Superficial Fungal Skin Infection - Wright Flashcards

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1
Q

what is the causative organism (in general) for tinea or “ringworm”

A

Dermatophyte - fungi that live in soil and on animals and humans.

They are capable of digesting keratin and invading hair, skin, and nails

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2
Q

what are the 3 main genera of dermatophyte that cause tinea infections

A

Trichophyton

Microsporum

Epidermophyton

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3
Q

what is the most common dermatophyte infection in children

A

Tinea Capitis

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4
Q

what race is tinea capitis more common in

A

African American

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5
Q

What are the two most common causes of Tinea Capitis (what dermatophytes)

A

Trichophyton tonsurans

Microsporum canis

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6
Q

most M cani infections occur in what race of children

A

Caucasian

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7
Q

most T tonsurans infections occur in what race of children

A

African Americans

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8
Q

what is the most common transmission route for tinea capitis

A

human to human

asymptomatic carriage in humas appears to be a major reservoir for infection

also fomites

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9
Q

what are the clinical features of tinea capitis

A

scaling and patchy alopecia

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10
Q

in Tinea Capitis, is the scaling diffuse or localized?

A

Scaling can be diffuse (“seb-derm” like) or localized

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11
Q

“black dot” pattern of tinea capitis - due to broken hair shafts - which dermatophyte causes this most often?

A

T tonsurans it grows inside of hair shafts, weakens them, causes them to break off at scalp

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12
Q

if you see pustules (sign of inflammation) in the setting of Tinea Capitis, what should you have a high index of suspicion for?

A

primary fungal infection

need to obtain fungal culture

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13
Q

What is this? what is a potential consequence?

A

Kerion this kind of inflammation may result in permanent scarring alopecia especially if it goes on long time without proper treatment

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14
Q

for tinea capitis, LAD is often seen where?

A

posterior cervical, sub-occipital

correlates well with + fungal culture in setting of scaling and alopecia

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15
Q

what is the gold standard for confirming the Dx of tinea capitis?

A

fungal culture

Know this $$

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16
Q

What is the utility of KOH use for viral culture - in suspected tinea capitis or some shit?

A

KOH application to the biopsied scale and/or broken hairs - helps to break down the skin cells, allows you to see fungal elements

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17
Q

how to you diff seborrheic dermatitis from tinea capitis?

A

seb derm is a more chronic problem

true seb derm is unusual after infancy and before puberty

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18
Q

how does seb derm present in infancy (to help diff from tinea capitis)

A

waxy yellow scale - known as cradle cap

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19
Q

How does seb derm present in teens - to help diff from tinea capitis

A

“dandruff”

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20
Q

how do you diff psoriasis of the scalp from tinea capitis

A

erythematous plaques with silvery scale favors postauricular and posterior hairline

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21
Q

define alopecia areata. How do you diff it from tinea capitis

A

well-circumscribed smooth bald patches

generally, will not see any scales or skin changes - non-inflamed looking, no LAD

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22
Q

key point - what is the treatment of tinea capitis? (generally)

what specific drug is gold standard

what treatment type will not work

A

requires systemic antifungal to penetrate hair follicle

Griseofulvin is gold standard

topical antifungals will not work

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23
Q

what is unique about M canis regarding its treatment? compared to Tricophyton Toransusnusnus

A

M canis may require higher doses and longer course for clearance

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24
Q

what is the utility of an antifungal shampoo, like ketoconazole, in treatment of Tinea Capitis

A

may help to decrease risk of transmission

consider use by all household members shampoo

by itself will not treat the damn fungus

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25
Q

Terbinafine can also be used to treat tinea capitis; what are the common side effects and what should you do about them? know this $$

A

HA, GI upset, dizziness, drug reactions,

hepatotoxicity, rare hematologic

baseline ALT/AST is advised

CBC monitoring advised for immunodeficient pts

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26
Q

What is the downside of use of Terbinafine - what is it less useful for

A

less effective for M canis infection

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27
Q

if pt has a kerion, what treatment modality should you consider adding to your regimen

A

systemic steroids

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28
Q

define tinea corporis

A

superficial fungal infection of skin

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29
Q

what is the MCC of tinea corporis in young children?

A

M canis

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30
Q

what is the classic clinical manifestation of Tinea Corporis?

