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Rheum/Musculoskeletal/Derm Week 3 > Superficial Fungal Infections > Flashcards

Superficial Fungal Infections Flashcards

1
Q

What is Tinea capitis?

A

ringworm of the scalp that is very common in 3-7 yos

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2
Q

What are the main causes of Tinea Capitis?

A
  • 90% by Trichophyton tonsurans
  • Microsporum canis
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3
Q

How is tinear capitis contracted?

A

Via humans, animals, fomites (shared brushes, combs, hats) or sometimes oil that results typically in a asymptomatic carrigae phase initially

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4
Q

What are the primary risk factors for tinea capitis?

A
  • large family size
  • crowded living conditions
  • low socioeconomic status
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5
Q

Tinea capitis presentations (seb derm more like in AA kids)

A

This occurs because the bugs can get into the hair shafts and cause them to break off

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6
Q

Tinea capitis presentations (you cannot diagnose this with a woodflam lamp anymore!)

A
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7
Q

Keroid is caused by marked inflammation that can cause permanent scarring and hair loss in these situations. For these you can consider sysemic steroids for decreased pain and inflammation

A
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8
Q

T or F. LAD is common with tinea capitis

A

T. Especially in the posterior cervical and sub-occipital regions (correlates well with + fungal cultures in setting of scaling and alopecia)

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9
Q

How can tinea capitis be confirmed?

A

gold standard is FUNGAL CULTURE (very important to confirm)

-use a moistened cotton tip to rub vigorously over the affected area and then use a standard bacterial culture

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10
Q

What is this?

A

Seborrheic Dermatits (in the DDx with tinea captitis)- this is usually more chronic and unusual after infancy and before puberty (infants with cradle cap (waxy yellow scale) or teen or adults with dandruff)

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11
Q

What dis stuff?

A

Psoriasis (on the DDx for tinea)- usually will see more erythema plaques with silvery scales and favors postauricular and posterior hairline

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12
Q

What is this?

A

Alopecia areata- on the DDx for tinea capitis except no broken hairs, LAD, erythema

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13
Q

How is tinea capitis treated?

A

Requires SYSTEMIC antifungal to penetrate hair follicle and griseofulvin is the gold standard (microsize or ultramicrosize)

Microsize used most often: 20mg/kg/d for at least 8 weeks

NOTE: M. canis infections may require higher doses and longer course for clearance

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14
Q

Advice on Tx for tinea capitis

A

Give with fatty food for absorption and may divide bid if large volume needed for bigger kids

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15
Q

AEs of Griseofulvin?

A

mostly well-tolerated but may see HA, GI pain, photosensitivity or drug rxns

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16
Q

Adjuvant Tx for tinea?

A

Add an antifungal shampoo 2-3 times a week (Ketoconazole 2% or selenium sulfide) to aid in removal or scales and eradicate spores (consider all members of house use)

Fomite education (dont share combs, etc.)

-Terbinafine can be used if 4+ yo

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17
Q

T or F. M. canis does not respond well to Terbinafine

A

T. Need to know what you’re treating

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18
Q

AEs of Terbinafine?

A

hepatotoxicity and rare heme effects (get a baseline ALT/AST and CBC monitoring if immunodeficient)

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19
Q

What is tinea corporis?

A

Superficial fungal infection of skin due to contact with infected person or animal

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20
Q

What are the main causes of tinea corporis in young children?

A

M. canis > M. audouinii, T > mentagrophytes

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21
Q

What are the main causes of tinea corporis in older childrena/adults?

A

T. rubrum, T. verrucosum, T. menatgrophytes (young child with T. rubrum likely has a parent with tinea pedis and/or onychomycosis)

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22
Q
A
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23
Q

What is a Majocchi’s granuloma?

A

Chronic tinea corporis infection may cause penetration into the hair follicles resulting in erythematous plaques or patches with nodules

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24
Q

What is this?

A

Nummular (solid redness; annular- red border) Atopic Dermatitis- this is on the DDx for tinea corporis but nummular and very pruritic

needs steroids to treat

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25
Q

What dis?

A

Psoriasis- on the DDx for tinea corporis BUT more of a dull pink colour, nummular and distribution is different

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26
Q

What is this?

A

Granuloma annulare- very similar to tinea corporis- never scaly, with a raised ‘rubbery’ rim and tend to show up on the dorsal ahnds, wrists, feet, and ankles

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27
Q

How is tinea corporis used?

A

Topical for superificial/localzied for at least 2-4 weeks and treat affected area and and extra rim of normal skin. If no improvement, and culture positive, proceed to oral therapy. Consider systemic therpay for disseminated/Majocchi’s and tinea faciei

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29
Q

What is Tinea Manuum?

A

tinea of the hands that is most common in men (rare in children)

30
Q

What are the major causes of Tinea Manuum?

A

T. rubrum, T. mentagrophytes, and E. floccosum

31
Q

Diagnosis?

A

KOH (branched septated hyphae) and follow up with a fungal culture

33
Q

What is tinea cruris?

