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Clin Med I > Tinea & Scabies > Flashcards

Tinea & Scabies Flashcards

1
Q

Etiology of Tinea Capitis

A

Refers to head

Caused by a variety of fungal species

Trichophyton species (T. tonsurans)
Microsporum species (M. canis)
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2
Q

Epidemiology of Tinea Capitis

A

Age: Children

Ethnicity: African Americans

Decreased personal hygiene, low socioeconomic status, overcrowding

Asymptomatic carriers

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3
Q

Clinical Presentation of Tinea Capitis

A
  • Scaly patches with alopecia (hair loss)
  • Patches of alopecia with black dots
  • Widespread scaling with subtle hair loss
  • Kerion (a boggy edematous painful plaque)
  • Favus (multiple cup-shaped yellow crusts / scutula)
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4
Q

Associated Signs of Tinea Capitis

A

Cervical adenopathy

Dermatophytid reaction (similar to eczema)

Erythema Nodosum (rare): reddish, painful, tender lumps or nodules most commonly located in the front of the legs below the knees

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5
Q

Diagnosis of Tinea Capitis

A

Physical exam

KOH prep

Wood’s Lamp

Culture

Dermascope

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6
Q

Treatment of Tinea Capitis

A

Treated with systemic antifungal therapy (oral meds)

Griseofulvin x 6-12 weeks
- Tx of choice for Microsporum or empiric tx

Terbinafine x 2-4 weeks
- Tx of choice if suspect Trichophyton

Itraconazole (4-6 weeks) and fluconazole (3-6 weeks) or pulse therapy (8-12 weeks)

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7
Q

Etiology of Tinea Corporis

A

Refers to body

Caused by different species of fungus

T. rubrum
E. floccosum
T. interdigitale
M. canis
T. tonsurans
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8
Q

Epidemiology of Tinea Corporis

A

Occurs more frequently in:

Caregivers with children with tinea capitis

Athletes with skin to skin contact (tinea corporis gladiatorum)

Immunocompromised

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9
Q

Presentation of Tinea Corporis

A

Pruritic (itchy), Annular (round), Erythematous (skin redness) plaque

Central clearing

Raised, advancing border

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10
Q

Diagnosis of Tinea Corporis

A

History and physical exam

KOH prep to confirm

Culture

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11
Q

Treatment of Tinea Corporis

A

Usually treated with topical medications

Topical antifungals:

  • Clotrimazole, ketoconazole, etc.
  • at least two weeks duration

Consider systemic tx in special circumstances (itraconazole, terbinafine, fluconazole):

  • Immunocompromised
  • Failed topical tx
  • Tinea corporis gladiatorum (no participation for 10-15 days)
  • Duration varies with drug choice (1-4 weeks)
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12
Q

Improper Treatment of Tinea Corporis

A

Tinea Incognito

Mojocchi’s Granuloma

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13
Q

Etiology of Tinea Cruris

A

Refers to the crotch/genitals

Fungal infection that begins in the inguinal fold

T. rubrum
E. floccosum
T. interdigitale
T. verrucosum

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14
Q

Epidemiology of Tinea Cruris

A

Male gender

Sweaty/humid

Occlusive clothing

Obesity/skin folds

Athlete’s foot

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15
Q

Clinical Presentation of Tinea Cruris

A

Well-marginated, scaly, annular plaque with raised border

Extends from the inguinal fold to inner thigh

Scrotum typically spared

Pruritus and pain

Can be chronic and progressive

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16
Q

Diagnosis of Tinea Cruris

A

History and physical exam

KOH prep to confirm

Culture

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17
Q

Treatment of Tinea Cruris

A

Topical antifungals (clotrimazole)

Resistant cases: oral itraconazole

Treatment accompanying or associated with tinea pedis and/or onychomycosis

Daily drying powder

Lifestyle considerations: avoid tight clothing, weight loss

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18
Q

Etiology of Tinea Pedis

A

Athlete’s foot

Typically caused by the same species as tinea cruris

T. rubrum
T. interdigitale
E. floccosum

Chronic vs. Acute

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19
Q

Epidemiology of Tinea Pedis

A

Most common dermatophytosis in the world

Risk factors:

  • occlusive footwear
  • communal baths/showers/pools
20
Q

Clinical Presentation of Tinea Pedis

A

Acute:

  • presents as a self-limited, intermittent, and recurrent infection
  • itchy/painful vesicles or bulla following sweating
  • secondary staph infections are common

Chronic:

  • presents as a slowly progressive infection that persists indefinitely
  • erosions/scales between toes (esp. 3rd and 4th)
  • interdigital fissures
  • “moccasin ringworm”: sharp demarcation with accumulated scale in the skin creases
  • may present with tinea manuum (two feet, one hand)
21
Q

Diagnosis of Tinea Pedis

A

History and physical exam

KOH prep to confirm

Culture

Gram stain if bacterial infection suspected

22
Q

Treatment of Tinea Pedis

A

Treated similarly to corporis/cruris but typically requires longer treatment

Topical antifungal cream (clotrimazole) x 4 weeks

Oral meds for chronic/extensive disease (itraconazole, terbinafine, fluconazole)

Burow’s wet dressings for vesiculation or maceration, 20 minutes BID-TID

Treat secondary infections

Lifestyle considerations: foot powder, treatment of shoes, proper footwear

23
Q

Etiology of Onychomycosis

A

Infection of the nail by fungus, yeast, or non-dermatophyte molds

T. rubrum
T. mentagrophytes

Candida Albicans (yeast)