A

one or more well-defined annular scaly erythematous plaques with central clearing and a scaly, vesicular, papular, or pustular border

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31
Q

what is Majocchi’s Granuloma?

A

granulomatous folliculitis - erythematous plaques or patches studded with papules and/or nodules deeper infection of follicles foregin body reaction

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32
Q

what is the treatment of Majochi’s Granuloma?

A

cannot treat with topical antifungal

use systemic meds

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33
Q

how do you diff Nummular Atopic Dermatitis from Tinea Corporis?

A

NAD is not annular (everything round is not annular)

NAD is very very pruritic

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34
Q

how do you diff psoriasis from tinea corporis?

A

Psoriasis has “dull pink” erythema - silvery or white micacceous scale - nummular lesions - sheet like scales

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35
Q

how do you diff granuloma annulare from tinea corporis

A

granuloma annulare NO SCALES

raised, “rubbery” rim

location: dorsal hands, wrists, feet, ankles

36
Q

what is the treatment for localized tinea corporis?

A

topical (i’m assuming antifungals)

37
Q

start with topical tx for tinea corporis, if no improvement, what next?

A

reconsider dx or culture

culture +, proceed to oral therapy

38
Q

what treatment does she prefer for tinea corporis

A

ketoconazole cream

39
Q

This is impt

What is the final word on the use of combination products for treatment of tinea corporis? or anything?

A

do not use them

Antifungal + strong topical steroid

they often result in persistent/worsening infection (due to steroids immunosuppression)

40
Q

define Tinea Manuum

who is it more common in?

A

skin of hands

most common in men (t. MANuum)

rare in children

41
Q

what are the clinical manifestations of Tinea Manuum? What are the two general patterns?

A

chronic dryness of palms with redness and scaling two patterns

palmar - fine scale, may be unilateral

dorsal - annular, red, scaly

42
Q

what is on your DDx if you suspect tinea manuum

A

irritant or contact dermatitis, or psoriasis

43
Q

what is the treatment for tinea manuum - specifically for each of the two types

A

dorsal - topical antifungal, it is typically limited

palmar - requires oral antifungal

44
Q

Tinea Cruris

A

Jock itch

men more than women

rare in children

45
Q

what are the risk factors for Tinea Cruris

A

Jock itch

obesity, heat, humidity

46
Q

what are the clinical manifestations of Tinea Cruris? are your johnson and jingle bells typically involved?

A

Pruritic (very, very, very)

red, annular, scaly plaques over groin and medial thighs

Penis, Scrotum not affected (this is helpful for dx)

47
Q

how do you diagnose Tinea Cruris?

A

KOH and fungal culture

This is standard of dx for all these fucking Tinea

48
Q

what 4 other conditions are on your DDx if you suspect Tinea Cruris?

A

Candidiasis, Erythrasma, Psoriasis, Seb Derm

49
Q

how do you diff Candidiasis from Tinea Cruris?

A

candidiasis has satellite pustules - this is impt

50
Q

How do you diff erythrasma from Tinea Cruris

A

Erythrasma has NO SCALES

it also appears with coral red fluorsecence if you light it up with a Wood’s lamp

51
Q

Tx for Tinea Cruris? specific delivery form? what about if the jock itch is refractory?

A

topical AF, powders are helpful,

oral AF if refractory

52
Q

Tinea pedis

A

“athlete’s foot”

10% world’s population

males

risk factors - occlusive shoes, communal showers (Group hug in the shower later!!)

53
Q

what are the clinical manifestations of tinea pedis?

A

itching, scaling, blistering on soles, between toes

54
Q

what is moccasin in the setting of tinea pedis

A

fine, dry scale over soles

55
Q

what is vesiculobullous in the setting of tinea pedis

A

vesicular/bullae on soles, esp. insteps

56
Q

What two conditions are on your DDx if you suspect Tinea Pedis?

A

Contact dermatitis, Dyshidrotic eczema

57
Q

how do you diff contact dermatitis from tinea pedis

A

contact dermatitis - dorsal feet affected

58
Q

how do you diff Dyshidrotic eczema from tinea pedis? what is the keyword presentation of D eczema?

A

“tapioca vesicles”

this will be more pruritic

culture will be key to DDx here

59
Q

what is Tinea Unguium? what is another name for it?

