SUPERFICAL

FUNGAL
INFECTION
Dr. NDAYISABA CORNEILLE
CEO of CHG
MBChB,DCM,BCSIT,CCNA
Supported BY
Diagnostic procedures
 KOH: scales or hair with a
drop of potassium hydroxide
on a glass slide
 Tinea

 Candida

 Hairs

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Tinea versicolor “spaghetti and meatballs” Tinea KOH

Hair KOH (may see tinea inside orDr Ndayisaba Corneille

Candida KOH
around the hair shaft)
Tinea Capitis
 Fungal infection of the scalp characterized by
scaling and patchy alopecia (hair loss).
 The disease is primarily one of childhood.
 Distribution is worldwide.
 Transmission –person to person, from soil or
infected animals

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Tinea Capitis

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Keroin
Treatment of Tinea Capitis
 Griseofulvin – 10-15mg/kg/d for 6-8 weeks
(due to increase in resistant most recommend
increasing to 20-25mg/kg/d for 6 weeks)
On average: <1year 125mg qd
1-5 yrs 187mg qd
6-12 yrs 250-375mg qd
Take after fatty meal

 If a kerion is present- Terbinafine for 6 weeks

On average: <20Kg 62.5mg qd
20-40mg 125mg qd
>40mg 250mg qd
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Tinea capitis continued
 May advise ketoconazole shampoo to all family
members to help prevent transmission
 Topical treatment usually is not sufficient
because the fungus goes deep into hair follicles
 Advise family members to disinfect all combs
and not to share them the infected person
 Community and school should be visited to treat
other active cases

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Human Favus
 Tinea favosa (favus = honeycomb) is a chronic
inflammatory fungal infection of the scalp, hair,
glabrous skin and nails

 Characteristic lesions are the scutula (yellow, cup-

shaped crusts)

 Hairs become lusterless and broken, and scarring

atrophy and alopecia may ensue.
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Human Favus

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Tinea Barbae
 Uncommon
superficial fungal
infection of the
beard area
 Usually seen in
cattle farmers
 Because of hair
involvement treat
with griseofulvin

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Tinea Faciei
 Clinical:
-scaling present in less
than 2/3 of cases
-annular plaques may
occur but can be hard to
appreciate
 Symptoms:
-itching, burning, often
worse after sun
exposure

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Tinea Corporis
Superficial fungal infection of
skin (except hands, feet, groin)

Predisposing factors:
 Diabetes
 Leukemia
 HIV
 Animal/human contact
 Chronic scalp/foot/hand
reservoir
Wide range of clinical
presentations:
 including annular scaly
 kerion-like
 vesicular
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Tinea Manum
 Almost all cases of
tinea manum show
tinea pedis as well.
(One hand –two feet
phenomenon)
 Clinical:

Most often scaly, dry,

hyperkeratotic
infection

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Tinea Pedis
 Clinical types:
-Interdigital
-Vesiculobullous
-Hyperkeratotic Tinea Pedis-Hyperkeratotic

Tinea Pedis- vesicullobullous

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Tinea
Cruris
Extremely rare
in children
Secondary to
occlusion,
moisture

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 Treatment of T. faciei, T. corporis, T.
Manum, T. pedis, T. cruris
 Uncomplicated, localized:
 Topical antifungals:
Clotrimazole cream BID x 2-4 weeks

 Ketaconazole cream BID x 2-4 weeks
 Whitfield’s ointmnet BID x 2-4 weeks
(specially good for keratotic areas like palms and
soles, but can be too irritating for groin and
sometimes can irritate the face)
 Gentian Violet or Castellani’s paint for interdigital
moist areas paint bid 2-4 weeks
 Widespread or severe infection:
 Griseofulvin 10-15mg/kg qd for 4 weeks or longer (depends
on clinical response)
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Onychomycosis (Tinea Unguium)
 Distal subungual (most
common type):
 Infection of the nail bed and
ventral surface of nail plate
 Starts distally but can invade
laterally
 Associated with tinea pedis Distal subungual- most
common type
 Proximal subungual:
 Least common, but common
in HIV
 Invades proximal nail fold,
then nail plate

Proximal subungual- May be

sign of HIV
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Treatment of T. ungiuim
 Griseofulvin 10-15mg/kg/d for the duration of
nail growth. On average 3 months for
fingernails and 6months for toenails
(sometimes more)
 Terbinafine

