DERMATOPHYTOSIS

COURSE OF LECTURES
DEFINITION

DERMATOPHYTOSIS
 a superficial fungus infection involving the stratum corneum of the skin, hair,
and nails, caused by Microsporum, Epidermophyton, or Trichophyton species
of dermatophyte.The lesions may occur at any site on the body and, on the
skin, are characterized by erythema, small papular vesicles, fissures, and
scaling. Common sites of infection are the feet (tinea pedis), nails
(onychomycosis), and scalp (tinea capitis).
 Dermatophytosis or infections due to dermatophytes are called tinea
according to the site of infection as for example tinea corporis, involving the
arms, trunk and legs, tinea capitis (TC), involving the scalp, and tinea pedis
involving the foot.
AGENTS
 Dermatophytes are divided into three closely related genera:
Epidermophyton, Trichophyton and Microsporum.
 The main characteristic of these fungi, with the exception of keratinophily, is
their membership of a group that depends on their normal habitat: geophilic
dermatophytes are naturally present in the soil, zoophilic in animals, and
anthropophilic in humans. The fungal pathogens that infect humans belong
mostly to the second and third groups, geophilic dermatophytes being more
rarely involved in human disease.
 Zoophilic and anthropophilic dermatophytes evolved from a geophilic origin,
with the anthropophilic dermatophytes being the most highly specialized
group. They rarely infect other animals and they are also restricted to some
body parts. Some species including Microsporum audouinii, Trichophyton
tonsurans and T. soudanense mostly cause TC and are rarely isolated from
other body sites. Other species are responsible mostly for onychomycosis;
these include T. rubrum which is the main agent, followed by T. interdigitale.
Finally, Epidermophyton floccosum infects only the skin.
EPIDEMIOLOGY
 They are amongst the most common causes of skin disease in the world, and
the real prevalence is probably underestimated.
 Onychomycosis is the most common nail disorder in adults causing about 50 %
of all nail diseases.
 Large-scale studies on onychomycosis conducted in the US and Canada in the
late 1990s showed a prevalence rate of 14 % and 8 %, respectively. In Europe,
the prevalence rate is even more variable: 2.7 % in the UK and Spain, 8.4 % in
Finland, 12.4 % in Germany and 16.8 % in France in a more recent study.
 The Achilles project, the largest survey on foot disease undertaken in Europe,
conducted in 20 European countries during 1997–1998, showed a particularly
high prevalence of fungal foot disease and onychomycosis which accounted
for 40.6 % and 28 %, respectively (data extracted from study II,including
clinical and mycological examination of patients consulting a dermatologist).
 Most common dermatophytosis and dermatophytes involved according to the country
Most common Most common Region Country
dermatophytosis dermatophyte
Tinea pedis + T. rubrum Europe UK
onychomycosis Sweden
Germany
Belgium
Poland
Slovakia
Spain
Greece
Middle East Turkey (Dusce)
Iran (Tehran)
North and Central USA
America Mexico
Japan
Asia
Tinea corporis T. Mentagrophytes Middle East Lebanon
Saudi Arabia
T. Verrucosum Northern Iran
M. Canis Europe Italy
T. Rubrum Asia India
Tinea capitis T. Tonsurans Caribbean Haiti
M. Audouinii Africa Mali
T. soudanense + T. tonsurans Nigeria
M. audouinii Senegal
T. soudanense Ethiopia
T. violaceum Botswana
CLASSIFICATION
Dermatophytosis
 Tinea pedis (athlete's foot) – fungal infection of the feet
 Tinea unguium – fungal infection of the fingernails and toenails, and the nail bed
 Tinea corporis – fungal infection of the arms, legs, and trunk
 Tinea cruris (jock itch) – fungal infection of the groin area
 Tinea manuum – fungal infection of the hands and palm area
 Tinea capitis – fungal infection of the scalp and hair
 Tinea barbae – fungal infestation of facial hair
 Tinea faciei (face fungus) – fungal infection of the face
Other superficial mycoses (not classic ringworm, since not caused by dermatophytes)
 Tinea versicolor – caused by Malassezia furfur
 Tinea nigra – caused by Hortaea werneckii
CLINICAL COURSE

Specific signs can be:

 red, scaly, itchy or raised patches
 patches may be redder on outside edges or resemble a ring
 patches that begin to ooze or develop blister
 bald patches may develop, when the scalp is affected
 nails may thicken, discolour or begin to crack[
Tinea capitis
Tinea barbae
Tinea corporis
Tinea faciei
Tinea pedis
Tinea unguium
Tinea manuum
Tinea cruris
Diagnostic Tests

Diagnosis is based on the

 history
 physical examination
 microscopic examination of scrapings and hairs from the lesions
 fungal culture
 other techniques such as Wood’s lamp examination and histology of the
tissues
TREATMENT
Antifungal treatments include
 topical agents such as miconazole, terbinafine, clotrimazole, ketoconazole, or
tolnaftate applied twice daily until symptoms resolve — usually within one or
two weeks. Topical treatments should then be continued for a further 7 days
after resolution of visible symptoms to prevent recurrence. The total duration
of treatment is therefore generally two weeks, but may be as long as three.
 In more severe cases or scalp ringworm, systemic treatment with oral
medications may be given.
 To prevent spreading the infection, lesions should not be touched, and good
hygiene maintained with washing of hands and the body.
 Misdiagnosis and treatment of ringworm with a topical steroid, a standard
treatment of the superficially similar pityriasis rosea, can result in tinea
incognito, a condition where ringworm fungus grows without typical features,
such as a distinctive raised border.
disinfection
Dermatophyte spores are susceptible to benzalkonium chloride, dilute chlorine
bleach (1% sodium hypochlorite), enilconazole (0.2%), formaldehyde and some
strong detergents.
Dermatophytes are also reported to be susceptible to iodophors, glutaraldehyde
and phenolic compounds; however, some agents may have limited efficacy in
“real life” environmental disinfection. The mechanical removal of any material
containing keratin, such as shed skin and hairs, facilitates disinfection.
Vacuuming is considered to be the best method in many cases. Dusting may also
be appropriate. After mechanical removal, washable surfaces should be cleaned
thoroughly with detergent and water.
Dermatophytes are susceptible to high heat. Moist heat of 121°C, applied for at
least 20 minutes, or dry heat of 165-170°C for 2 hours, are reported to be
effective
PREVENTION

 Avoid sharing clothing, sports equipment, towels, or sheets.

 Wash clothes in hot water with fungicidal soap after suspected exposure to
ringworm.
 Avoid walking barefoot; instead wear appropriate protective shoes in locker
rooms and sandals at the beach.
 Avoid touching pets with bald spots, as they are often carriers of the fungus.