Papulosquamous disease: Tinea, pityriasis versicolor, drug eruptions Flashcards
What is tinea? Transmission?
Aka ringworm.
A superficial fungal infection of the skin caused by dermatophytes (a group of fungi that invade and grow in dead keratin).
Spread from person to person (anthropophilic), animal to person (zoophilic), or soil to person (geophilic)
Types of tinea?
Ringworm can affect any part of the body.
Tinea capitis = ringworm affecting scalp
Tinea pedis = feet
Tinea cruris = groin
Tinea corporis = body
Tinea manuum = hand
Tinea faciei = face
Tinea urguium/ onychomycosis = fungal nail infection
Presentation of tinea? Diagnosis/IVx?
Itchy rash
Red
scaly
well demarcated
Ring shape (annular) -can get bigger overtime.
Clinical diagnosis
Management of tinea?
Antifungal meds
Clotrimazole cream
Ketoconazole shampoo
Systemic agents such as terbinafine or itraconazole
What is pityriasis versicolor? Diagnosis/IVx? How long does it last? Cause?
Fungal infection -Pityrosporum orbiculare (yeast found on human skin)
Can last months to years
Common in early 20s
Clinical diagnosis
Can be confirmed by woodlamp, microscopy, fungal culture.
Presentation of pityriasis versicolor?
asymptomatic
copper/brown patches
pale patches on darker skin (versicolor alba)
itchy
dandruff
may start scaly and brown, then resolves through a non-scaly and white stage.
found on trunk, neck, arms.
RFs for pityriasis versicolor?
HOT/ HUMID weather
High levels of cortisol
- Cushing’s syndrome
- prolonged use of corticosteroid
Management of tinea versicolar?
Selenium sulfide 2.5% lotion or shampoo -leave on for 15-30mins then have a shower
- 7-10days daily
- can be diluted if irritating skin.
Topical miconazole cream for 2wks.
Management for tinea corporis?
Topical azoles
e.g. ketoconazole, clotrimazole, miconazole
Apply BD until clear, then +48hrs
Presentation of tinea cruris? RFs?
Itchy
Superficial fungal infection of the groin and adjacent skin.
Spares the genitals.
Large scaling
Well demarcated
red
tan
brown plaques
Wearing tight clothes
Travel to tropical climates
DM
obesity
athletes
males are affected more than female.
Management for tinea cruris?
Topical azoles
e.g. ketoconazole, clotrimazole, miconazole
Apply BD for 2-4wks.
Presentation of tinea capitus? Cause? Affects who the most?
superficial fungal infection of scalp.
Affects children 4-14years -common.
circumscribed lesions with areas of alopecia.
boggy
erythematous lesions with fine scales.
+/- occipital lymphadenopathy
Caused by trichophyton (92%) and microsporum (8%).
Management for tinea capitus?
Children:
- Griseofulvin 20-25mg/kg/d for 6-8wks
Adults:
- Terbinafine 250mg OD for 2-4wks
Monitor for hepatoxicity
Presentation and cause of tinea pedis?
Cause:
- walking barefoot, particularly in locker rooms or moist places
- secondary bacterial infection
Lesions may be:
- red
- scaling
- macerated
- fissured
- itchy
Treatment for tinea pedis?
Topical azoles
e.g. ketoconazole, clotrimazole, miconazole
Apply BD for 2-4wks.
Types of drug eruptions (reactions)?
Morbilliform
Urticarial
Fixed
Hyperpigmentation
Chemo-induced acral erythema
What is morbilliform drug eruption? Tx?
Drug induced exanthem.
A delayed type IV immune reactions.
Occurs 7-10days post-medication.
Widespread rash
maculopapular rash, often becoming confluent.
Itchy, spares the face.
Tx:
- antihistamines
- cooling lotion
What is urticarial drug eruption? Tx?
IgE reaction
Occurs minutes to hours post medication
Tx:
- Antihistamine
- cooling lotion +/- epinephrine
What is fixed drug eruption?
Round, erythematous plaques
May itch, burn, painful
Occurs minutes to hours post medication
Can affect any part of the body, commonly the glans penis.
What is hyperpigmentation drug eruption?
Fades with time
What is chemo-induced acral erythema drug eruption?
Tingling of palms, soles
Then swelling, erythema after several days.