On average: <20Kg 62.5mg qd

20-40mg 125mg qd
>40mg 250mg qd
Fingernails for 6 weeks
Toenails for 12 weeks
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Granulomatous Tinea
 Fungus grows
down the hair
follicle
 Topical
steroids are a
predisposing
factor
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Treatment of Granulomatous
tinea and severe tinea incognito
 Because of deeper hair follicle
involvement usually needs
systemic treatment
 Griseofulvin 10-15mg/kg qd for 4
weeks or longer (depends on
clinical response)
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Pityriasis (Tinea) Versicolor
 Scaly, coalescent,
hyperpigmented,
hypopigmented or
erythematous patches
 Trunk and proximal
extremities

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Treatment of Pityriasis
Versicolor
 Localized, uncomplicated:
-20% sodium thiosulfate solution to be brushed in
BID for 4 weeks
-2.5% selenium sulfide (selsum) shampoo or
ketoconazole (nizoral) shampoo once a week x 3
weeks, leave on overnight and then rinse in morning
-Clotrimazole or ketoconazole cream BID x 2-4weeks

 Extensive:(only if >30% body surface area)

-Ketoconazole (>2 yr)
3.3-6.6 mg/kg once daily for 2 days; followed by same
dose once a week every 2 weeks for 3 months
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Candidiasis
 Caused by candida albicans;

 Predisposing factors
 Immunodeficiency
 Diabetes
 Antibiotictx
 Systemic steroid tx

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Oral Candidiasis
 Oral thrush (most common
form of oral candida):
 Sharply defined patch of creamy
white pseudomembrane which,
when removed, leaves an
erythematous base.
 Buccal mucosa, tongue, gums,
palate may be affected.
 May see ulcerations & necrosis
in severe states.

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 Oral Candidiasis

 Angular cheilitis (perleche)

 Oral commisures involved w/
erythema, fissuring, maceration
 Not always associated with Candida
- may be due to nutritional
deficiency and mechanical factors.

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Treatment of oral candida
 Nystatin oral suspension- swish and swallow 4
times a day
-Newborns: 200,000-400,000 Units/day
-<2 years old 400,000-1,000,000 Units/day
->2 years old 1,000,000-2,000,000 Units/day

 For angular cheilitis- topical clotrimazole or

nystatin cream or ointment BID x 2-4 weeks
 Special attention to precipitating factors
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Candida Intertrigo
 In body folds
 Rare in children
 Begins as erythematous, moist
exudate in skin fold
 Progresses to subcorneal
pustules, erosions, satellite
papules.
 Predisposing conditions-
obesity, occlusive clothing,
diab, occupat-ions favoring
excessive moisture

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Genital & Perineal Candida
 Diaper candidiasis
 Commonly seen in conjunction with diaper dermatitis.
Classically see subcorneal pustules, satellite papules.
 Vulvovaginitis
 Common in pregnancy. Itchy, tenderness, thick creamy
vaginal discharge. Rx w/ topicals (butoconazole,
terconazole, miconazole, or clotrimazole) or oral
(fluconazole, itra or keto)
 Candidal Balanitis
 Papules, pustules on glans, may extend to prepuce;
Candida is most common cause of infectious balanitis
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Genital & Perineal Candida

Diaper Candidiasis

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Candida balanitis

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Intertrigo, balanitis, and Diaper
Candida
 Uncomplicated, localized:
 Topical Clotrimazole, Ketoconazole or Nystatin cream or
ointment bid 2-4 wks
 For moist, macerated areas 0.5% gentian violet solution bid 2-
4 weeks
 Extensive disease:
 Ketoconazole
Pediatric, over 2 years: 3.3-6.6 mg/kg once daily
x 2weeks. Dosage has not been established for
children less than 2 years of age.
 Fluconazole
<3 years: Not established
>3 years
Oropharynx (thrush): 3 mg/kg/d PO as single dose
Diaper area: 6mg/kg PO single dose

Dr Ndayisaba Corneille
Treatment of Candida
Vulvovaginitis
 Oral:
-Fluconazole 150mg po x1
-Itraconazole 200mg po bid x1 day

 Intravaginal:
-Butoconazole 2%- 5gm qnote x 3 days
-Clotrimazole 1%- 5gm qnote x 7 days
or 100gm vaginal tab -2 qnote x 3 day
-Miconazole 2%- 5gm qnote x 7 days
or 200gm tab – 1 qnote x 3 days
-Terconazole 0.4%- 5gm qnote x 7 days
or 80mg tab- qnote x 3 days
-Tioconazole 6.5%- x 1 dose

Dr Ndayisaba Corneille
 END
BY
DR NDAYISABA CORNEILLE
MBChB,DCM,BCSIT,CCNA,Cyber Security

contact: amentalhealths@gmail.com , ndayicoll@gmail.com

whatsaps :+256772497591 /+250788958241

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