A

nail infucktion Onychomycosis

60
Q

epidemiology of Tinea Unguium (Onychomycosis)

A

60% over age 70, males

61
Q

what are the general causes of Tinea Unguium (Onychomycosis)

A

non-dermatophyte molds, yeasts

62
Q

what are risk factors for Tinea Unguium (Onychomycosis)

A

IS’d, diabetes, HIV, poor circulation, trauma, dystrophy

63
Q

what are the clinical manifestations of Tinea Unguium?

A

discoloration, thickening, onycholysis

64
Q

What are the 4 patterns of Tinea Unguium (Onychomycosis)

A

Distal subungual

Proximal subungual

White superficial

Candida

65
Q

which of the 4 patterns of Tinea unguium is most common? and describe it

A

Distal subungual

invasion of distal nail plate, onycholysis with thickening and discoloration

spreads proximally back towards nail matrix

66
Q

which of the 4 patterns of Tinea Unguium is pathognomonic with HIV (only seen in HIV)

A

proximal subungual

spreads distally

67
Q

which of the 4 patterns of Tinea Unguium is this?

A

white superficial

68
Q

which of the 4 patterns of Tinea Unguium is this?

A

Candida - classic presentation

69
Q

What is Chronic Paronychia? what is most commonly seen with?

A

nail dystrophy

commonly seen with candida albicans

70
Q

What is Trachyonichia? (DDx from tinea unguium)

A

20 nail dystrophy

may not affect all nails at first, but progress to it

“rough nails” - ridging, grooves, pitting, discoloration, fragility

71
Q

what is trachonychia commonly associated with? (DDx from tinea unguium)

A

psoriasis

72
Q

What are Beau’s lines?

A

Transverse grooves of furrows

stress causes temporary arrest of nail matrix

nail may shed completely (Onychomadesis)

will grow back normally

I guess this is on your differential of tinea unguium

73
Q

Suspect tinea unguium, what is a classic finding that will push you towards physical trauma as cause of nail dystrophy?

A

bilateral, symmetrical involvement of the longest toes, or the 5th toes whatever is jamming into shoes

74
Q

Dx of Tinea Unguium - in addition to KOH prep and fungal culture of nail clipping, what else do you need to do?

A

PAS stain of nail clipping

75
Q

are topicals effective in Tinea unguium?

A

no - they do not penetrate nail plate well and do not reach nail matrix

76
Q

what is the common, effective treatment for tinea unguium

A

Terbinafine - again, need to do CBCs and LFTs (Sweatman - just CBCs)

77
Q

tinea unguium treatment - how long must you treat for fingernails? toenails? why?

A

fingernails - 4-6 months

toenails - 12-18 months

time it takes for the nail to grow out, turn over

78
Q

what is Tinea versicolor?

A

ptyriasis versicolor

common superficial fungal disorder of skin, commonly caused by yeast forms of dimorphic fungi - Malassezia furfur - part of normal skin flora

79
Q

what is the clinical presentation of tinea versicolor

A

multiple scaling, oval macules, patches, and thin plaques over upper trunk, proximal arms, sometimes face and neck

80
Q

what causes the hyper or hypopigmentation seen in Tinea Versicolor

A

Azelaic acid production

81
Q

when is tinea versicolor more prominent?

A

during the summer - sun exposure intensifies pigmentation differences

82
Q

How do you make the dx of T versicolor? what do you look for on KOH prep?

A

“spaghetti and meatballs” (hyphae and spores)

83
Q

what are the two treatment options for T versicolor?

A

Selenium sulfide lotion/ shampoo or ketocoazole topical

84
Q

T versicolor - severe, recurrent, fails topical therapy - what do you use? and what is a weird recommendation associated with this?

A

systemic ketoconazole work up a sweat - causes yeast to come out of skin and ketoconazole can affect it or something

85
Q

you see Angular Chelitis with paronychia in the presentation, what fungal infection do you suspect

A

Candidiasis

angular chelitis - oral commissures - painful, erythematous, small pustules

86
Q

what is the tx for candidiasis?

A

topical anti-yeast cream and decrease moisture

87
Q

What can happen if corticosteroids are used (improperly) for tx of Tinea Corporis? what is this called?

A

may blunt the appearance

Tinea Incognito