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15 Derma > Fungal Skin Infections > Flashcards

Fungal Skin Infections Flashcards

1
Q

superficial vs subcutaneous vs deep mycosis

A

superficial: stratum corneum, hair nails
subcutaneous: dermis, subcutaneous tissue
deep: hematogenous spread

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2
Q

most common etiology of tinea

A

trichophyton rubrum (skin) and trichophyton tonsurans (tinea capitis)

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3
Q

pathogenesis of tinea

A
  • adhesion: adherence of arthroconidia to keratin
  • invasion: cell wall inhibit immunity -> invasion and desquamation
  • host defense
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4
Q

classification of tinea

A 
body: tinea corporis
scalp and hair: tinea capitis
face/beard: tinea faciale, tinea barbae
hand: tinea manuum
foot: tinea pedis
groin: tinea cruris
nail: tinea unguinum / onychomycosis
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5
Q

classic presentation of tinea corporis

A

annular plaque with slightly raised, scaly, active, erythematous border

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6
Q

differentials of tinea corporis

A
  • psoriasis: silvery white scales and auspitz sign, fhx
  • pityriasis rosea: herald patch, secondary eruption
  • tinea versicolor: yellow-green fluorescence in wood lamp, ziti/spaghetti meatballs sign on koh
  • nummular eczema: coin-shaped, pinpoint erosions and excoriations
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7
Q

skin findings in non inflammatory tinea capitis

A
  • scales
  • arthroconidia form a sheath around hairs
  • hairs break off above level of scalp
  • wood’s lamp: green fluorescence
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8
Q

skin findings in black dot form of tinea capitis

A
  • hairs break off at level of scalp = grouped black dots within patches of polygonal shaped alopecia
  • normal hairs within patches of broken hairs
  • diffuse scaling
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9
Q

skin findings in inflammatory tinea capitis

A
  • inflamed, boggy, tender areas of alopecia + follicular pustules to furunculosis
  • posterior cervical lymphadenopathy
  • zoophilic or geophilic
  • negative koh and culture
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10
Q

how to distinguish tinea capitis from seborrheic dermatitis

A

sd:
- greasy yellowish scaling found in sites rich with sebaceous gland
- no hair loss, no hair breaking!!

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11
Q

how to distinguish tinea capitis from scalp psoriasis

A
  • scales more prominent and readily retained
  • hairs not broken and not permanently lost!!
  • can involve other body areas
  • fhx
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12
Q

most common tinea

A

tinea pedis

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13
Q

skin findings in interdigital type tinea pedis

A
  • scaling, erythema, and maceration of interdigital skin

- web: dry, scaly and fissured OR white, macerated, and soggy

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14
Q

how to distinguish tinea pedis from erosio interdigitalis blastomycetica

A
  • rf: dm and wet work
  • macerated white skin with fissures with raw red bases in web
  • macerated skin peels off = painful, raw, denuded area
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15
Q

skin findings in chronic hyperkeratotic moccasin type tinea pedis

A

patchy or diffuse scaling on soles, lateral and medial aspects of feet

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16
Q

how to differentiate tinea pedis from palmoplantar psoriasis

A
  • thick hyperkeratotic plaques with erythema, fissuring, and scaling
  • sterile pustules
  • symmetric and involved other body parts
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17
Q

t/f genitalia including the scrotum, are affected in tinea cruris

A

false, not affected!

18
Q

skin findings in tinea cruris

A

well marginated annular plaque with a scaly raised border and central clearing, often bilateral

site: inguinal fold to inner thigh

19
Q

how to distinguish tinea cruris from erytrasma

A
  • reddish brown, thin, finely wrinkled patches
  • uniform appearance, NO CENTRAL CLEARING
  • coral red on wood’s lamp
20
Q

how to distinguish tinea cruris from candidal intertrigo

A
  • beefy red patches with satellite papules and pustules
  • WITH SCROTAL INVOLVEMENT
  • koh: pseudohyphae and budding yeast
21
Q

diagnostics for tinea

A
  • koh: long, septated branching hyphae
  • culture (sda)
  • biopsy: hyphae in stratum corneum
22
Q

treatment of tinea

A
  • topical
  • oral for hair follicles, onychomycosis, or large
  • terbinatine, fluconazole itraconazole, griseofulvin
23
Q

risk factors for chronic paronychia, nail psoriasis, and onychomycosis

A

read

24
Q

onychmycosis vs tinea unguium

A

onychomycosis: fungal infection of the nail due to dermatophytes, non-deramtophyte molds, or yeasts

tinea unguium: dermatophyte infection of the nail

25
Q

most common form of onychomycosis

A

distolateral subungual type

26
Q

nail findings in dlso

A
  • distal nail plate turns yellow/white as hyperkeratotic debris causes nail to rise and separate from underlying bed
  • spreads proximally up the nail bed
  • dystrophic nail
27
Q

nail findings in pso

A
  • fungi enter posterior nailfold-cuticle area
  • nail separates forming white to beige opacities on proximal nail plate

seen in hiv patients

28
Q

5ps for sexual history

A 
partners (# and gender)
practices
protection from stds
past history of stds
prevention of pregnancy
29
Q

nail findings in white superficial type onychomycosis

A
  • surface: soft, dry, powdery, can be scraped away

- nail plate: not thickened and remains adherent to nail bed

30
Q

pathophysio of white superficial type onychomycosis

A

direct invasion of dorsal nail plate -> white to dull yellow, sharply bordered patches on surface of toenail

31
Q

how to differentiate onychomycosis and nail psoriasis

A
  • pitting on nail plate surface (ice pick)
  • onycholysis
  • oil spot lesion
32
Q

how to differentiate onychomycosis and chronic paronychia

A
  • mild swelling around proximal and lateral nailfolds
  • many or all fingers
  • candida
  • contact irritant exposure
  • no subungual thickening!!
33
Q

diagnosis of onychomycosis

A
  • koh examination (most cost effective)
  • culture (most specific)
  • nail biopsy with pas exam (most sensitive)
34
Q

management of onychomycosis

A
  • ciclopirox, amorolfine, tioconazole, efinaconazole

- efina and ciclo 48 wks

35
Q

risk factors for oral candidiasis

A
  • hiv infection
  • infants
  • adults

read

36
Q

type of candidiasis with background erythema with adherent whitish material on oropharyngeal mucosal surfaces, can be brushed off

A

pseudomembranous form

37
Q

type of candidiasis: shiny depapillated lingual surface

A

erythematous atrophic formp

38
Q

type of candidiasis: maceration and transverse fissuring or crusting at commissures

A

angular cheilitis

39
Q

how to distinguish leukoplakia from oral candidiasis

A
  • premalignant for scc
  • cannot be brushed off
  • hairy leukoplakia
40
Q

how to distinguish oral lichen planus from oral candidiasis

A
  • buccal mucosa or tongue
  • red and smooth with loss of papillae
  • nonerosive: dendritic pattern/lacy white network
  • erosive: painful; localized or extensive
41
Q

treatment for oral candidiasis

A
  • oral nystatin
  • moderate to severe: oral fluconazole 1-2 wks
  • refractory or resistant: itraconazole, posaconazole, voriconazole, amphotericin b

15 Derma (7 decks)

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