DERMATOPHYTE INFECTION

The fungi that infect skin / hair / nails are called "dermatophytes" and belong to the following genera: Microsporum, Trichophyton and Epiderimophyton.

Predisposing Factors

•        Local or systemic immune suppression.

•        Genetic susceptibility.

•        Diabetes.

•        Environmental factors.

Depending on the site of body involved, different names are given.

•        Head : Tinea capitis

•        Face : Tinea faciei

•        Beard : Tinea barbae

•        Trunk / body : Tinea corporis

•        Groin / gluteal folds : Tinea cruris

•        Palms : Tinea manuum

•        Soles : Tinea pedis

•        Nail : Tinea unguium

Clinical features

•        Sharply marginated, annular or polycyclic lesions with erythematous papules, vesicles, scaly borders and central clearing.

•        Tinea capitis – presents as area of partial hair loss, dull gray, lusterless hair that are easily pulled out or inflamed boggy, indurated swelling with pustules and crusting in the inflammatory type.

•        Tinea unguium: may present as dirty, dull, dry, pitted, ridged, split, discoloured, thick, uneven nails with subungual hyperkeratosis.

Diagnosis & Investigations

•        Mainly clinical

•        Microscopy- KOH mount

•        Culture – Sabouraud’s dextrose agar

•        Woods lamp examination – greenish yellow fluorescence

Non-pharmacological treatment

•        Avoid tight fitting clothes and shoes

•        Avoid prolonged working in wet area

•        Keep the skin dry

Pharmacological treatment

Topical treatment:

•        Clotrimazole, miconazole or Luliconazole as cream, ointment, lotion or powder formulation. To apply twice a day for 4-6 weeks.

•        5% Amorolfine or 8% Ciclopirox olamine nail lacquer. To apply twice or thrice a week for 2-3 months.

Systemic treatment:

•        Tab Fluconazole 150mg/ week for 4-6 weeks (3-6 mg/kg in children)

•        Cap Itraconazole 200 OD for 2-4 weeks (5mg/kg/day in children)

•        Tab Terbinafine 250mg/day for 2-4 weeks (6mg/kg/day in children)

•        Tab Griseofulvin 500mg OD for 6-8 weeks (10-20mg/kg/day in children)

•        Treatment have to be continued for 3-6 months for tinea unguium.

CANDIDIASIS

It is a common infection caused by a yeast Candida. Most commonly caused by Candida albicans and sometimes by other species of candida.

Clinical features

•        Flexural candidiasis – multiple diiscr etepustuIes on erythematous base with satellite lesions. Commonly seen between fingers, toes, axilla, groin and buttocks.

•        Candidal paronychia – painful, swollen and red proximal and lateral nail folds with occasional discharge of pus.

•        Oral candidiasis (Thrush) - friable greyish white membranous plaques in mouth.

•        Candidal balanoposthitis – intense erythema with desquamation/ superficial erosions, fissuring, maculopapular rash over glans and foreskin.

•        Candidal vulvovaginitis – vulvar pruritus, thick curd like vaginal discharge, dysuria and dyspareunia.

Diagnosis & Investigations

•        Clinical

•        Microscopy – 10% KOH exa mination to look for yeast cells and mycelia.

•        Culture – Sabauraud,s Dextrose agar medium

Non- pharmacological Treatment

•        Maintain personal hygiene

•        Keep the affected area dry and clean

•        Control of underlying co-morbidities

Pharmacological Treatment

Topical Therapy:

•        Clotrimazole 1% mouth paint BD for 4 weeks

•        Clotrimazole or miconazole cream BD for 2-4 weeks.

•        Clotrimazole vaginal pessary – daily for 5-7 days

Systemic therapy:

•        Tab. Fluconazole 150mg single dose (3-6 mg/kg in children)

PITYRASIS VERSICOLOR

It is a mild, superficial fungal infection of the skin caused by the mycelial form of malassezia furfur.

Predisposing conditions

Hot, humid and damp conditions.

Clinical features

•        MacuIes which may be hypo or hyper pigmented covered with branny scales.

•        Usually asymptomatic but sometimes mild irritation may be present.

•        Sites : Mainly on upper trunk, neck and upper arms.

Diagnosis & Investigations

•        Clinical

•        Direct examination under woods lamp- yellow fluorescence

•        10% KOH examination of skin scrapings – mycelia and yeast form seen

Treatment

•        Topical therapy:

Lotions to be applied for 5-10 minutes before bath.

-         Selenium sulfide 2.5 % to be applied once daily x 14 days

-         Zinc pyrithione 1% to be applied once daily x 1 4 days

-         Ketoconozole 2% to be applied once daily x 2 weeks

-         Miconazole2 % to be applied once daily x 2 weeks

•        Systemic therapy:

-         Tab Fluconazole 400 mg single dose

-         Ketoconazole 200 mg OD x 7 -1 0 days.

-         Itraconazole 200 mg OD x 3 -7 days.