Fungal Infections, Papallosquamous

categories of fungi

mold

mildew

mushrooms

yeast

main types of fungi that cause infection

dermatophytes

yeast

structure of dermatophyte

multicellular

consists of hyphae

long, branching, filamentous structures of a fungus

hyphae

unicellular budding fungus

yeast

first step in diagnosing a scaling annular rash

KOH prep test

what is looked for in a KOH prep test

hyphae

Stains hyphae green against a grey background

KOH with chlorazol black E

yeast undergo what kind of reproduction

asexual; via budding

fungal cultures are typically needed for _

hair and nail infections

agar best for nail infetions

Sabaroud's agar

only _ cause hair tinea

dermatophytes

agar best for hair cultures

mycosel agar

Office-based test where yellow medium turnspink within 6-7 days in the presence of alkaline dermatophyte metabolic products.

dermatophyte test medium (DTM)

how does DTM compare to fungal culture

faster but less accurate

superficial fungal infections are caused by fungi that _

only invade fully keratinized tissues

examples of fully keratinized tissues

skin

hair nails

scalp ringworm medical term

tine capitis

body ringworm medical term

tinea corporis

athletes foot medical term

tinea pedis

jock itch medical term

tinea cruris

nail fungus infection medical term

tinea unguium / onychomycosis

trichophyton rubrum causes

tinea corporis

tinea ungium

Trichophyton tonsurans causes

tinea capitis

Microsporum canis causes

tinea corporis (less commonly)

Major Organisms of Dermatophytosis (4)

trichophyton rubrum

tricophyton tonsurans

microsproum canis

epidermophton species

age group for tinea capitis

children between age 2-10

rare in adults

tinea capitis will sometimes cause _

a kerion

presentation of tinea capitis

scaly plaques with associated alopecia on the scalp

is tinea capitis contagious?

highly contagious

kerion description

painful, eryhtematous, boggy plaque associated with alopecia and pustules

age group of tinea corporis

all ages

tinea corporis is more common in what climate

warmer climates

symptoms of tinea capitis

red, scaly rash on scalp

itching

hair loss

rashes elsewhere on body

Characterized initially by a ring-like eruption on the body or the face

tinea corporis

symptoms of tinea corporis

red circular lesion with raised edges

middle of lesion might become less red as grows

itching

Erythematous annular or serpiginous plaque with central clearing and advancing margin of scale

tinea corporis

tinea cruris usually does not involve _ (body part)

scrotum

who is most commonly affected by tinea pedis

teen and adult males

causes of tinea pedis (4)

sweating

not drying the feet

wearing tight socks/shoes

warm weather

whitening of skin b/t toes

scaling of the feet

itchy rash of feet

blisters of feet

tinea pedis

Erythematous thin plaque with diffuse scale in a moccasin distribution + interdigital erythema, maceration, and scale

tinea pedis

who is tinea unguium most common in

adolescents and adults

signs of tinea unguium

thickening and crumbling of the ends of nails and nail plate

yellowing of the nails

cause of tinea incognito

use of topical corticosteroids on dermatophyte infections

fungal infections are often misdiagnosed as

psoriasis

dermatitis

specific treatment of tinea infections are based on what 3 main things

medical history

extent of condition

location

tinea locations treated with topical or oral antifungals

body

groin

foot

azoles are _

fungistatic

fungistatic medications

ketoconzaole

clotrimazole

itraconazole

fluconozale

what do allylamines do

kill the pathogen

allylamines examples

terbinafine

naftifine

benzalylamines are _

fungicidal

example of Benzaylamines

butenafine

nystatin is an effective treatment for _

cutaneous Candida infections

most cutaneous dermatophyte infections of the epidermis can be managed with _

topical antifungal therapy

nystatin should NOT be used for

dermatophyte infectionns

some topical antifungal drugs have intrinsic _

anti-inflammatory properties

oral antifungal treatment is used for _

extensive infections

refractory to topical therapy

infections of the follicles

nail infections

what to watch for with terbinafine (3)

cutaneous adverse reactions

hepatotoxicity

drug interactions

itraconazole hs a black box warning for _

CHF

drug interaction associated with itraconazole

CYP3A4

what to watch for with griseofulvin

GI upset

headache

rash

why is oral ketoconazole no longer recommended

severe liver injury

adrenal insufficiency

drug interactions

etiology of tinea versicolor

malassezie furfur

malaseezia globosa

wood's lamp is helpful to diagnose _

tinea versicolor

tinea versicolor appearance under wood lamp

pale yellow/green fluorescence

when is tinea versicolor more common

during summer months

age group for tine versicolor

adolescence

early adulthood

Hypo- or Hyper- pigmented coalescing macules and patches on the trunk and upper arms with fine scale

tinea versicolor

tinea versicolor OTC treatment

selsun blue shampoo

head and shoulders shampoo

nizoral shampoo

tinea versicolor RX treatment

ketoconazole 2%

cicloporix 1% shampoo

fluconazole 300 mg

itraconazole 200 mg

seborrheic dermatitis worsens with _

stress and during cold/dry winter months

increased incidence and severity of seborrheic dermatitis with what conditions?

HIV

Parkinson disease

etiology of Seborrheic Dermatitis

overgrowth of Malassezia on sebum-rich skin

dysregulated immune response

skin barrier disruption

Seborrheic Dermatitis common locations

scalp and face

Symmetric, poorly defined erythematous patches with yellow, greasy scale and fine flaking

seborrheic dermatitis

goal of seborrheic dermatitis treatment

CONTROL, not cure

cradle cap treatment

mineral oil and gentle combing

SD of the scalp treatment

antifungal shampoos

topical corticosteroid scalp solution

topical corticosteroids for scalp SD

clobetasol

fluocinolone

treatment for face SD

antifungal creams

mild potency topical steroids

non-steroid topicals

topical steroids for facial SD

hydrocortisone

desonide

drug class for non-steroidal topicals for facial SD

calcineurin inhibitors

non-steroid topicals for facial SD

tacrolimus

piemcrolimus

superficial inflammatory dermatitis driven by moisture and friction

intertrigo

yeast associated with intertrigo

Candida

predisposing factors of candidal intertrigo

obesity

diabetes

imunosuppresion

pregnancy

hyperhidrosis

incontinence

common sites of candidal intertrigo

inframammary

axillary

inguinal/genital

abdominal panniculus

gluteal cleft

digtial web spaces

diaper area

Bright, "beefy" erythema with erosions/maceration

Satellite papules at the periphery

Fine peripheral scaling/collarettes

candidal intertrigo

how does yeast present on KOH stain

spaghetti and meatballs

Tx for candidal intertrigo

keep folds dry/ventilated, reduce friction

topical antifungal creams

topical antifungal powders

skin inflammation involving the epidermis and superficial dermis

dermatitis

characteristic of acute dermatitis

itching

erythema

vesiculation

characteristic of chronic dermatitis

pruritis

xerosis

lichenification

scaling

with/wo fissuring

an inflammatory reaction resulting from exposure to a substance that causes a reaction for most people who come in contact with it

irritant contact dermatitis

an acquired sensitivity to substances that produce inflammatory reactions only in those who have been previously sensitized to the allergen

allergic contact dermatitis

rash and symptoms usually occur within _ of exposure to irritants

hours

occurs when sufficient concentration of a chemical, such as detergents, solvents, or bleaches come into contact with the skin for sufficient time in any person to cause erythema, scaling, or blisters

irritant contact dermatitis

type of immune reaction with allergic contact dermatitis

delayed type IV T-cell mediated hypersensitivity reactions