2.  Superficial and cutaneous  Subcutaneous  Deep (systemic)

3.  Caused by fungi living as saprophytes  Hair, dead skin and lipids secretions  They don’t provoke any immune response  No pain or itching

4.  Common, mild and chronic infection of stratum corneum  World-wide  More common in tropics and sub-tropics  In temperate regions more common during summer

5. Pityriasis versicolor Caused by Malassezia yeast, which is lipophilic dimorphic fungus

6. KOH Parker ink staining

7. Tinea nigra Typical brown to black, non-scaling macules on the palmar aspect of the hands. Note: there is no inflammatory reaction

8.  Infections in the living parts of the body:  Skin  Hair and nail  Mucocutaneous membranes  Genitalia  Tow types can be recognized  Dematophytes infections  Non-dermatophytes infections

9.  Ringworm (hair and skin)  Favus (hair)  Onychomycosis (nail)

10. Infections of the skin, hair and nails due to a group of related filamentous keratinophilic fungi called dermatophytes

11.  Microsporum Hair, skin  EpidermophytonSkin, nail  TrichophytonHair, skin, nail  Digest keratin by their keratinases  Resistant to cycloheximide

12.  Some have a world-wide distribution  Some are restricted to particular regions  About 10 species are common causes of human infection  Classified into three groups depending on their usual habitat

13.  Human is usual host  T. rubrum (foot & nail infections)  E. floccosum (foot & nail infections)  T. tonsurans (scalp infections)  M. audouinii (scalp infections)

14.  Normal habitat is soil  Can cause infections in both humans and animals  Microsporum gypseum

15.  Often associated with a particular animal  Microsporum canis: cats and dogs  Trichophyton verrucosum: horse and cattle

16.  Skin:  Circular dry lesions  Slightly raised red scaly margins  Surrounded by red itchy skin  Fungus remain restricted to stratum corneum  Metabolites provoke inflammation  Hair:  Typical lesions → scarring + alopecia  Nail:  Thickened, deformed, fragile, discolored  Sub-ungual debris accumulation

17. Infection is named according to the anatomic location involved

18.  Ringworm  Tinea pedis (athlete's foot)  Tinea manuum (hands)  Tinea corporis (trunk, neck and back)  Tinea cruris (hairy skin around the genitilia)  Tinea barbae (hairy skin in the face)  Tinea capitis (scalp and eyebrows)

19.  Favus (scalp)  Onychomycosis (nail)

20. Athlete's foot (Tinea pedis )

21. Tinea pedis

22. Tinea manuum

25. Tinea corporis caused by M. canis following contact with infectious cat Tinea corporis

26. Tinea of the groin showing typical erythematous lesions on the inner thighs Tinea of the buttocks Tinea cruris

27. Tinea barbae

28. Tinea capitis caused by M. canis following contact with infectious cat Tinea capitis showing extensive hair loss caused by M. canis

29.  Favus  Special form of tinea capitis  Onychomycosis  Fungal infection of nail  The term "tinea unguium" is used specifically to describe dermatophytic onychomycosis

30. FavusTinea capitis showing alopecia

31. Tinea of the nails caused by T. rubrum

32.  50 % of suspicious materials may be negative  Hyphae and/or arthrospores is diagnostic  Culture is more reliable:  Determined species  Source of infection  Can be positive even if direct examination is negative

33. Hyphal elements seen in skin scraping preparation

34.  Dependant on the clinical setting  Topical or oral antifungal

35. InfectionRecommendedAlternative Tinea unguium [Onychomycosis] Terbinafine 250 mg/day 6 weeks for finger nails, 12 weeks for toe nails. Itraconazole 200 mg/day/3-5 months or 400 mg/day for one week per month for 3-4 consecutive months. Fluconazole 150-300 mg/ wk until cure [6-12 months]. Griseofulvin 500-1000 mg/day until cure [12-18 months]. Tinea capitis Griseofulvin 500mg/day [not less than 10 mg/kg/day] until cure [6-8 weeks]. Terbinafine 250 mg/day/4 wks. Itraconazole 100 mg/day/4wks. Fluconazole 100 mg/day/4 wks Tinea corporis Griseofulvin 500 mg/day until cure [4-6 weeks], often combined with a topical imidazole agent. Terbinafine 250 mg/day for 2-4 weeks. Itraconazole 100 mg/day for 15 days or 200 mg/day for 1week. Fluconazole 150-300 mg/week for 4 weeks. Tinea cruris Griseofulvin 500 mg/day until cure [4-6 weeks]. Terbinafine 250 mg/day for 2-4 weeks. Itraconazole 100 mg/day for 15 days or 200 mg/day for 1week. Fluconazole 150-300 mg/week for 4 weeks. Tinea pedis Griseofulvin 500mg/day until cure [4-6 weeks]. Terbinafine 250 mg/day for 2-4 weeks. Itraconazole 100 mg/day for 15 days or 200 mg/day for 1week. Fluconazole 150-300 mg/week for 4 weeks. Chronic and/or widespread non-responsive tinea. Terbinafine 250 mg/day for 4-6 weeks. Itraconazole 200 mg/day for 4-6 weeks. Griseofulvin 500-1000 mg/day until cure [3-6 months]. Oral management options

36.  Onychmycosis  Intertrigo  Mucocutaneous candidiasis  Thrush  Vulvo-vaginitis

37. Intertrigo caused by Candida albicans

38. Red macerated rash under pendulous breasts is a common presentation of cutaneous candidiasis

39. This condition should not be considered a primary Candida infection as it preceded by an irritant dermatitis

40.  Skin, subcutaneous tissues, fascia and bone  Localized  Trauma  More in tropics  Mycetoma, chromomycosis and sporotrichosis

41. Mycetoma

43. Sporotrichosis A 60-year-old woman developed multiple subcutaneous nodules and abscesses on her right hand and forearm 7 days after finger thorn prick

44. Sporotrichosis

45. Classical Chromoblastomycosis: Fonsecaea pedrosoi De Hoog, Centraalbureau voor Schimmelcultures

46. Nodulose chromoblastomycosis (Senegal): Fonsecaea pedrosoi De Hoog, Centraalbureau voor Schimmelcultures

47.  Difficult  Surgical excision  Itraconazole and other antifungal