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School of Medicine

Tadulako University
Palu

LECTURE BLOCK 8
2014

FUNGAL INFECTION
IN DERMATOLOGY

Diany Nurdin
Dermato-venereology department
Faculty of Medicine
Tadulako University
Palu

FUNGAL INFECTION

A. CLASIFICATION :
- SUPERFICIAL MYCOSIS
- SUB-CUTANEOUS/DEEP MYCOSIS
- SYSTEMIC MYCOSIS

- SUPERFICIAL MYCOSIS
- Dermatophyta
- Non Dermatophyta

DERMATOPHYTOSIS
GENUS:

Trichophyton Sp.
Epidermophyton Sp.
Mycrosporum Sp.

TINEA CAPITIS, T.CORPORIS,T.BARBAE,


T.CRURIS, T.PEDIS et MANUUM AND
ONYCHOMYCOSIS

Cont...
CLASSIFISATION
1. ANTHROPOPHILIC
2. ZOOPHILIC (M.canis dog and cat)
3. GEOPHILIC ( M. gypseum soil)

TRANSMISION:

DIRECT : SKIN TO SKIN CONTACT


- INDIRECT : TOWEL, WEAR, COMB, ETC.
-

PATHOGENESIS :
ADHERENCE PENETRATION DEVELOPMENT OF
HOST RESPONSE

CLINICAL MANIFESTATION

TINEA CORPORIS

- Erythematous patch/papule with


scale
- Circinate, ringworm like,annular
- Active border
- Central healing
- Itchy, esp. sweating

TINEA CAPITIS
Kerion

Gray patch

Favus

Black dot

TINEA CRURIS

TINEA PEDIS

Chronic intertriginous type,


vesiculo-bullous type and
chronic hyperkeratotic type

LABORATORY EXAMINATION
1. Woods Lamp:
Blue-green fluorescence
2. Microscopy: KOH 10-30%
3. Culture: Saborauds agar
4. Biopsy
5. Skin test

NON DERMATOPHYTOSIS
1.CANDIDIASIS

Confluent and discrete erythematous,


eroded areas with pustular and erosive satellite lesions

CUTANEUS CANDIDIASIS

EPIDEMIOLOGY
Age: Any age.
Etiology: Candida albicans

Predisposing factors:
Diabetes, obesity, hyperhidrosis,
heat, maceration,
polyendocrinopathies,
systemis and topical corticosteroid

CUTANEUS CANDIDIASIS

LABORATORY
Direct microscopy: scraping using Grams
stain
or KOH preparation (10-30%)
Fungal culture: Saboraud medium

MANAGEMENT
Prevention: Keeping intertriginous areas
dry
Therapy : Topical antifungal

MUCOSAL CANDIDIASIS

Mucosal candiddiasis is a Candida


infection occuring on the mucosa of the
upper aerodigestive tract and
vulvovagina.

EPIDEMIOLOGY
Age : All ages
Etiology : Candida albicans
Transmission : Overgrowth associated
with local or systemic suppression of
immunity or antibiotic therapy

MUCOSAL CANDIDIASIS

RISK FACTORS:

HIV infection
debilitation
diabetes mellitus
broad spectrum antibiotic therapy
topical or parenteral
corticosteroid
Parenteral hyperalimentation
corpus alienum

MUCOSAL CANDIDIASIS

PHYSICAL EXAMINATION

1. Vaginitis with white discharge, vaginal


erythema and edema. White plaques that
can be wiped off on vaginal and/or cervical
mucosa.
2. Oropharyngeal candidiasis
Pseudomembranous candidiasis (thrush).
Removable white plaques on any mucosal
surface.

MUCOSAL CANDIDIASIS

MANAGEMENT: Topical and systemic antifungal

2. PITYRIASIS VERCISOLOR

Pityriasis versicolor is a chronic


asymptomatic scaling dermatoses
caused by overgrowth of Pityrosporum
ovale.

EPIDEMIOLOGY

Age; young adult

Etiology: P. ovale (Malassezia


furfur)

Predisposing factors:
high humidity, high rate sebum
production

PITYRIASIS VERSICOLOR

SKIN SYMPTOM
Usually none or mild
pruritus

SKIN LESIONS
Macule, white to
brown color, sharply
marginated with fine
scaling (finger nail
sign)

PITYRIASIS VERSICOLOR

LABORATORY
EXAMINATIONS
Direct microscopy
KOH 10 to30%

Spaghetti and meat ball app

TREATMENT
Systemic antifungal
Griseovulfin :Dermatophytosis T. Kapitis
Azole group (ketokonazol, flukonazol,
Itrakonazol : All fungal
Terbinafin: Dermatophytosis, PVC

Topical
Azole : all fungal
Terbenafin, whitfield oint : Dermatophyta
Selenium sulfide, Na thiosulfate : PVC

EPYZOONOSIS

ECTOPARASITIC INFECTION

Epidemiology:
Parasitic infection are
endemic in many developing countries

Risk factors:
1. Social - economic
2. Health education
3. Hygiene
4. Etc.

CLASSIFICATION

1. Completed inflammation:
a. Amoebiasis of the skin
b. Insect bites
2. Incomplete inflammation:
a. scabies
b. larva migrans (creeping Eruption)
c. pediculosis

Insect bites
Caused : insect toxin
Symptoms and Signs :
erythema with central necrosis
papule and punctum
nodus/urtika with punctum
vesicula bulla

TOXIC IRITANT DERMATITIS


ec insect poison

Scabies
Caused: Sarcoptes Scabiei
Predilection:
Adult: hands, wrist, elbows,
anterior axillary fold, abdomen, buttocks,
areolas of female breasts, genital.
Infant : head, neck, palm and sole

SCABIES
General Considerations :

Itching especially during night

Sign : papule, pustule, excoriation,


hyper pigmentation
cunniculus (burrow)
Transmitted by skin to skin contact
or sexually

THERAPY
CAUSATIVE THERAPY
PERMETHRIN
GAMEKSAN
BENZYL BENZOAT
2-4 OINT (SULFUR)
IVERMECTIN ORAL (NOT AVAILABLE)

SYMPTOMATIC THERAPY
ANTIHISTAMIN

Cutaneus Larva migrans


( creepings eruption)
Aetiology: larva Ankylostoma braziliensis
Characteristic sign :
A serpiginous, linear,raised, tunnel-like erythematous
lesions, outlining the path of migration of the larva.
Skin Symptom: Local pruritus (Itchy)

A serpiginous,
linear,raised, tunnel-like
erythematous lesions

MANAGEMENT

Anti parasite :

Anti helmint gol albendazole,


tiabendazole

Cryo surgery
Nitrogen liquid

REFERRENCES

Odom,.R., James,W., Berger,T., 2000.


Andrews Diseases of the skin, 9 th
ed., WB Saunders Company
JawetzMelnick JL. Adelberg EA, Brokks
GF, Butel JS and Ornston LN 2004
Medical Microbiology, 21 th ed. Simon
and Schuster Asia Pte Ltd, Singapore.
JAAD
Verma S, Heffernan MP. Superficial
Fungal InfectionIn: Wolff K, Goldsmith
LA, Katz SI,, editors. Fitzpatrick's
Dermatology in General Medicine. 7th
ed. New York: McGrow-Hill Companies;
2008

THANK YOU