Tinea infections - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
The presentation depends on the site and the strain of the fungus involved. Tinea infections are superficial fungal infections. Dermatophytes of genera Trichophyton, Microsporum and Epidermophyton causes Tinea infections. Trichophyton commonly involve skin, hair and nail. Microsporum commonly involve skin and hair. Epidermophyton commonly involve skin and nails. ,,,, The presentation depends on the site and the strain of the fungus involved.
Tinea infections are superficial fungal infections. Dermatophytes of genera Trichophyton, Microsporum and Epidermophyton causes Tinea infections. Trichophyton commonly involve skin, hair and nail. Microsporum commonly involve skin and hair. Epidermophyton commonly involve skin and nails. ,,,,
In most Tinea infections the patient presents with a scaly rash. Dertmatophytes invade only into the stratum corneum, and the inflammation they cause is a result of metabolic products of the fungus or a delayed hypersensitivity reaction. Usually zoophilic fungi (those transmitted to humans by animals) cause a more severe inflammation than the anthrophillc variety (spread from person to person). ,,,,, In most Tinea infections the patient presents with a scaly rash.
Dertmatophytes invade only into the stratum corneum, and the inflammation they cause is a result of metabolic products of the fungus or a delayed hypersensitivity reaction. Usually zoophilic fungi (those transmitted to humans by animals) cause a more severe inflammation than the anthrophillc variety (spread from person to person). ,,,,,
Pruritus Most patients complain of pruritus, it ranges from mild to intense itching. ,,, Pruritus
Most patients complain of pruritus, it ranges from mild to intense itching. ,,,
Contact history Tinea infections are contagious and communicable fungal infections. Therefore contact history with infected family member or sharing clothes, combs, towels, bedlinen or animal contact may be positive in the history. Overcrowding and poor social conditions are risk factors in the history. ,,,, Contact history
Tinea infections are contagious and communicable fungal infections. Therefore contact history with infected family member or sharing clothes, combs, towels, bedlinen or animal contact may be positive in the history. Overcrowding and poor social conditions are risk factors in the history. ,,,,
History of immunosuppression. Protection against fungal infections is mediated by cell mediated immunity (CMI). Conditions such as long term steroid therapy, Cushing syndrome, HIV infection and malnutrition are possible risk factors in the history. ,,, History of immunosuppression.
Protection against fungal infections is mediated by cell mediated immunity (CMI). Conditions such as long term steroid therapy, Cushing syndrome, HIV infection and malnutrition are possible risk factors in the history. ,,,
Common among young adults Due to physiological changes occur with puberty sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media to growth of causative organisms. ,,, Common among young adults
Due to physiological changes occur with puberty sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media to growth of causative organisms. ,,,
History of living in tropical regions Warmth and humidity provides a suitable environment to pathogenic growth of causative organisms. ,,, History of living in tropical regions
Warmth and humidity provides a suitable environment to pathogenic growth of causative organisms. ,,,

