Pathogenic features refer diagram a. Normal continual shedding of stratum corneum protects from dermatophytes b. Inflammatory reactions following dermatophytoses 1. Penetration of stratum corneum CMI response 2. Vesiculation occurs in severe cases 3. Stratum corneum contains nucleated cells! - Inflammatory reaction increases epidermal cell division rates pass more rapidly through epidermis - Full differentiation of cells of different strate does not take place 4. Loss of normal translucency causing - stratum corneum to appear white - And dermal vessels to dilate 5. Mononuclear inflammatory cells infiltrate the dermis NOTE: A crude extract called TRICHOPHYTON from certain dermatophyres produces a tuberculin-like response in most adults This contains 2 moieties of galactomannan Carbohydrate immediate response Peptide Delayed Type Hypersensitivity and probably immunity, too.
y y y y y
Superficial mycoses named according to site of infection. These usually correspond to site of local inoculation. Degree of inflammation often dictated by the nature of the environment from which fungus originates. Anthrophilic dermatophytes milder IR in humans e.g: microsporum dermii
TINEA CAPITIS (SCALP RINGWORM)
y y -
Mainly affects prepubertal children ages 4-14 Often seen in Crowded living conditions
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y y y
Areas of poverty Infection of hair shaft: Ectothrix fungi that produces arthrospores ON hair shaft. Present with gray or scaling patches of alopecia with or without inflammation. Black dot appeatance seen. Kerions and prominent inflammatory lesion +. Kerions = nodular, circumscribed exudative tumefaction (swelling) covered with pustules (usually M. canis, rarelt y T. verruocosum or T. mentagrophytes) Endothrix Fungus that grows INSIDE the hair shaft. Cuticle not destroyed Clinically appears as simple scaling of scalp May resemble seborrheic dermatitis dandruff There may be gray patches of alopecia with or without inflammation or black dot alopecia in which hair breaks off at roots Favus infection leads to crusting and matter hair on the scalp with such severe invasion that permanent alopecia often results. Usually seen in Eastern Europe and Africa.
Like tinea capitis, but affects the hair follicles and shafts of the facial area. May develop into tumourlike abscess Usual aetiologies: T. mentagrophytes, T. verrucosum
y y y y
Affects non-hairy, glabrous (smooth & bare) skin. Can be the extensions of scalp or groin infections. Range from mild to highly inflamed lesions with pustules. Central areas may become brown / hypoigmented and less scaly.
TINEA CRURIS (JOCK ITCH)
y y y y y y y
Commonly in men. May involve perineum, perianal and thighs. Rarely affects srotum (cf Candida typically involves scrotum) Typically presents with bilateral erythematous plaques with central healing. Erythematous border active. May have vesicles and papules. Pruritus and burning sensations most common complaints. Infection usually transmitted from foot to groin. Predisposing factors sweating, wet/many layered clothing
TINEA PEDIS (ATHLETE S FOOT)
Most common dermatophytosis
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Usual cause T. rubrum Occlusive footwear warmth and wet for fungal growth Presents in 4 general fashions: Interdigital infection with erythema, maceration and scalin. Moccasin foot erythema and thick hyperkeratotic scales Inflammatory infections with vesicles, usually on the medial foot Less common ulcerative infection affecting the web spaces of the toes If tinea unguium (of the nails) + tinea pedis may persist due to reinfections.
TINEA UNGUIUM (ONYCHOMYCOSIS)
y y y y
Infection causes nails to become opaque, chalky or yellowish. May become thickened and brittle. Toenails more frequently unvolved. Incidence increases with age.
DERMATOPHYTID or ID REACTION
y y y y
Allergic response to tinea processes that cause terile dermatitis at distant sites. Most common Tinea pedis itching and burning near the creases. Vesicles and bullae may form. Lesions may persist until primary process resolves.
TINEA VERSICOLOR Aetiology:
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Genus: Malassezia Species: Malassezia furfur (formerly Pityrosporum orbiculare/ovale) Organisms: Lipophilic and makes use of medium-chain length fatty acids Excess heat, humidity, pregnancy, oral contraceptives, malnutrition, burns and corticosteroids promote their proliferation.
Begins as small circular macules of various colours (versicolor) white, pink or brown depending on host s response reddish; hyperaemic inflammation Hypopigmented/hyperpigmented depends on melanosome formation in individual
Upper trunk most commonly affected. Highes numbers in areas of increases sebaceous activity. Usuall asuymptomatic. Itch when inflamed.
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Clinical manifestations UV (Wood s) light examination in darkened room M. audouinii, M. canis & T. schoenleinii all give off a blue-green colour. Tinea versicolor: whitish-yellow fluorescence. Skin/nail scrapings (keratinized/flaking material)/cutting: +10-20% KOH direct microspopy hyphae - Cellophane tape Tinea versicolor. spaghetti and meatballs appearance. Culture Sabouraud s agar 1-3 weeks. - Identified by colony colour, texture Light microscopy morphologic patterns
TREATMENT Most tinea infections: Topical agent imidaole b.d x 2-3/52 y Severe cases: oral - Itraconazole - Fluconazole - Terbinafine Tinea versicolor: - 2.5% selenium sulphide suspension (Selsun shampoo) entire body 10 minutes x 7.7 - Single dose oral keto/itra/flunazole
PREVENTION & CONTROL Keep clean Dry body surfaces all the time