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8/4/2019 Mycology Lecture Final
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FUNGAL
INFECTIONSOF THE SKIN
DERMATOMYCOSES
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MYCOSES MEANSFUNGUS
DERMATO MEANS
SKIN
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Superficial
Dermatomycoses
(tinea)
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Deep
Dermatomycoses
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Superficial mycoses
invade skin surface
i.e epidermis andepidermal appendages
especially hairs and nail
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Classification
Regional:
T.CAPITIS:
-FAVUS
-RING WORM
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RINGWORM:INFLAMMATORY
-PUSTULAR FOLLICULITIS-KERION CELZI
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NON-INFLAMMATOR
1-GRAY PATCH.
2-BLACK DOT R.W.
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T.CORPORIS:
-T.CIRCINATA.
-T.CRURIS.
-T.VERSICOLOUR
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-T.MANUS.
-T.PEDIS.
-ONYCHOMYCOSES
(T.UNGIUM).
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Tinea Capitis
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Fungus infection of
the scalp
Ring Worm
Favus
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Ring WormGray Patch
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Is the commonest
variety of mycotic
scalp affections.
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incubation period
is 1- 4 weeks.
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Usually affects
children at
school age
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spreads in epidemics
especially in family
and school children
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usually causedby
MicrosporonAuduini
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Grey Patch
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Symptoms
Apart from hair
affection, the patient
complains ofhair fall
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Unaccompanied
by any local
symptoms
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Hairs are shortly
cut. Covering
scales are small,
dry, slate colored
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Slightly adherent to
the surface of the
scalp but easily
detached on scraping
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28/258Grey Patch
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This patch is
followed by the
appearance of
other patches,
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we get multiple
patches dispersed on
the scalp of the same
clinical picture
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T.Capitis
MultipleScaly
type
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Mode of infection
DirectBy contact withinfected person.
I di t
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Indirect
By contact with
material soiled with
the organisms e.g.head caps, bed sheets
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DiagnosisScales and hairs are
xamined for detectio
offungal elements
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by KOH or
Lactophenolpreparation
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Culture can be used
in difficult cases.
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SamplingFor
Fungal
Detection
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KOH preparation
showing spores in the
hair shaft
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Differential Diagnosis
From other scaly
lesions on thescalp
P i i
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Psoriasis.
L.E.
Lichen planopilarisFavus.
Lichen accuminatus
(PRP)
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PrognosisSelf-limited at
puberty
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Microscopic Examination
of Hair in Ring Worm
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1-In gray patch
variety it shows
microsporon hair
l l
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Fungal elements
surround the hair
in an irregular
mosaic form.
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bl k d
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2-In black dot
variety the hair matrix
is filled with mycotic
elements forming a
sac form
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3- In kerion Celzi:
hair is surrounded
by regularly arranged
elements like acolumn
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4-In Favus:
Fungal elements are
arranged parallelto
long axis of the hair
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Black dot R.W
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This variety is
characterized by
the development of
l l l i
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scaly macular lesion
on the scalp of
children with well
defined border.
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Black
Dot
R.W
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On removal of these
cales the underlyin
epidermis is slightly
inflamed
O l
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On close
examination we find
the hair follicle ostia
are blocked with
black dotsblack dots hi h th
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which are the
remains of the
broken hair at the
surface of the scalp
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usually caused
by Trichophyton
Violaceumand
T. Tonsurans.
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Inflammatory
types of R.W
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Usually affect
children but may
affect adults
b id l
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besides scalp
affection the
beard areamay
be affected.
The extent of
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The extent of
inflammation varies
according to the
invading fungus.