Clinicals - Examination

Fact Explanation
Round, scaling area of alopecia and diffuse scaling in the scalp Tinea infections involving the scalp is called Tinea capitis. Usually this is a disease of children. Anthrophilic organisms cause bald and scaly areas with minimal inflammation and hair breaks off 3-4 cm from the scalp. Zoophillic fungi induce more intense inflammation causing red boggy area with pustules resulting a kerion. ,,,,, Round, scaling area of alopecia and diffuse scaling in the scalp
Tinea infections involving the scalp is called Tinea capitis. Usually this is a disease of children. Anthrophilic organisms cause bald and scaly areas with minimal inflammation and hair breaks off 3-4 cm from the scalp. Zoophillic fungi induce more intense inflammation causing red boggy area with pustules resulting a kerion. ,,,,,
Single or multiple annular plaques in the trunk and limbs with scalling and erythema most prononced at the periphary. Tinea infections involving the body surface including trunk and limbs are Tinea corporis. The lesions expand slowly and healing in the center leaves a typical ring like pattern. ,,,, Single or multiple annular plaques in the trunk and limbs with scalling and erythema most prononced at the periphary.
Tinea infections involving the body surface including trunk and limbs are Tinea corporis. The lesions expand slowly and healing in the center leaves a typical ring like pattern. ,,,,
Sharply demarcated area in the groin with elevated, scaling, serpengious borders. Tinea infections involving the groin is called as Tinea cruris. This is common and affects men more than women. The eruption is sometimes unilateral or asymmetrical. The upper inner thigh is involved and lesions expand slowly. ,,,, Sharply demarcated area in the groin with elevated, scaling, serpengious borders.
Tinea infections involving the groin is called as Tinea cruris. This is common and affects men more than women. The eruption is sometimes unilateral or asymmetrical. The upper inner thigh is involved and lesions expand slowly. ,,,,
Interdigital maceration, Diffuse scaling on soles and sides of feet. Tinea infections involving the feet is called as Tinea pedis(athlete's foot). The causative organisms are Trichophyton Rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum. ,,,, Interdigital maceration, Diffuse scaling on soles and sides of feet.
Tinea infections involving the feet is called as Tinea pedis(athlete's foot). The causative organisms are Trichophyton Rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum. ,,,,
Diffuse dry scaling on one palm Tinea infections involving the hand is called as Tinea manuum. The causative organisms are Trichophyton Rubrum, Trichophyton mentagrophytes and epidermophyton floccosum. ,,,, Diffuse dry scaling on one palm
Tinea infections involving the hand is called as Tinea manuum. The causative organisms are Trichophyton Rubrum, Trichophyton mentagrophytes and epidermophyton floccosum. ,,,,
Slightly scaling, erythematous patches and plaques in face. Tinea infections involving the face are Tinea faciale. When involving the beard are in men it is called as Tinea barbae. Commonly caused by zoophilic organisms. ,,,, Slightly scaling, erythematous patches and plaques in face.
Tinea infections involving the face are Tinea faciale. When involving the beard are in men it is called as Tinea barbae. Commonly caused by zoophilic organisms. ,,,,
Subungal debris with separation of the nail bed. Tinea infections involving the nail are Tinea unguium. The initial changes occur at the free edge of the nail, which become yellow and crumbly. Toe nail infection is associated with Tinea pedis. Finger nail infections are similar but less common. ,,,, Subungal debris with separation of the nail bed.
Tinea infections involving the nail are Tinea unguium. The initial changes occur at the free edge of the nail, which become yellow and crumbly. Toe nail infection is associated with Tinea pedis. Finger nail infections are similar but less common. ,,,,

Investigations - Diagnosis

Fact Explanation
Woods light examination Uses ultraviolet light to observe skin closely. It reveal some of epidermophytes with green fluorescence. But some causative fungus does not fluoresce. ,,,, Woods light examination
Uses ultraviolet light to observe skin closely. It reveal some of epidermophytes with green fluorescence. But some causative fungus does not fluoresce. ,,,,
Light microscopic examination The skin scrapings should be taken from the scaly margin of a lesion, with a small curette or a scalpel blade, and clippings or scrapings from the most crumbly part of the nail. Broken hair should be plucked with tweezers. The specimens are cleared in pottassium hydroxide. Branching hyphae and spores can easily be seen. ,,,,, Light microscopic examination
The skin scrapings should be taken from the scaly margin of a lesion, with a small curette or a scalpel blade, and clippings or scrapings from the most crumbly part of the nail. Broken hair should be plucked with tweezers. The specimens are cleared in pottassium hydroxide. Branching hyphae and spores can easily be seen. ,,,,,
Culture Culture Should be carried out in a mycology or bacteriology laboratory. Transport medium is not necessary, and specimens can be sent in folded black paper and dry petri dish. The report may take as long as a month: microscopy is much quicker. ,,,, Culture
Culture Should be carried out in a mycology or bacteriology laboratory. Transport medium is not necessary, and specimens can be sent in folded black paper and dry petri dish. The report may take as long as a month: microscopy is much quicker. ,,,,

Investigations - Management

Fact Explanation
Follow up clinic visits To assess the response to treatments and complications of the disease follow up clinic visits are arranged. ,,, Follow up clinic visits
To assess the response to treatments and complications of the disease follow up clinic visits are arranged. ,,,
Periodic monitoring When patients are treating with systemic antifungals, periodic monitoring of liver function tests and full blood count is important because of the serious side effects such as hepatotoxicity and thrombocytopenia. ,,,,, Periodic monitoring
When patients are treating with systemic antifungals, periodic monitoring of liver function tests and full blood count is important because of the serious side effects such as hepatotoxicity and thrombocytopenia. ,,,,,

