Fungal Infections

Candida Infections

-Usually caused by candida albicans

-Imbalance in normal flora

-Grows in warm, moist environment

-Infections confined to mucous membranes and intertriginous area

Predisposing Factors of candida infections

-Infancy

-Pregnancy

-OCP use

-Systemic antibiotic therapy

-Topical or systemic steroid therapy

-Skin maceration

-Immunosuppression

What is Candidal Balanitis?

Infection of the foreskin and glans penis

Can Candidal Balanitis spread to surrounding areas?

Yes, it can spread to surrounding areas.

In which populations does Candidal Balanitis commonly occur?

It occurs in uncircumcised men and young children.

What is the appearance of lesions in Candidal Balanitis?

Pinpoint erythematous papules evolve into umbilicated pustules.

What happens to pustules in Candidal Balanitis?

Pustules rupture leaving 1-2mm, white erosions.

What symptoms can limit retraction of the foreskin in Candidal Balanitis?

Edema and pain can limit retraction of the foreskin.

Risk factors for Candidal Balanitis

-Poor Hygiene

-Sex with infected individuals

-Diabetic

Diagnosis of Candidal Balanitis

-History and exam

Tests for Candidal Balanitis

-KOH

-Fungal Culture

-Bacterial Culture

DDX of Candidal Balanitis

-Herpes

-Inverse psoriasis

-Irritant contact dermatitis

Treatment for Candidal Balanitis

-Topical antifungal (Miconazole, clotrimazole, nystatin BID x 7-14 days)

-Diflucan 150 mg PO daily x 3 days for severe

Candidal Diaper Dermatitis

-Beefy red plaques with satellite papules and pustules

Risk factors for Candidal Diaper Dermatitis

-Prolonged exposure to moisture and friction from the diaper

-Use of broad-spectrum antibiotics

-Non-breast fed

Diagnosis of Candidal Diaper Dermatitis

-History and Physical

-Testing (KOH and cultures)

DDX for Candidal Diaper Dermatitis

-Irritant contact dermatitis

-Strep perianal cellulitis

-Staph impetigo

-Herpes

-Inverse psoriasis

-Zinc deficiency

What is a key treatment for Candidal Diaper Dermatitis regarding diaper management?

Minimize wet diapers

What should be allowed to help treat Candidal Diaper Dermatitis?

Diaper free time

What type of ointment should be applied for Candidal Diaper Dermatitis?

Barrier ointment

What should be avoided when treating Candidal Diaper Dermatitis?

Harmful cleansers

What type of antifungals are used topically for Candidal Diaper Dermatitis?

Topical azole antifungals

How often should topical azole antifungals be applied for Candidal Diaper Dermatitis?

2-3 times a day until resolution

What is Candidal Intertrigo?

An inflammatory condition of skin folds.

What skin findings suggest candidal involvement in Candidal Intertrigo?

Erythematous satellite papules and pustules.

What are common complaints associated with Candidal Intertrigo?

Burning, tenderness, pruritus, and malodorous discharge.

Diagnosis of Candidal Intertrigo

-History and Exam

-Tests (KOH and Culture)

DDX of Candidal Intertrigo

-Inverse psoriasis

-Allergic contact dermatitis

-Erythrasma

Treatment of Candidal Intertrigo

-Daily cleansing with a mild cleanser

-Dry completely

-Aerate area

-Application of drying powder

-Application of barrier cream

What is a common topical treatment for Candidal Intertrigo?

Topical azoles (1-2 times daily for 2-4 weeks)

What can be used to relieve pruritus in Candidal Intertrigo?

Low dose topical steroids

What is the recommended dosage of Diflucan for severe cases of Candidal Intertrigo?

150 mg PO weekly for 4 weeks

Cutaneous Fungal Infections

-Dermatophytes survive on dead keratin

-Dermatophytes responible for a majority of fungal infections

-Three pathogens (microsporum, trichophyton, epidermophyton)

Diagnosis of Cutaneous Fungal Infections

-KOH

-Woods lamp (will not fuoresce)

Tinea Corporis

-Fungal infection anywhere but feet, groin, or hand

-Caused by Trichophyton rubrum

-Lesion size varies

DDX of Tinea Corporis

-Nummular eczema

-Psoriasis

-Pitriasis rpsea

Clinical features of Tine Corporis

-Pruritic circular erythematous or hyperpigmented scaling plaque

-Central area will become hypopigmented and less scaly

-Extensive rash should raise concern for autoimmune

Tinea Faciei

-Infection o nthe face

-Uncommon

-Misdiagnosied as atopic dermatitis, psoriasis or seborrheic dermatitis

What is Tinea Mauum?

An infection on the hand.

How does the dorsum of the hand appear in Tinea Mauum?

It will appear like ringworm.

What is the appearance of the palms in Tinea Mauum?

They will have a dry diffuse keratotic appearance.

What condition is Tinea Mauum often misdiagnosed as?

Eczema.

With which other condition is Tinea Mauum commonly seen?

Tinea pedis.

What nail condition may be present with Tinea Mauum?

Onychomycosis.

Tinea Pedis

-Athletes foot

-Most common dermatophyte infection

-Acquired by direct contact

-Accompanied by onychomycosis, tinea cruris, or tinea manuum

-Severe itching

What is the most common type of tinea pedis?

Interdigital Tinea Pedis

What organism causes Interdigital Tinea Pedis?

