INFECTIONS OF THE SKIN
It comprises about
30%of skin diseases
seen by the general
From the dermatological point of view, they are classified into:
Superficial mycoses invade skin surface i.e epidermis and epidermal appendages especially hairs and nails
-FAVUS -RING WORM
2-BLACK DOT R.W.
-T.CIRCINATA. -T.CRURIS. -T.VERSICOLOUR
-T.MANUS. -T.PEDIS. -ONYCHOMYCOSES
Fungus infection of the scalp
Ring Worm Favus
Is the commonest variety of mycotic scalp affections.
incubation period is 1- 4 weeks.
Usually affects children at school age
spreads in epidemics
especially in family
and school children
usually caused by Microsporon Auduini
Apart from hair affection, the patient complains of hair fall
Clinical picture well circumscribed scaly macular lesion on the scalp
by any local symptoms
Hairs are shortly cut. Covering scales are small, dry, slate colored
Slightly adherent to the surface of the scalp but easily detached on scraping
This patch is followed by the appearance of other patches,
we get multiple patches dispersed on the scalp of the same clinical picture
T.Capitis Multiple Scaly type
Multiple Scaly Type
Mode of infection
By contact with infected person.
By contact with material soiled with the organisms e.g. head caps, bed sheets
Scales and hairs are of fungal elements
examined for detection
Culture can be used in difficult cases.
Sampling For Fungal Detection
KOH preparation showing spores in the hair shaft
From other scaly lesions on the scalp
Psoriasis. L.E. Lichen planopilaris Favus. Lichen accuminatus (PRP)
Self-limited at puberty
of Hair in Ring Worm
1-In gray patch
variety it shows microsporon hair
Fungal elements surround the hair in an irregular mosaic form.
2-In black dot
variety the hair matrix is filled with mycotic elements forming a sac form.
3- In kerion Celzi:
hair is surrounded
by regularly arranged
elements like a column
Fungal elements are arranged parallel to long axis of the hair
Black dot R.W
This variety is characterized by the development of
scaly macular lesion on the scalp of children with well defined border.
Black Dot R.W
On removal of these epidermis is slightly
scales the underlying
On close examination we find the hair follicle ostia are blocked with black dots black dots
which are the remains of the broken hair at the surface of the scalp
usually caused by Trichophyton Violaceum and T. Tonsurans.
Black Dot R.W.
types of R.W
children but may
besides scalp affection the beard area may
The extent of inflammation varies according to the invading fungus.
It might be: Mild
slight erythema of the skin in the affected by discharge
patch which is covered
Hairs are stuck
together broken, and
you can see short as well as long hairs
marked edema, redness and tumefaction of the affected hair
leading to the
formation of a boggy soft swelling
On pressure pus comes out from the hair follicle
Each hair is
surrounded by a pool of pus and is easily detached
This inflammatory swelling is called
It usually heals by scar formation
It is usually caused by:
one of the most common mycotic scalp affections
caused by Trichophyton
Age: all ages, more
common in children ,
it does not
show self healing at puberty
Extends throughout life leading to
not as high as in R.W.,
sporadic cases can be detected among children
It can also affect glabrous skin and nails
Favus Of The Scalp
characterized by the
Which is the initial lesion of
It is a crust like lesion, yellowish in color, with a concavo-convex surfaces.
with its convexity at the scalp making for itself an erosion or depression in the epidermis.
This leads to firm
adherence to the
friable, cup shaped, with a characteristic mousy odor
polygonal in outline measuring about
few mms. to one cm in diameter
If moistened with alcohol the color
The hair in the affected area in the scalp is but show changes in picture and color.
usually of normal length
Hair becomes thin, dry, friable, grayish in appearance , lusterless and dull gray in color
the scalp appears as if dusted with powder
shown to be a pure culture of the invading fungus
under the microscope fungal elements are invading the hair with no elements outside.
All are within the hair
Hairs are few in number and not completely destroyed
Fungal elements are
arranged parallel to the long axis of the hair
This includes the following:
T T T T
. . . .
Circinata . Cruris . Manus & Pedis Versicolour .