A

“jock itch” common in men and rare in children with risk factors including obesity, heat, and humidity and having the same causal organisms as Tinea Manuum

34
Q

Actual penis and scrotum are not usually affected. Same diagnosis

36
Q

Risk factors for tinea pedis?

A

occlusive shoes and communal pools/showers

37
Q

What is ‘moccasin’ pattern Tinea pedis caused by?

A

T. rubrum (fine dry scale over soles)

38
Q

What is ‘vesiculobullous’ pattern Tinea pedis caused by?

A

Vesicles/bullous on soles (esp. insteps) due to T. mentographytes commonly

39
Q

What is this?

A

•Contact Dermatitis (on the DDx for tinea pedis)

–Dorsal feet more commonly affected

40
Q

What is this?

A

Dyshidrotic eczema (on the DDx for tinea pedis)- more likely on the soles or between toes characterized by “tapioca vesicles” that are VERY itchy

41
Q

Describe Tinea Unguium

(Onychomycosis)

A

Nail infection common in ELDERLY males

42
Q

What are the most common causes of TInea Unguium?

A

T. rubrum, T. mentagrophytes, E. Floccosum but can be caused by Non-dermatophyte molds and yeasts

43
Q

What are the risk factors for contracting tinea unguium?

A

Immunosuppression, diabetes, HIV, poor circulation, trauma, dystrophy

44
Q

What are the patterns of Tinea Unguium?

A

–Distal subungual

–Proximal subungual

–White superficial

–Candida

45
Q

What is this?

A

–Distal subungual pattern = most common

•Invasion of distal nail plate, onycholysis with thickening and discoloration

46
Q

What pattern of tinea unguium is this?

A

Proximal subungal

–Uncommon and pathognomonic for HIV positive patient

47
Q

What pattern of tinea unguium is this?

A

•White superficial

–White plaques on dorsal nail plate

48
Q

What is this?

A

Candida- notice how red the nail is around the nailbed

49
Q

What is this?

A

Chronic Paronychia

•Nail dystrophy caused by Candida albicans

–Confirm with stain and culture

50
Q

How is Chronic Paronychia treated?

A
  • Topical ketoconazole if mild
  • Oral fluconazole if severe (»3 mos for fingernails)–Baseline CBC, LFT’s
51
Q

What is this?

A

Trchyonychia (aka 20 nail dystrophy)

•Ridging, grooves, pitting, discoloration, fragility

52
Q

What are the causes of trachyonychia?

A

Can be Idiopathic, lichen planus, psoriasis, etc.

53
Q

What is this? When is it common?

A

Beau’s Lines- Transverse grooves or furrows that results when stress causes temporary arrest of nail matrix (very common after Hand, Foot, and Mouth disease)

•Nail may shed completely (onychomadesis)

55
Q

What is this?

A

Habit Tic Deformity- Habitual picking at the cuticle

57
Q

How are nail infections treated?

A

Topical agents are not very effective because they dont penetrate the nail plate well or reach the nail matrix so Penlac (8% Ciclopirox lacquer) may work if superifical infection not involving lunula (has to be given for months) and urea helps soften the nail plate

58
Q

Tx for nail infections?

A

Systemic therapy typically needed and terbinafine is the DOC (Griseofulvin not that effective and has a high recurrence rate) usually 6 weeks for fingernails and 12 weeks for toenails

59
Q

Is any monitoring needed during nail infection therapy?

A

Yes, get a baseline CBC and LFT and repeat in 2-4 weeks typically (not 100% necessary)

60
Q

How long does it take fingernails to grow out? Toenail?

A

Fingernail- 4 to 6 months

Toenail- 12-18 months

61
Q

What is Tinea versicolor?

A

aka pityriasis veriscolor (a common superficial fungal disorder of skin), caused by the dimorphic fungus Malssezia furfur (aka Pitrosporum), a normal skin flora.

Usually presents in adolescence and likely oily spots of skin

62
Q

How does this present?

A

Multiple scaling, oval macules, patches and thin plaques over upper trunk, proximal arms, and sometimes face and neck regions. It can be hyper- or hypopigmented due to azelaic acid production.

63
Q

When is Tinea versicolor common?

64
Q

What is Pityriasis alba?

A

On the DDx for tinea versicolor that is most common on the face but the discoloration is patchy and usually due to dry skin

65
Q

What is this?

A

KOH prep is usually sufficient (spaghetti and meatball appearance)

66
Q

How is tinear versicolor treated?

A

Education is a big part because the course of this tends to be chronic and recurrences are common.

Drugs; Topical selenium sulfide lotion/shampoo effective

67
Q

How can recurrent or severe tinea versicolor be treated?

A

Can go to systemic therapy- ketoconazole (work up a sweat, wait 10-12 hr to shower) or fluconazole (doesnt require a sweat) once a week

and still use topical for maintenance

68
Q

Places for candidisis? Types?

A
  • Intertriginous
  • Paronychia
  • Angular Cheilitis at oral commissures due to increased moisture (e.g. elderly, lip lickers, dentures) (below)
69
Q

How can candidiasis be treated?

A
  • Topical anti-yeast cream
  • Decrease moisture

Rheum/Musculoskeletal/Derm Week 3 (27 decks)

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