Superficial Fungal Skin Infection - Wright Flashcards
what is the causative organism (in general) for tinea or “ringworm”
Dermatophyte - fungi that live in soil and on animals and humans.
They are capable of digesting keratin and invading hair, skin, and nails
what are the 3 main genera of dermatophyte that cause tinea infections
Trichophyton
Microsporum
Epidermophyton
what is the most common dermatophyte infection in children
Tinea Capitis
what race is tinea capitis more common in
African American
What are the two most common causes of Tinea Capitis (what dermatophytes)
Trichophyton tonsurans
Microsporum canis
most M cani infections occur in what race of children
Caucasian
most T tonsurans infections occur in what race of children
African Americans
what is the most common transmission route for tinea capitis
human to human
asymptomatic carriage in humas appears to be a major reservoir for infection
also fomites
what are the clinical features of tinea capitis
scaling and patchy alopecia
in Tinea Capitis, is the scaling diffuse or localized?
Scaling can be diffuse (“seb-derm” like) or localized
“black dot” pattern of tinea capitis - due to broken hair shafts - which dermatophyte causes this most often?
T tonsurans it grows inside of hair shafts, weakens them, causes them to break off at scalp
if you see pustules (sign of inflammation) in the setting of Tinea Capitis, what should you have a high index of suspicion for?
primary fungal infection
need to obtain fungal culture
What is this? what is a potential consequence?
Kerion this kind of inflammation may result in permanent scarring alopecia especially if it goes on long time without proper treatment
for tinea capitis, LAD is often seen where?
posterior cervical, sub-occipital
correlates well with + fungal culture in setting of scaling and alopecia
what is the gold standard for confirming the Dx of tinea capitis?
fungal culture
Know this $$
What is the utility of KOH use for viral culture - in suspected tinea capitis or some shit?
KOH application to the biopsied scale and/or broken hairs - helps to break down the skin cells, allows you to see fungal elements
how to you diff seborrheic dermatitis from tinea capitis?
seb derm is a more chronic problem
true seb derm is unusual after infancy and before puberty
how does seb derm present in infancy (to help diff from tinea capitis)
waxy yellow scale - known as cradle cap
How does seb derm present in teens - to help diff from tinea capitis
“dandruff”
how do you diff psoriasis of the scalp from tinea capitis
erythematous plaques with silvery scale favors postauricular and posterior hairline
define alopecia areata. How do you diff it from tinea capitis
well-circumscribed smooth bald patches
generally, will not see any scales or skin changes - non-inflamed looking, no LAD
key point - what is the treatment of tinea capitis? (generally)
what specific drug is gold standard
what treatment type will not work
requires systemic antifungal to penetrate hair follicle
Griseofulvin is gold standard
topical antifungals will not work
what is unique about M canis regarding its treatment? compared to Tricophyton Toransusnusnus
M canis may require higher doses and longer course for clearance
what is the utility of an antifungal shampoo, like ketoconazole, in treatment of Tinea Capitis
may help to decrease risk of transmission
consider use by all household members shampoo
by itself will not treat the damn fungus
Terbinafine can also be used to treat tinea capitis; what are the common side effects and what should you do about them? know this $$
HA, GI upset, dizziness, drug reactions,
hepatotoxicity, rare hematologic
baseline ALT/AST is advised
CBC monitoring advised for immunodeficient pts
What is the downside of use of Terbinafine - what is it less useful for
less effective for M canis infection
if pt has a kerion, what treatment modality should you consider adding to your regimen
systemic steroids
define tinea corporis
superficial fungal infection of skin
what is the MCC of tinea corporis in young children?
M canis
what is the classic clinical manifestation of Tinea Corporis?
one or more well-defined annular scaly erythematous plaques with central clearing and a scaly, vesicular, papular, or pustular border
what is Majocchi’s Granuloma?
granulomatous folliculitis - erythematous plaques or patches studded with papules and/or nodules deeper infection of follicles foregin body reaction
what is the treatment of Majochi’s Granuloma?
cannot treat with topical antifungal
use systemic meds
how do you diff Nummular Atopic Dermatitis from Tinea Corporis?
NAD is not annular (everything round is not annular)
NAD is very very pruritic
how do you diff psoriasis from tinea corporis?
Psoriasis has “dull pink” erythema - silvery or white micacceous scale - nummular lesions - sheet like scales