Nondermatophyte molds

24
Q

Risk Factors for Onychomycosis

A

Advanced age

Tinea pedis

Genetics

Immunodeficiency

Household infection

25
Q

Distal Subungual Onychomycosis

A
  • Most common subtype by far
  • Typically starts with great toe, but all can be affected
  • White/brown/yellow discoloration starts at distal corner and spreads towards the cuticle
  • Distal end of the nail breaks, exposing the nail bed
26
Q

Proximal Subungual Onychomycosis

A
  • Starts near the cuticle and progresses distally
  • Relatively uncommon presentation
  • Usually seen in severely immunocompromised population (AIDS)
27
Q

White Superficial Onychomycosis

A
  • Starts with dull white spots on the surface of the nail plate
  • Spreads centrifugally until entire nail is involved
  • Lesions can be scraped for lab sample
28
Q

Fingernail Onychomycosis

A

Commonly caused by yeast (Candida Albicans)

Thickening of nail with yellow/brown discoloration

May cause chronic paronychia (An infection of the tissue folds around the nails)

29
Q

Diagnosis of Onychomycosis

A

KOH prep of nail scrapings

Culture

Histopathology (biopsy)

30
Q

Treatment of Onychomycosis

A

No obligatory, but should be considered if the patient:

  • Has a history of cellulitis
  • Diabetic
  • Desires cosmetic improvement
  • Complains of discomfort/pain

Dermatophyte onychomycosis:

  • Oral terbinafine (6 weeks for fingernails, 12 weeks for toenails)
  • Alternative options: fluconazole, intraconazole

Nondermatophyte onychomycosis:
- Oral intraconazole (6 weeks for fingernails, 12 weeks for toenails)

31
Q

Etiology of Candida Intertrigo

A

Any infectious or noninfectious inflammatory condition of two closely opposed (intertriginous) skin surfaces

Often due to Candida species

32
Q

Risk Factors of Candida Intertrigo

A

Moisture (humidity, incontinence)

Skin friction (obesity, sumo wrestling)

Immunocompromised

33
Q

Clinical Presentation of Candida Intertrigo

A

Typically affects the groin, mammary/abd folds, web spaces, and axilla

Erythematous, macerated (soggy or softened) plaques and erosions

Satellite papules/pustules

Fine peripheral scaling

34
Q

Diagnosis of Candida Intertrigo

A

History and physical exam

KOH prep

Culture

35
Q

Treatment of Candida Intertrigo

A

Preventative measures:

  • drying agents
  • weight loss
  • address underlying medical conditions

Topical medications x 2-4 weeks

  • Nystatin
  • Azoles

Systemic medications in resistant/severe cases
- Fluconazole x 2-6 weeks

36
Q

Etiology of Tinea Versicolor

A

Fungal infection of the skin

Caused by Malassezia sp.

Normal fungal skin flora that becomes pathologic when it transforms into the mycelial form

37
Q

Epidemiology of Tinea Versicolor

A

Tropical climate

Adolescents/young adults

Risk Factors:
- Hyperhidrosis, Genetics, immunosuppression, not contagious

38
Q

Clinical Presentation of Tinea Versicolor

A

Varies with skin tone/location (can be hypo/hyper pigmented, erythematous)

  • Macules (flat lesions), patches, plaques on trunk/UE
  • Can coalesce
  • Often have fine scale

Typically asymptomatic but can be mildly pruritic

39
Q

Diagnosis of Tinea Versicolor

A

History and physical exam

KOH prep

Wood’s Lamp: yellow to yellow-green fluorescence in 1/3

40
Q

Treatment of Tinea Versicolor

A

Usually treated with topical antifungal medications

Topical treatments:

  • Azole antifungals (clotrimazole) x 2 weeks
  • Selenium sulfide (lotion, shampoo, foam) x 1 weeks
  • Zinc Pyrithione shampoos x 2 weeks

Systemic:

  • reserved for extensive disease or failed topical therapy
  • Not used in children
  • Oral azole antifungals (itraconazole x 5-7 days)

pigment changes can persist for months after successful tx

recurrence common, consider prophylaxis

41
Q

Scabies Etiology

A

A parasitic infection

Caused by Sarcoptes scabiei mite:

  • host harbors 3-50 female mites
  • female mite excavates a burrow in the stratum corneum in which she lays 2-3 eggs/ days for her 30-day lifespan
  • eggs hatch in 10 days
  • can live for 3 days away from host
42
Q

Clinical Presentation of Scabies

A

Initial lesion

Burrow is pathognomonic (indicative of a particular disease or condition)

Severe pruritus, worse at night

43
Q

Scabies in the Immunocompromised

A

Crusted Scabies (Norwegian scabies)

  • Fissures provide avenue for bacteria which can lead to sepsis
  • Requires oral medications
44
Q

Diagnosis of Scabies

A

Visualization of the burrow

Microscopic identification of the mite, eggs, or fecal pellets (Scybala)

Dermatoscope

45
Q

Treatment of Scabies

A

Permethrin 5% cream - initial tx + 2nd application 10-14 days later

Oral Ivermectin - single dose repeated two weeks later

Patient education

  • treat household and close contacts simultaneously
  • Post scabetic itch can persist up to 2 weeks
  • oral anihistamines and emollients can provide symptomatic relief
  • wash linens in hot water and dry under high heat
46
Q

Pubic Lice

A

Parasites, larger than scabies

Caused by the crab louse, Phthirus pubis

Most commonly affects teens and young adults
Transmitted primarily via sexual contact

Presents with itching in groin/axilla

Diagnosed by visualizing the lice or egg (nit)
Using a microscope helps

Treatment is permethrin 1% cream, repeat/recheck in 10 days

Treat sexual partners
Have another STI about 30% of the time

Clin Med I (5 decks)

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