Superficial Dermatophyte Infections

Onychomycosis

JI ESLAO, JESSICA
JI PRUDENCIO, DEBBIE
SUPERFICIAL FUNGAL INFECTIONS
• Most common of all mucocutaneous
infections
- caused by overgrowth of transient or resident
flora associated with a change in the
microenvironment of the skin
 DERMATOPHYTE
• Group of fungi capable of infecting nonviable
keratinized cutaneous structures

• ETIOLOGY
- 3 genera: Trichophyton, Microsporum, Epidermophyton
• ONSET
- Children: scalp infections (Trichophyton, Microsporum)
- Young and older adults: intertriginous

• TRANSMISSION
- Another person
- Animals
- Soil
 CLASSIFICATION
• Dermatophytoses of keratinized epidermis (epidermal
dermatophytosis, epidermomycosis): Tinea facialis, tinea
corporis, tinea cruris, tinea manus, tinea pedis

• Dermatophytoses of nail apparatus (onychomychosis): Tinea

unguium (toenails, fingernails)

• Dermatophytoses of hair and hair follicle (Trichomycosis):

Dermatophytic folliculitis, Majocchi's (trichophytic)
granuloma, tinea capitis, tinea barbae.
 Dermatophytoses of Epidermis
• Most common dermatophytic infection
• May be followed/accompanied by
dermatophytic infection of hair/hair follicles
and/or the nail apparatus
TINEA PEDIS
• Dermatophytic infection of
the feet
• Erythema, scaling,
maceration, and/or bulla
formation
• Provides breaks in the
integrity of the epidermis
through which bacteria can
invade
TINEA MANUUM
• Chronic dermatophytosis of
the hand
• Unilateral, pruritic and
painful
• Well-demarcated scaling
patches, hyperkeratosis and
scaling confined to palmar
creases, fissures on palmar
hand
TINEA CRURIS
• Subacute or chronic
dermatophytosis of the
upper thigh and adjacent
inguinal and pubic regions
• Large, scaling, well-
demarcated dull
red/tan/brown plaques
• Central clearing, and
papules, pustules may be
present at margins
TINEA CORPORIS
• Trunk, legs, arms, and/or
neck
• Small to large scaling,
sharply marginated plaques
with or without pustules or
vesicles, usually at margins
• Peripheral enlargement and
central clearing produces
annular configuration with
concentric rings or arcuate
lesions
TINEA FACIALIS
• Dermatophytosis of the
glabrous facial skin
• Well-circumscribed macule
to plaque of variable size
• Elevated border and central
regression; scaling is often
minimal
 Dermatophytoses of Hair
• Dermatophytes are capable of invading hair follicles
and hair shafts, causing dermatophytic trichomycosis
(tinea capitis, tinea barbae, and dermatophytic
folliculitis)
• Two types of hair
involvement are:
TINEA CAPITIS
• Predominantly a disease of preadolescent
children
• Ectothrix or endothrix
• Scaling, diffuse or circumscribed alopecia
TINEA BARBAE
• Beard and moustache
areas with invasion of the
hair shaft
• Pustular folliculitis hair
follicles surrounded by
red inflammatory papules
or pustules, often with
exudation and crusting
• Less follicular
involvement, there are
scaling, circular, reddish
patches
 ONYCHOMYCOSIS
• Any infection of the nail caused by
dermtophyte fungi, non-dermatophyte fungi,
or yeast
• T. rubrum: 71%
• T. mentagrophytes: 20%
Distal and Lateral Subungal Onychomycosis

• Begins in the hyponychial area or nail fold

• Primary or secondary
 Superficial White Onychomycosis
• Surface of the dorsal nail
• Mold
Proximal Subungal Onychomycosis
• Posterior nail fold (cuticle area) and migrates along
the proximal nail groove
• Involve underlying matrix proximal to the nail bed
and nail
• Associated with immunocompromised states
 DIFFERENTIAL DIAGNOSIS
• PITYRIASIS VESICOLOR
- Chronic asymptomatic
scaling epidermomycosis
associated with the
superficial overgrowth of
the hyphal form of
Malassezia furfur
- Well-demarcated scaling
patches with variable
pigmentation, occurring
most commonly on the
trunk
 DIAGNOSTIC TESTS
•Definitive diagnosis requires
demonstration of fungal pathogens by
microscopic examination or culture of
skin, nail, or hair scrappings from the
suspected lesions.
 1. Microscopy
•
Wood's Lamp. Examination of lesions
involving the scalp or beard with a wood's
lamp may reveal fluorescent pteridine of
certain pathogens.
 Ectothrix – small or large arthroconidia
forming a sheath around the hair shaft
 Endothrix – arthroconidia within the hair
shaft
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• Skin and nails.
• Skin scrapings
• Nail clippings of the entire thickness of
dystrophic areas of nail as proximal as possible
• 10-20% KOH
 2. Culture

•
Specialization of superficial fungi is based on
macroscopic, microscopic and metabolic
characteristics of the organism.
•
Sabouraud’s dextrose agar – nonselectuive
culture medium consisting of peptone,
dextrose agar and distilled water.
•
Mycosel or mycobiotic agar – A selective
growth medium. It consists of Sabouraud’s
agar with cycloheximide (0.5 g/L) and
chloramphenicol (0.05 g/L)
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12/18/14
 Differential Diagnoses:
•
Contact Dermatitis
•
Psoriasis
•
Candidiasis
 PSORIASIS VS. DERMATOPHYTOSIS

12/18/14
CANDIDIASIS VS. ONYCHOMYCOSIS

12/18/14
12/18/14
DISEASE
TREATMENT
TOPICAL TREATMENT SYSTEMIC
TREATMENT
Tinea capitis Only as adjuvant Griseofulvin, 20-25
Selenium sulphide mg/kg/day
Zinc pyrithione Fluconazole, 6 mg/kg/day
Povidone iodine Itraconazole, 3-5
Ketoconazole mg/kg/day
Terbinafine, 3-6 mg/kg/day

Tinea barbae Only as adjuvant Griseofulvin, 1 g/day

Topical antifungals Itraconazole, 200 mg/day
Terbinafine, 250 mg/day
Fluconazole, 200 mg/day
Tinea corporis/cruris Allylamines Adults:
Imidazoles Fluconazole, 150 mg/wk
Tolnaftate Itraconazole, 100 mg/day
Butenafine Terbinafine, 250 mg/day
Ciclopirox Griseofulvin, 500 mg/day
Children:
Griseofulvin, 10-20
mg/kg/day
Itraconazole, 5 mg/kg/day
Terbinafine, 3-6 mg/kg/day
DISEASE TOPICAL TREATMENT SYSTEMIC TREATMENT

Tinea pedis/manuum Allylamine Adults:

Azole Terbinafine, 250 mg/day
Ciclopirox Itraconazole, 200 mg
Benzylamine twice/day
Tolnaftate Fluconazole, 150 mg/wk
Undecenoic acid Children:
Itraconazole, 5 mg/kg/day

Onychomycosis Ciclopirox Terbinafine, 250 mg/day

Amorolfine Itraconazole, 200 mg/day
Fluconazole, 150-300 mg
once/wk
 Thank You and Have a
Nice Day…..

12/18/14