fungal infections Cutaneous: dermatophytes, pityriasis versicolor, candidiasis. Subcut.: mycetoma Systemic: histoplasmosis, candidiasis, aspergillosis

Dermatophytes=ringworm=tinea 3 genera: trichophton, microsporum, epidermophyton. All give similar clinical picture. Invade keratin only. Zoophilic, anthropophilic and geophilic Clinical features depend on the site

Tinea pedis * swimming pools, occlusive footwear. * clinically: interdigital scaling diffuse scaling of sole recurrent vesicles of the sole mostly 3rd toe web, itchy , painful or asymptomatic

Interdigital scaling

Diffuse scaling of foot

Bullous tinea pedis

Tinea unguium (onychomycosis) Toe nail more common than finger nail due to spread from a near focus of tinea pedis Free edge becomes yellow proximal invasion with darkening of color Thickening of the nail plate and onycholysis

onychomycosis

Bilateral big toe nail discoloration Main clinical finding ? Bilateral big toe nail discoloration Diagnosis ? Onychomycosis [T. unguium] Prove the Dx. Nail clipping for KOH exam. & culture

Tinea corporis Erythematous scaly plaque, grow peripherally and clear centrally annular configuration =active border Close inspection vesicles and pustules

Tinea cruris Affects inguinal folds, mostly men, summer Erythematous plaque, scale, active border, not affects scrotum, vesicles and pustules Differential diagnosis: *Flexural ps. *candidiasis: satellite papules, pustules *seborrheic derm.:

T. cruris

Tinea faciei Erythematous annular plaque- face Diff. diag.: * seborr. Derm.: nasolabial, eyebrows, eyelashes, ears * Rosacea: bilateral, telangiectasia.

Tinea capitis Patch of hair loss, scales, easily epilated hair. Usually children Zoophilic spp.: Intense inflamm., boggy swelling, pustules = kerion Diff. diag.: alopecia areata: no inflamm. trichotillomania: psych. upset, broken hair

Non-scarring scaly patches with hair loss Clinical findings ? Non-scarring scaly patches with hair loss Diagnosis ? Tinea capitis Type of T. capitis ? Gray patch non-inflammatory T. capitis Confirm the diagnosis ? KOH / Culture / Wood’s lamp Treatment ? Gresiofulvin 10mg/kg/day/6weeks

Kerion Diagnosis ? Cause ? Zoophilic Fungi Treatment ? Griseofulvin This boy presented with a hemispherical crusted mass with hair loss on the lower part of the scalp of one month duration. Diagnosis ? Kerion Cause ? Zoophilic Fungi Treatment ? Griseofulvin

Investigations Skin scraping, nail clipping, hair plucking + KOH Culture on sabouraud’s dextrose agar wood’s light green fluorescence in some cases of T. capitis

Treatment Topical imidazoles ex. Clotrimazole, miconazole, econazole Few patches of T corporis, facei, cruris and pedis. Systemic therapy ex. Griseofulvin, terbinafine, imidazoles ex. Fluconazole, ketoconazole, itraconazole Tinea capitis, t. unguium, t.incognito, wide spread t. corporis, pedis and feciei

Candidiasis Opportunistic inf. Predisposing: age extremes, D.M, low immunity, ill fitted denture, obesity, antibiotics, pregnancy, malignancy. Oral thrush: whitish patches, removal erythem. base Angular stomatitis: whitish patches, soreness Intertrigo: (inguinal, axilla, under the breasts) erythematous patches, satellite papules and pustules Erosio interdigitale: eroded patch affects the webs

investigations Swab or scrapping for microscope exam yeasts Culture Treatment ● Correction of underlying pred. factor ● Topical azoles ● Nystatin or amphotericin ● Fluconazole, itraconazole

Interdigital erythema, fissuring and maceration Clinical findings ? Interdigital erythema, fissuring and maceration Interdigital (Flexural) Candidiasis Diagnosis ?

Oral thrush

Angular stomatitis

Intertriginous candidiasis

Pityriasis versicolor Affects young adults, hot humid climate Pityrosporum orbiculare, Keratinophilic and lipophilic. Brownish or hypopigmented round patches, with fine scales Upper trunk, upper arms, neck. Tend to recur.

Pityriasis versicolor Brownish patches with branny scales on the upper trunk Pityriasis versicolor

Pityriasis versicolor

investigations Usually it is a clinical diagnosis Scrapping. Wood’s light lemon yellow

treatment Topical: azoles: *ketoconazole shampoo * other azole creams selenium sulphide shampoo ● Systemic : fluconazole, ketoconazole, itraconazole

Antifungal therapy * Imidazoles: clotrimazole, miconazole econazole, ketoconazole. topical broad spectrum * Triazoles: itraconazole, fluconazole systemic broad spectrum * griseofulvin: systemic…dermatophytes * nystatin: topical and systemic..candidiasis

Summary T. pedis: interdigital scaling; diffuse scaling or bullae T. unguium: yellow free edge proximal invasion with darkening. Onycholysis. T. cruris and corporis: eryth. Scaly. With active boarder. T. capitis: patchy hair loss with inflamm.

Summary Oral thrush: whitish patches Angular stomatitis: whitish patches, soreness Intertrigo: erythematous patches, satellite papules and pustules Erosio interdigitale: eroded patch Pityriasis versicolor:Brownish or hypopigmented round patches, with fine scales