Fungi and Infestations

Question 1

what is another word for tinea infection

Answer 1

ringworm

Question 2

what is seen in a characteristic tinea infection

Answer 2

erythematous scaly lesion with a leading edge and a ‘spared’ center

Question 3

how is tinea classified

Answer 3

by body location

Question 4

where is tinea pedis found

Answer 4

foot

Question 5

where is tinea manuum found

Answer 5

wrist/hand

Question 6

where is tinea cruris found

Answer 6

groin

Question 7

where is tinea corpis found

Answer 7

all over the body

Question 8

where is tinea captis found

Answer 8

on the top of the head

Question 9

what population is tinea captis more common in

Answer 9

afrocaribbean

Question 10

what is onychomycosis

Answer 10

tinea of nails, extremely common causing onycholysis, hyperkeratosis and discoloration - often confused for psoriasis

Question 11

how do you investigate tinea infection

Answer 11

scrapings from the leading edge of the infection

or if on nails clippings are sent

certain fungi flouresce under UV (woods) light

if hair - hair samples + root is best

Question 12

what are some differentials for tinea infection

Answer 12

psoriasis
discoid eczema
erythasma
candidisasis

Question 13

how do you differentiate candidiasis from tinea

Answer 13

candidiasis has satellite lesions and pustules

Question 14

what are the high risk groups for candidiasis infection

Answer 14

young
very old
immunocompromised
diabetics

Question 15

what’s the treatment for candidiasis infection

Answer 15

systemic = Polyenes (Nyastatin/Amphotericin B) 
localised = clotrimazoles or oral fluconazole

Question 16

what treatment is usually recommended for nail infections

Answer 16

topical treatment - Azole (a triazole like itraconazole) or Terbinafine
Systemic treatment - terbinafine/itraconazole

Question 17

whats the treatment lengths for terbinafine for skin, fingernail and toenail infections

Answer 17

skin 250mg 2-4 weeks
fingernail - 250mg 3 months
toenail - 250mg 3-6 months

Question 18

why are imidazoles generally avoided for systemic therapy

Answer 18

they cause inhibition of androgen synthesis leading to gynaecomastia

Question 19

what type of azole is the systemic therapy of choice

Answer 19

Triazoles

Question 20

why is griseofulvin less popular now

Answer 20

it is fungistatic not fungicidal

Question 21

who gets given griseofulvin

Answer 21

children under 12 with tinea

Question 22

what is malassezia furfur

Answer 22

a type of fungi that manifests in either Pitryiasis versicolour or seborrheic dermatitis

Question 23

what is Pitryiasis versicolour

Answer 23

finely scaled yellow/brown macules commonly on trunk - may be hyperpigmented/hypopigmented depending on skin type

Question 24

what is the treatment for Pitryiasis versicolour

Answer 24

topical antifungal 7/7 (or itraconazole if immunosuppressed)

Question 25

what is seborrhoeic dermatitis

Answer 25

mild form of dermatitis that commonly affects brow, paranasal areas and perioral areas known as cradle cap in infants

Question 26

how do you treat seborrheic dermatitis

Answer 26

topical azoles low potency steroids for rapid short term treatment (doesnt work long term) Sometimes topical immunomodulators such as tacrolimus and pimecrolimus are used off license, especially when withdrawing from long term steroids

Question 27

what causes scabies

Answer 27

sarcoptes scabiei mite

Question 28

how does scabies spread

Answer 28

human to human contact

Question 29

what is a clinical feature of scabies

Answer 29

itchy spot that becomes excoriated scratch-like burrow spot if untreated more burrows

Question 30

what sites are most common for scabies

Answer 30

``` axilae finger webs flexures breasts insteps ankles ```

Question 31

what is norweigan/crusted scabies and who gets it

Answer 31

severe form of scabies, elderly or immunocompromised

Question 32

what causes the excoriation in scabies

Answer 32

pruitis from the mite faeces

Question 33

whats the treatment for scabies

Answer 33

12 hour application for permetrin/malathion repeated after a week (lifecycle of mite - treatment doesnt kill eggs) avoid close contact and wash linens/clothes

Question 34

what is the most common complication post-treatment of scabies

Answer 34

eczema development after the mites have gone

Question 35

whats the treatment for headlice

Answer 35

fine tooth combing daily + use of suitable conditioner pediculocides (malathion, permethrin,carbaryl) regular checking