• INTRODUCTION

• Fungal skin infections are grouped as either

superficial or deep (including the systemic
ones)
• Three fungal genera—Trichophyton,
Microsporum, and Epidermophyton—account
for the vast majority of infections. Others are
by Penicilliosis. Fungal reservoirs for these
organisms include soil, animals, and infected
humans
• The yeasts are caused by Tinea and Candida
like C. albicans, C. arusei and C. tropicalis
• Incidence
• Fungal infections are a global health problem
and it is estimated that 20-25% of world’s
population has skin mycosis
• These pathogens are basically zoophilic &
anthropophylic
• The organisms grows best in warm, moist
environment including inside closed shoes,
socks, swimming pools and on floors of
bathrooms
 The common dermatophytes causing
infections are: Trichophyton rubrum, T.
interdigitale, T. verucosum & T. tonsurans;

 Micrispora include M. audouinii, M. canis

while the
 Epidermphyton are like E. floccosum
 Tinea capitis
 Is called ringworm of scalp and commonly

affects children upto puberty and is

infectious
 It often causes transient hair loss but other

forms may result in permanent alopecia

 It involves portions of scalp or the whole of

scalp
 Types: Non-inflammatory type and the severe

forms - Favus, kerion and scutulum

• CFs: white patches, scaly red areas, itching
and sometimes, pus filled-lesions called
Kerion.
• Low grade fever, lymphadenopathy can also
occur
• Areas with small black dots and broken off
hair stumps, called favus
• There could be inflammed areas with thick
scaly skin called Scutulum
• The last three types named above can result
in permanent hair loss as a complication.
 For T. capitis - the useful tests are:

 Wood’s light examination

 KOH test – is very important
 Fungal culture – takes 2-3 weeks
 Skin biopsy for histopathology but this is not

done routinely
 It is preferred to use both systemic and
topical treatment
 Oral – Griseofulvin 125, 250 or 500mg od or

Bd for 4-6 weeks

 Alternatively, Fluconazole, Itraconazole or

Terbinafine may be used

 Topical therapies:
 Clotrimazole, Miconazole, Fluconazole or

Terbinafine Creams for 2 weeks

 Body and face – T. corporis, T. faciei & T.
manuum (hands)
 It can involve different parts of the body ie

the trunk, extremities, the face and hands

 The skin lesions consist of white patches that

are anular/circular or ring-like with active

edges, scaly with formation of papules along
the edges with redness (inflammation) and
partly healed central areas
 Tinea cruris (of groin & other crural areas)
 This is sometimes called Jock itch because it

is associated by intense itching, more

common in men
 Involved areas are usually moist and warm

due to sweating. The lesions can be

secondarily be infected by bacteria & contain
pus
 Most often occurs in those with T. pedis who

transfer the infection through repeated

scratching of toe webs
 Is caused by a fungus that lives on dead
tissue outer layers of skin, hair and toe nails
– T. rubrum
 The organism grows in warm, moist

environment eg inside closed shoes, socks,

swimming pools and on floors of bathrooms
 Affected skin is pruritic, with burning, scaling

plaques on the soles, extending to the lateral

aspects of the feet and interdigital spaces
often with maceration. There is also be
reddening with blister formation
 This infection of nail

 This is characterized by thickened yellow

nails and subungual debris (Hyperkeratosis)
 The nail develops different colour like dark,

brownish or yellow
 May become soft or brittle with roughening of

the nail matrix

 The diagnosis is mostly clinical but
confirmation is done by KOH examination of
skin scrappings, nail clippings and fungal
culture
 The results reveal presence of fungal

elements (hyphae or pseudohyphae in case of

yeast in fection)
 Can be topical for tinea of body, face and
hands
 For onychomycosis – both systemic and

topical
 Duration also depends on the region affected

for example, for scalp and extensive body

surface, the oral is for 1 month, and for nails
it is 3 months
 For most patients, topical treatment with
terbinafine (Lamisil), clotrimazole (Canesten,
Mycelex), or econazole (Spectazole) cream is
adequate when applied twice daily for 2 to 4
weeks
 For onychomycosis, tinea capitis, and

extensive dermatophyte disease, systemic

treatment is often necessary
 Start with griseofulvin or fluconazole for
scalp or extensive dermatophyte skin
infections and nail infection
 Itraconazole (Sporanox) or terbinafine