Management - Supportive

Fact Explanation
Educate the patient Tinea infections are common superficial fungal infections, that can be treated successfully. ,,,, Educate the patient
Tinea infections are common superficial fungal infections, that can be treated successfully. ,,,,
Advise regarding hygiene Tinea infections are contagious and communicable fungal infections. They can be treated successfully but recurrence is common. Therefore advise not to share clothes, towels, bedlinen, etc. Advise regarding importance of daily bathing and wearing clean dry clothes. ,,,, Advise regarding hygiene
Tinea infections are contagious and communicable fungal infections. They can be treated successfully but recurrence is common. Therefore advise not to share clothes, towels, bedlinen, etc. Advise regarding importance of daily bathing and wearing clean dry clothes. ,,,,

Management - Specific

Fact Explanation
Local imidazole preparations An imidazole containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for 3-4 week period is usually adequate. Imidazoles interfere with fungal oxidative enzymes to cause lethal accumulation of hydrogen peroxide. They also reduce the formation of ergosterol, an important constituent of fungal cell wall which thus becomes permeable to intracellular constituents. When topical treatment has failed systemic drugs need to be considered. ,,,,,, Local imidazole preparations
An imidazole containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for 3-4 week period is usually adequate. Imidazoles interfere with fungal oxidative enzymes to cause lethal accumulation of hydrogen peroxide. They also reduce the formation of ergosterol, an important constituent of fungal cell wall which thus becomes permeable to intracellular constituents. When topical treatment has failed systemic drugs need to be considered. ,,,,,,
Topical nail preparations Many patients now prefer to avoid systemic treatment. For them a nail lacquer containing amorolfine is worth a trial. Ciclopirox is an alternative topical tratment available in USA. Both amorolfine and tioconazole nail solutions can be used as adjunct to systemic therapy. , Topical nail preparations
Many patients now prefer to avoid systemic treatment. For them a nail lacquer containing amorolfine is worth a trial. Ciclopirox is an alternative topical tratment available in USA. Both amorolfine and tioconazole nail solutions can be used as adjunct to systemic therapy. ,
Terbinafin Has now largely superseded griseofulvin. It acts by inhibiting fungal squalaneepoxidase and does not interact with cytochrome p-450 system. It is fungicidal and so cures chronic dermatophyte infections more quickly and more reliably than griseofulvin. 250mg daily given for 2-6 weeks. ,,, Terbinafin
Has now largely superseded griseofulvin. It acts by inhibiting fungal squalaneepoxidase and does not interact with cytochrome p-450 system. It is fungicidal and so cures chronic dermatophyte infections more quickly and more reliably than griseofulvin. 250mg daily given for 2-6 weeks. ,,,
Itraconazole Is now preferred to Ketoconazole , which occasionally damages the liver, and is a reasonable alternative to terbinafin if this is contraindicated. Fungistactic rather than fungicidal, it interferes with cytochrome P-450 system, thus a review of any other medication being taken is needed before a prescription is issued. ,,,,,, Itraconazole
Is now preferred to Ketoconazole , which occasionally damages the liver, and is a reasonable alternative to terbinafin if this is contraindicated. Fungistactic rather than fungicidal, it interferes with cytochrome P-450 system, thus a review of any other medication being taken is needed before a prescription is issued. ,,,,,,
Griseofulvin Was for many years drug of choice for chronic dermatophyte infections, but is now largely reserved for treatment of tinea capitis. Griseofulvin prevents fungal growth by inhibiting mitosis. The therapeutic efficacy of griseofulvin depends on its capacity to bind to keratin. ,,, Griseofulvin
Was for many years drug of choice for chronic dermatophyte infections, but is now largely reserved for treatment of tinea capitis. Griseofulvin prevents fungal growth by inhibiting mitosis. The therapeutic efficacy of griseofulvin depends on its capacity to bind to keratin. ,,,
Ketoconazole This drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects, including rashes, Thrombocytopenia and gastrointestinal disturbances. 200mg daily given for 2-6weeks . ,,,,, Ketoconazole
This drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects, including rashes, Thrombocytopenia and gastrointestinal disturbances. 200mg daily given for 2-6weeks . ,,,,,

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