Skin Infections: Tinea and Candida

Question 1

FUNGAL infections are broadly divided into those that are limited to the ___, ___ and ___ and are considered superficial and those that involve the ___ and ___ tissues and are called “deep fungal infections”.

Answer 1

These infections are broadly divided into those that are limited to the stratum corneum, hair and nails and are considered superficial and those that involve the dermis and subcutaneous tissues and are called “deep fungal infections”.

Question 2

2 most common presentations of candida infections

Answer 2

• Tinea Versicolor
• Thrush
• Candida intertrigo

Question 3

morphology of tinea

Answer 3

primary: macule, often with central celaring
secondary: branny scale

Question 4

organism most commonly responsible for tinea versicolor

Answer 4

malassezie furfur

Question 5

tinea skin infeciton is secondary to a ___.

Answer 5

yeast

Question 6

morphology of thrush

Answer 6

primary: erosion
secondary: macerated white scale.

Oral thrush is a yeast infection caused by Candida sp., which is common in neonates. In older children and adults, this infection is otherwise pathologic and suggests immunosuppression.

Question 7

treatment for candida intertrigo

Answer 7

Treatment includes trying to keep affected skin dry and the use of topical anti-yeast treatments such as clotrimazole, nystatin, ketoconazole or terbinafine cream. Often it is combined with weak topical steroid therapy to treat the resultant dermatitis.

Question 8

morphology and clinical features of candida intertrigo

Answer 8

• Morphology: Patch, pustules, papules
• Secondary Morphology- erosions, scale
• Clinical Features: Candida intertrigo is seen in areas where moisture is trapped in skin
folds. SATELLITE LESIONSare often seen at the periphery of these scaling patches, which are small inflammatory papules, pustules or erosions.

Question 9

diaper version of candida intertrigo

Answer 9

DIAPER DERMATITIS

• Morphology- patch, pustules
• Secondary Morphology- erosions
Diaper rash, a form of intertrigo, is often is superinfected with candida. Here you can see the satellite lesions consistent with Candida sp.

Question 10

____ are fungal infections caused by three genera of fungi that have the unique ability to invade and multiply within keratinized tissue such as hair, skin and nails. These fungi, collectively called “dermatophytes”. The three genera responsible for most human disease is ____ ,____ AND ____, which are repsonsible for

• Tinea Corporis
• Tinea Pedia
• Tinea Cruris
• Tinea Unguis

Answer 10

Dermatophytoses are fungal infections caused by three genera of fungi that have the unique ability to invade and multiply within keratinized tissue such as hair, skin and nails. These fungi, collectively called “dermatophytes”. The three genera responsible for most human disease is Microsporum, Trichophyton and Epidermophyton

• Tinea Corporis
• Tinea Pedia
• Tinea Cruris
• Tinea Unguis

Question 11

morphologies for all forms of tinea except in nails are

Answer 11

• Morphology: Annular plaque, patch, vesicle
• Secondary morphology- scale, fissure

Question 12

term for ring worm, and its clinical features

Answer 12

TINEA CORPORIS
• Clinical Features: Here we see a dermatophyte infection of the skin showing the
classic annular or ring configuration which gives this infection it’s common name of ringworm.

Question 14

what to do when there is a scaling dermatoses

Answer 14

As superficial dermatophyte infections can mimic other inflammatory dermatoses such as eczema, especially as they are generally very pruritic, a good practice is to do a fungal scraping on all scaling dermatoses which look atypical or do not respond to therapy as expected.

Question 15

another term for athletes foot

Answer 15

tinea pedis.

Tinea pedis is the most common dermatophyte infection. Clinically the inflammatory response to the dermatophyte differs based upon individual host response. Commonest location is on the foot in the 4th web space.
A mild host response may simply show maceration in toe web spaces.

Question 16

what gives rise to a moccasin pattern

Answer 16

thickened stratum corneum is called a keratoderma and is another clinical pattern seen in superficial fungal skin infections. This pattern is also called a moccasin pattern because of the resemblance to a second skin over the sole of the foot.

Question 17

another term for jock itch. where does it originate?

Answer 17

Tinea cruris, also known colloquially as jock itch, is usually spread to the groin from tinea pedis.

Question 18

overall, how can you treat cutaneous superficial dermatomycosis?

Answer 18

Cutaneous superficial dermatomycosis can be effectively treated topically with terbinafine, ketoconazole or azole antifungal agents. Nystatin does not usually work as it is only effective against yeast organisms.

Question 19

morphology and clinical features of tinea unguis

Answer 19

Morphology: Nail Dystrophy
Clinical Features: Fungal nail disease is known as onychomycosis.

The dystrophy of the nail may be secondary to previous nail trauma, or may mimic psoriasis of the nail and is commoner as we age, and nail growth slows.

Treatment is difficult and usually requires prolonged oral therapy. Systemic terbinafine, itraconazole and fluconazole have been successful in treating superficial dermatophyte infections of the nails, but hepatotoxicity is an uncommon but significant health issue.

Question 20

Answer 20

tinea m. furfor.

treatment with a sulphate wash and anti-fungal

Question 21

Answer 21

oral thrush

Question 22

Answer 22

candida intertriga

• when moisture is tapped in skin folds
• needs nystatin and keep it dry
• weak corticosteroids

Question 23

Answer 23

diaper rash

Question 24

Answer 24

tinea corporis

Question 25

Answer 25

tinea corporis aka ring worm. can mimic eczema. do a fungal scaling for all scaling dermatoses

Question 26

Answer 26

blistering erythema due to tinea infection

Question 27

Answer 27

keratoderma

due to fungal infection on foot

Question 28

Answer 28

jock itch via tinea pedis. treat with -azoles (besides nystatin since candida wont help here)

Question 29

Answer 29

onychomycosis treat with fluconazole and watch for hepatotoxicity