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It might be:
Mild
li ht th f th
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slight erythema of the
skin in the affected
patch which is covered
by discharge
H i t k
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Hairs are stuck
together broken, and
you can see short as
well as long hairs
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Pustular folliculitis Severe
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Severe
marked edema,
redness and
tumefaction of theaffected hair
leading to the
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leading to the
formation of a
boggy soft
swelling
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On pressure pus
comes out from
the hair follicle
Each hair is
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Each hair is
surrounded by a
pool of pus and is
easily detached
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Kerion
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Kerion Celzi
Kerion
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Kerion
Celzi
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This inflammatory
swelling is called
Kerion CelziIt usually heals by
scar formation
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It is usually caused
by:
Microsporon Canis
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Favus
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one of the most
common mycotic
scalp affections
d b
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caused by
Trichophyton
Schoenleini
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Age:
all ages, more
common in children
but it does not
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but it does not
show self healing
at puberty
E d h h
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Extends throughout
life leading to
cicatrical alopecia
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Favus
cicatricalalopecia
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Contagiosity
not as high as
in R.W.,
di
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sporadic cases
can be detected
among children
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It can also affect
glabrous skin
and nails
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Favus Of The Scalp
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Favus Of The Scalp
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Post
Favic
Alopeci
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Which is the
initial lesion of
Favus
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Scotulum
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s a crus e
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s a crus e
lesion, yellowish
in color, with a
concavo-convex
f e
it its convexity at
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it its convexity at
the scalp making fo
itself an erosion or
depression in the
epidermis
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This leads to firm
adherence to the
scalp,
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on detachement
sero-sanginous
discharge appears
The scotulum is
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The scotulumis
friable, cupshaped,
with a characteristic
mousy odor
polygonal in outline
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polygonal in outline
measuring about
few mms. to one
cm in diameter
If moistened with
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If moistened with
alcohol the color
becomesdeeper
The hairin the affected
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area in the scalp is
usually of normal lengtbut show changes in
picture and color.
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Favic Hair
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Favic Hair
Hair becomes thin,
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,
dry, friable, grayish
in appearance ,
lusterless and dullgray in color
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the scalp appears
as if dusted with
powder
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Microscopic
Examination
The scotulum is
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The scotulum is
shown to be a pure
culture of the
invading fungus
un er themicroscope
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p
fungal elements are
invading the hair
with no elements
t id
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All are withinthe hair
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Fungal elements are
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Fungal elements are
arranged parallel to
the long axis of the
hair
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Tinea Corporis
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This includes
the following:
T Circinata
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T . Circinata .
T . Cruris .
T . Manus & Pedis
T . Versicolour .
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Tinea Circinata
Occurs anywhere
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Occurs anywhereon the body
surface especially
on exposed parts
in the form of
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in the form of
one or multiple
circinate macular
lesions
lesion is made
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lesion is made
ofwell defined
erythematousscaly patches
spreading
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sp ead g
eccentrically
forming a circinat
appearance
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i.e healing in the
center and activit
at the border.
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Tenia
Circinata
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T.Circinata
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T.Circinata
Multiple
Patches
The activity appears
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The activity appears
in the form of
erythema vesicles
and papules.
center may show
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center may show
hyper-pigmentation
and covered with
branny scales
The patient complains
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p p
of
itching and
disfigurement
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T C
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Differential Diagnosis
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From
other circinateeruptions:
Differential Diagnosis
Superficial:
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Pityriasis Rosea . Psoriasis . Lichen planus . Seborrhoeic dermatitis Erythema multiforme. Impetigo .
Deep:
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pSyphilis.Leprosy.
T.B.
Leishmaniasis.
S id i.
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Tenia Cruris
A circinate macular
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lesion occupying
the inner surfaceof the upper partsof both thighs
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Usually
accompanied
with T. pedis.
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Other flexures
may share in
the affection
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It is usually a
symmetrical
affection
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and posteriorly to
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and posteriorly to
the perineum and
gluteal folds
The lesion is
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brownishred in color
with well defined
border and circinateconfiguration
Surface shows
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minute scaliness
and tendency for
healing withspreading margin
T.cruris
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T i C i
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i t t i
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Intertrigo
Erythrasma
Psoriasis
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Tinea
Versicolour
a very common
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y
superficial fungus
infection of the
skin
affecting both
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affecting bothsexes and
commonly seen
at puberty
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It is caused byMicrosporoon
FurFur
Mild asymptomatic
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dysfiguring macular
eruption affecting
the vest area
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short jacketwith longsleeves
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Sites Of
T.V.C
Macules are oval,rounded
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or patchy, brownish or
coffe et lait in colourvarying from light to
deep brown
The lesions are well
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defined and covered
by fine branny
adherent scales.