Occurs anywhere on the body surface especially on exposed parts
in the form of one or multiple circinate macular lesions
lesion is made of well defined erythematous scaly patches
spreading eccentrically forming a circinate appearance
i.e healing in the at the border.
center and activity
The activity appears in the form of erythema vesicles and papules.
center may show
and covered with branny scales
The patient complains
itching and disfigurement
From other circinate eruptions:
Pityriasis Rosea . Psoriasis . Lichen planus . Seborrhoeic dermatitis Erythema multiforme. Impetigo .
A circinate macular lesion occupying the inner surface of the upper parts of both thighs
Usually accompanied with T. pedis.
Other flexures may share in the affection
It is usually a symmetrical affection
It might extend both anteriorly to the pubic area, scrotum,
and posteriorly to the perineum and gluteal folds
The lesion is brownish red in color with well defined border and circinate configuration
Surface shows minute scaliness and tendency for healing with spreading margin
Erythematous scaly conditions affecting the flexures :
Intertrigo Erythrasma Psoriasis
a very common superficial fungus infection of the skin
affecting both sexes and commonly seen at puberty
It is caused by
Mild asymptomatic dysfiguring macular eruption affecting the vest area
short jacket with long sleeves
Sites Of T.V.C
Macules are oval,rounded or patchy, brownish or coffe et lait in colour
light to deep brown
The lesions are well defined and covered by fine branny adherent scales.
T.V.C. On The Chest
T.V.C. on the Back
Colour changes in different sites in the
same patient and
among different individuals
Colour change is ascribed to the following factors:
colour of the lesion and normal skin colour of the patient.
Site of the lesion whether on an exposed site or a hidden site.
Hygiene of the patient as frequent baths removes the scaly layer on the lesion
that prevents the reach of UV to the skin underneath.
Tenia Manus & Pedis
Superficial fungus infection of both hands and feet.
It may take one of the following clinical pictures
1-Erythematous scaly or circinate type. 2-Eczematous or vesiculobullous type
Both types occur on the dorsal aspect of
the hands and feet
Erythematous Scaly Type
on the palmar and plantar aspects
type is the interdigital type
Clinical picture of
the standard type:
Affects the interdigital spaces between toes and fingers
The skin becomes whitish, sodden, macerated and the depth of the cleft is fissured
On removal of the macerated keratinous
is erythematous, moist , and may be eroded
It is very common among athelets and called atheletic foot
of the nails
caused by many species of fungi
The affected nail is dry, brittle, lusterless and the surface is pitted and grooved.
Nails may be separated
from the nail bed
nails retain its luster, thick accompanied by paronychia
eczema Lichen planus Psoriasis. Syphilis. Lichen accuminatus.
Treatment of Mycoses
An oral antibiotic fungicidal agent derived from penicillin species.
It is given in a tablet form each tablet contains 250 mgm of ordinary griseofulvine
same therapeutic effect is obtained by 125 mgm of fine particle F.P. Griseofulvin
From 10-25 mg/kg body wt. in divided doses.
It may be given in a single weekly dose calculated by
1/3 of body weight in tablets/ week not exceeding 20 tablets per week
all superficial fung
.V . C. Erythrasma. Moniliasis.
Pregnancy, liver, kidney or heart disease.
Side effects :
- Nausea - Vomiting
Duration of Treatment:
T.corporis 3-4 weeks T.capitis 5-7 weeks T.Pedis 7-9 weeks
Nails 3-4 months Toes 5-6 months
Other systemic antifungals are now in common use.
They should be used with caution as some of them have serious side effects as:
which is a potent hepatotoxic drug
are used safely
in indicated cases
But they are expensive and limited to worthy cases.
For Tinea Versi Color Fluconazole capsules 150 mgm once weekly for 4 weeks may be given in resistent cases
Tr.Iodine,Tolnaftate Clotrimazole, Undecylinic acid derivatives
Salicylic acid 3 Benzoic acid 6 lanovaseline 100
we use modified forms of Whitfield ointment because the original formula is very irritant but very effective.
fungal infections, we use
In cases of
or the preparation called
paint which must be prepared fresh