(Lamisil) are suitable alternatives

 The above drugs are also available in creams

or solutions for topical use
 Tinea Capitis, Extensive Dermatophyte
Disease
 Griseofulvin 20-25 /kg/day PO for 8 weeks
 Fluconazole 6 /kg/day PO for 20 days

 For Onychomycosis
 Griseofulvin 20-25 /kg/day PO for 8 - 12

weeks
 Itraconazole 3-5 /kg/day PO for 4-6 weeks
 Terbinafine 3-6 /kg/day PO for 4-8 weeks
 Candidiasis refers to a group of infections
caused by Candida albicans or by other
members of the genus
 These organisms typically infect the skin,

nails, mucous membranes, and

gastrointestinal tract, but they also cause
systemic disease
 Infection is common in immune-

compromised patients, diabetics, the elderly,

and patients receiving antibiotics
 Candida albicans accounts for 70% to 80% of
all candidal infections
 C. albicans commonly resides on skin and

mucosal surfaces. Alterations in the host

environment can lead to its proliferation and
subsequent skin infection, ie it is an
opportunistic infection
 Candidal intertrigo is a specific infection of

the skin folds (axillae, groin)

 Thrush is oropharyngeal candidiasis,
characterized by white nonadherent plaques
on the tongue and buccal mucosa

 Angular cheilitis is the presence of fissures

and reddened scaly skin at the corner of the
mouth, which often occurs in diabetics and in
those who drool or chronically lick their lips
 Paronychia is an acute or chronic infection of
the nail characterized by tender, edematous,
and erythematous nail folds, often with
purulent discharge; this disease is common in
diabetics
 Candidal vulvovaginitis is an acute

inflammation of the perineum characterized

by itchy, reddish, scaly skin and mucosa;
creamy discharge; and peripheral pustules.
 The counterpart in men is balanitis,
characterized by shiny reddish plaques on the
glans penis
 It causes itching and much discomfort
 Treatment
 For candidal intertrigo and balanitis, topical

antifungal agents such as clotrimazole,

terbinafine, or econazole cream, apply twice
daily for 6 to 8 weeks, is usually curative
when coupled with aeration and compresses
 For thrush, the treatment is nystatin
suspension or clotrimazole troches four to
six times daily until symptoms resolve
 Systemic antifungal drugs, such as

fluconazole 100 to 200 mg/day or

itraconazole 100 to 200 mg/day, for 5 to 10
days may be necessary for severe or
extensive disease
 For paronychia, treatment consists of

aeration and a topical antifungal agent such

as Griseofulvin, terbinafine, clotrimazole, or
econazole for 2 to 3 months
 Tinea versicolor is a common opportunistic
superficial infection of the skin caused by the
ubiquitous yeast Malassezia furfur
 Prevalence is high in hot, humid climates.
 The risk factors include oral contraceptive

use, heredity, systemic corticosteroid use,

Cushing's disease, immunosuppression,
hyperhidrosis, and malnutrition
 Signs & symptoms
 Infection produces discrete and confluent,

fine scaly, well-demarcated, hypopigmented

or hyperpigmented plaques on the chest,
back, arms, and neck. Pruritus is mild or
absent
 Diagnosis is by clinical presentation &

confirmed by KOH preparation exhibits short

hyphae and spores with a spaghetti-and-
meatballs appearance
 Selenium sulfide shampoo or lotion (2.5%)
Also, ketoconazole solution are the mainstay
of treatment, applied to the affected areas
and the scalp daily for 5 to 10 days, then
once a month thereafter
 Alternatively, a variety of topical antifungal

agents, including terbinafine, clotrimazole, or

econazole creams, applied twice daily for 6 to
8 weeks can be used
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