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T V C
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T.V.C. On The Chest
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T.V.C. onthe Back
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Colour changes in
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ifferent sitesin th
same patient and
among differentindividuals
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Colour change is
ascribed to the
following factors:
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Site of the lesion
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whether on an
exposed site or a
hidden site.
yg ene o e
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atient as frequen
baths removes the
scaly layer on the
l i
that prevents
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the reach of UV
to the skin
underneath.
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Tenia Manus
& Pedis
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Superficial fungus
infection of bothhands and feet.
It may take one
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of the following
clinical pictures
1-Erythematous scaly
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or circinate type.
2-Eczematous or
vesiculobullous type
Both types occur on
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Both types occur on
the dorsal aspect of
the hands and feet
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Erythematous Scaly Type
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3-Hyperkeratotictype:
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on the palmar
and
plantar aspects
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Hyperkeratotic Type
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H k i T di
4-Commonest
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type is the
interdigital type
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Clinical picture of
the standard type:
Affects the
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interdigital
spaces between
toes and fingers
The skin becomes
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whitish, sodden,
macerated and the
depth of the cleftis fissured
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d l
On removal of
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the macerated
keratinous
material
the underlying skin
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is erythematous,
moist , and may be
eroded
It is very common
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among athelets
and called
atheletic foot
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Onychomycosis
fungus infection
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of the nails
caused by many
species of fungi
The affected nail
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is dry, brittle,
lusterless and the
surface is pittedand grooved.
Nails may be
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y
separated
rom the nail bed
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Onychomycosis
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Differential Diagnosis
Moniliasis
nails retain its
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luster, thick
accompanied
by paronychia
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Fungal
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Monilial
Chronic eczema
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Lichen planus
Psoriasis.Syphilis.
Lichen accuminatus.
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Treatment
ofMycoses
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General
Treatment
Griseofulvine
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An oral antibiotic
fungicidal agent
derived frompenicillin species.
It is given in a
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tablet form each
tablet contains250
mgm of ordinarygriseofulvine
The same therapeutic
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effect is obtained by
125 mgm offineparticle F.P.
Griseofulvin
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It may be given
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in a single
weekly dose
calculated by
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T .V . C.Erythrasma.
Moniliasis.
Contraindications
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Pregnancy,
liver, kidney or
heart disease.
Side effects :
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- Nausea
-Vomiting
- Headache
Duration of Treatment:
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T.corporis 3-4 weeks
T.capitis 5-7 weeks
T.Pedis 7-9 weeks
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onychomycosis
Nails 3-4
monthsToes 5-6 months
Other systemic
f
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antifungals are
now in common
use.
They should be
d h
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used with caution
as some of them
have serious sideeffects as:
l
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Ketoconazolewhich is apotent
hepatotoxic drug
Terbenafine
d
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and
Itraconazoleare used safelyin indicated cases
But they are
d
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expensive and
limited to
worthy cases.
or nea ers o or
Fl l l
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Fluconazole capsules150 mgm onceweekly for 4 weeks
may be given inresistent cases
l
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LocalTreatment
local fungicidals
T I di T l f
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Tr.Iodine,Tolnaftate
Clotrimazole,
Undecylinic acidderivatives
Whitfield ointment
S li li id 3
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Salicylic acid 3
Benzoic acid 6
lanovaseline 100
we use modified form
f Whitfi ld i t t
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ofWhitfield ointmentbecause the original
formula is very irritant
but very effective.
In cases of
i d
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eczematisedfungal infections,
we use
Preparations containing
f i id l t
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fungicidal agent
plus
hydrocortisone oranother steroid
or the preparation
ll d
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called
Castellanipaint which must beprepared fresh
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