Superficial Fungal

Infections
Oleh : Dini Permata Sari, S.Farm, M.Si., Apt
 Introduction….
Superficial fungal infections are benign infections of the skin, scalp
and nails caused by Candida albicans or dermatophytes.
 Candidiasis

• Candidal diaper dermatitis

• Erythema of the perianal area with peripheral desquamation and sometimes
pustules. Secondary infection may develop.
– Buttocks must be kept clean (ordinary soap and water) and dry.
– Avoid humidity: according to the context, expose the buttocks to air or change
diapers more frequently; remove plastic pants.
– Protect the skin with zinc oxide ointment if diarrhoea is present.
– If diaper dermatitis is severe and persistent despite these measures, consider an
intestinal infection (nystatin PO: 100 000 IU 4 times daily for 20 days).
 Other candidiasis

– Candidiasis of skin folds: miconazole 2% cream, one application 2 times

daily for 2 to 4 weeks

– Oral candidiasis: Stomatitis

– Vulvovaginal candidiasis: Abnormal Vaginal Discharge

 Dermatophytoses

Dermatophytes cause various clinical lesions, depending on the

anatomic site involved: scalp, glabrous (hairless) skin, folds or nails.
Anatomic site Clinical features
Scalp Common in children.
Scalp ringworm Depending on the species:
Tinea capitis • One or more round, scaly,
erythematous plaques with the
ends of broken hairs.
• Inflammation,
suppuration, crusting and perip
heral
lymphadenopathy (kerion).
• Permanent hair loss (favus).
Some scalp ringworms are
contagious:
simultaneously examine (and
treat) symptomatic contacts.
Treatment
• Shave or cut hair short on and around the lesions.
• Local treatment: 2 times
daily, clean with soap and water, dry and applymiconazole 2% cream
or Whitfield’s ointment for 2 weeks or longer if necessary.
• Administer systemic treatment as local treatment alone does not cure
scalp ringworm:
griseofulvin PO for 6 weeks minimum (up to 8 to 12 weeks)
Children 1 to 12 years: 10 to 20 mg/kg once daily (max. 500 mg daily)
Children ≥ 12 years and adults: 500 mg to 1 g once daily, depending on
severity
or itraconazole PO
Children: 3 to 5 mg/kg once daily for 4 to 6 weeks (max. 200 mg daily)
Adults: 200 mg once daily for 2 to 4 weeks
• Suppurative lesions: treat superinfection before applying local antifungal
treatment.
• For painful kerion: paracetamol PO.
In pregnant lactating/breastfeeding women: oral antifungals are contraindicated.
Apply a topical treatment (miconazole 2% cream or Whitfield’s ointment)
to limit the spread of infection until it is possible to treat orally.
Anatomic site Clinical features Treatment
Glabrous skin Erythematous, scaly, pruritic macule For non widespread, localised tinea:
Ringworm of the body with a well-demarcated, raised, Local treatment: 2 times daily, clean
Tinea corporis vesicular border and central healing. with soap and water, dry and
apply miconazole 2% cream
or Whitfield’s ointment for 2 to 4
weeks or for 2 weeks after clinical
resolution.
• Reserve oral antifungals for
particularly extensive lesions:
griseofulvin PO for 4 to 6 weeks or
itraconazole for 2 weeks.
Anatomic site Clinical features Treatment
Folds • Interdigital spaces (Tinea pedis): Topical treatment as above. If
Tinea pedis (athlete’s foot) Pruritus, fissure and whitish oozing lesions, use miconazole
Tinea cruris scales in the 2% cream only (do not use
3rd and/or 4th interdigital spaces . Whitfield’s ointment).
• Groin (Tinea cruris):
Circumscribed, pruritic,
erythematous plaque, with a pale
centre surrounded by vesiculo-
pustules, extending outward from
the groin.