syndrome: Moccasin tipte sıklıkla bir el de etkilenebilir. Etkilenmiş elde: unilateral fine scaling in the creases
3. İnflamatuvar (Veziküler): ayağın medialinde veziküller ve büller. Dermatophytid reaksiyon (id reaksiyonu): reaction to fungal elements presenting as a dyshidrotic-like eruption on the fingers and palms
4. Ülseratif: exacerbation of interdigital tinea pedis, ulcers and erosions in the web spaces, commonly secondarily infected with bacteria. Seen in immunocompromised and diabetic patients

Question 4

DDx of tinea pedis

Answer 4

Psoriasis
Contact Dermatit

Question 5

Describe the tx of tinea pedis

Answer 5

Tedavi: 1 ay boyunca
Hijyen
1. Topikal Antifungal: Hepsinde
A. First-Line: Allylamines once or twice daily for 1-2 weeks
i) Terbinafine
ii) Naftifine
iii) Butefine krem/jel/spray/losyon
B. Second-Line: Imidazoles twice daily for 4-6 weeks
i) Ketoconazole
ii) Clotrimazole
iii) Miconazole
iv) Oxiconazole
2. Oral Antifungal: Reküren, resistant ya da mocassin tip hastalıkta. Diyabetik ve immün-kompromise hastalarda düşünülebilir
i) Terbinafine 1x250 mg/gün, 2 hafta
ii) Itraconazole 2x100 mg/gün, 2 hafta

Question 6

What does the patient have to be careful of?

Answer 6

Hijyen
Nemli kalmasın
Kapalı ayakkabılar giymesin
Spor salonu, ortak havuz vs. dikkat etsin