Trichophyton rubrum

What are the symptoms of Interdigital Tinea Pedis?

Dry, scaly, macerated, or fissured skin between toes

How does Interdigital Tinea Pedis present in relation to web spaces?

It extends out of the web spaces

What is moccasin tinea pedis?

Chronic tinea pedis

What is a characteristic of moccasin tinea pedis regarding treatment?

Resistant to treatment

What fungus causes moccasin tinea pedis?

Trichophyton rubrum

What is a visual characteristic of moccasin tinea pedis?

Diffuse hyperkeratotic silvery, white plaques

Where on the body does moccasin tinea pedis occur?

On the soles of the feet

What is a common underlying condition associated with moccasin tinea pedis?

Underlying erythema

Vesiculobullous tinea pedis

-Highly inflammatory infection

-Caused by Trichophyton interdigitale

-Clusters or pruritic and painful vesicles and pustules

-Underlying erythema

DDX of tinea infections

-Atopic Dermatitis

-Contact dermatitis

-Palmoplantar Psoriasis

-Keratoderma

-Acute palmoplantar dyshidrotic eczema

What is a topical treatment for Tinea infections that involves azole antifungals?

Topical azole antifungals (apply 1-2 times daily for 1-3 weeks)

What is the recommended application frequency and duration for Butenafin 1% cream in treating Tinea infections?

Daily for 2-4 weeks

How often should Terbinafine 1% cream be applied for Tinea infections, and for how long?

2 times daily for 2-4 weeks

What is the oral treatment for tinea infections with Terbinafine?

250 mg daily for 1-2 weeks

What is the oral treatment for tinea infections with Itraconazole?

200 mg daily for a week

What is the oral treatment for tinea infections with Fluconazole?

150-200 mg once weekly for 2-4 weeks

What is another name for Tinea Cruris?

Jock Itch

What fungus causes Tinea Cruris?

Trichophyton rubrum

What are the symptoms of Tinea Cruris?

Marked pruritus and erythema on the proximal medial thigh

How does Tinea Cruris spread?

Centrifugally with partial central clearing

What is the appearance of Tinea Cruris lesions?

Slightly elevated erythematous or hyperpigmented sharply demarcated borders

Which area does Tinea Cruris spare?

Scrotum

DDX of Tinea Cruris

-Candidal Intertrigo

-Inverse Psoriasis

-Erythrasma

-Seborrheic Dermatitis

What is a recommended treatment for Tinea Cruris?

Apply moisture absorbing powder

What type of clothing should be avoided when treating Tinea Cruris?

Tight fitting clothing

What type of underwear is recommended for Tinea Cruris?

Cotton underwear

What are some topical antifungals used for Tinea Cruris?

Econazole, miconazole, butenafine

How often should topical antifungals be applied for Tinea Cruris?

2 times daily for 10-14 days

What is the dosage of terbinafine for severe Tinea Cruris?

250 mg once daily for 1-2 weeks

What is the dosage of itraconazole for severe Tinea Cruris?

200 mg once daily for a week

What is the dosage of fluconazole for severe Tinea Cruris?

150-200 mg once weekly for 2-4 weeks

Tinea Versicolor

-Pityriasis versicolor

-Caused by Malassezia Furfur

-Common in adolescents or young adults

-Tropical climates

-Lesion do not tan

What are the characteristics of tinea versicolor lesions?

Well demarcated macules, patches, and thin plaques with a fine scale.

Where is tinea versicolor commonly found on the body?

Upper trunk, neck, and proximal extremities.

What symptom is commonly associated with tinea versicolor?

Mild pruritus.

What causes hypopigmentation in tinea versicolor?

Azelaic acid damaging melanocytes.

Diagnosis of Tinea Versicolor

-KOH (spaghetti and meatballs)

-Woods Lamp (yellow to yellow-gream fluorescence

DDX of Tinea Versicolor

-Vitiligo

-Pityriasis Rosea

-Guttate PSoriasis

-Secondary Sypphilis

What is a key component of patient education for Tinea Versicolor?

Patient education

What is the recommended application method for Topical Selenium sulfide 2.5% lotion or shampoo?

Apply from neck to waist and rinse after 10 minutes daily

How should Topical Zinc Pyrithione 1% or 2% shampoo be used?

Apply and rinse after 5 minutes daily for 2 weeks

What is the usage guideline for Ketoconazole shampoo 2%?

Apply and rinse after 5 minutes daily for 3 days

How should Miconazole, clotrimazole, econazole, or ketoconazole be applied?

Apply at bedtime for 2-4 weeks

What is the application frequency for Ciclopirox 1% cream?

Apply BID for 14 days

What is the recommended application method for Terbinafine 1%?

Apply BID for a week

When are oral azoles indicated in the treatment of Tinea Versicolor?

For severe cases

What is Angular Chelitis?

Acute or chronic inflammation at the corners of the mouth.

What areas can Angular Chelitis extend to?

It may extend to the perioral skin or oral mucosa.

What are common symptoms of Angular Chelitis?

Pruritus and burning.

Who is commonly affected by Angular Chelitis?

It is common in the elderly.

What is one treatment to improve oral hygiene for Angular Chelitis?

Improve oral hygiene

What type of lip balm should be used at bedtime for Angular Chelitis?

Thick protective lip balm

What cream can be used for inflammation in Angular Chelitis?

Pimecrolimus 1% cream