ï‚ Superficial and cutaneous ï‚ Subcutaneous ï‚ Deep (systemic)

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Text of ï‚ Superficial and cutaneous ï‚ Subcutaneous ï‚ Deep (systemic)

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  • Superficial and cutaneous Subcutaneous Deep (systemic)
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  • Caused by fungi living as saprophytes Hair, dead skin and lipids secretions They dont provoke any immune response No pain or itching
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  • Common, mild and chronic infection of stratum corneum World-wide More common in tropics and sub-tropics In temperate regions more common during summer
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  • Pityriasis versicolor Caused by Malassezia yeast, which is lipophilic dimorphic fungus
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  • KOH Parker ink staining
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  • Tinea nigra Typical brown to black, non-scaling macules on the palmar aspect of the hands. Note: there is no inflammatory reaction
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  • 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
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  • Ringworm (hair and skin) Favus (hair) Onychomycosis (nail)
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  • Infections of the skin, hair and nails due to a group of related filamentous keratinophilic fungi called dermatophytes
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  • Microsporum Hair, skin EpidermophytonSkin, nail TrichophytonHair, skin, nail Digest keratin by their keratinases Resistant to cycloheximide
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  • 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
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  • Human is usual host T. rubrum (foot & nail infections) E. floccosum (foot & nail infections) T. tonsurans (scalp infections) M. audouinii (scalp infections)
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  • Normal habitat is soil Can cause infections in both humans and animals Microsporum gypseum
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  • Often associated with a particular animal Microsporum canis: cats and dogs Trichophyton verrucosum: horse and cattle
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  • 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
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  • Infection is named according to the anatomic location involved
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  • 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)
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  • Favus (scalp) Onychomycosis (nail)
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  • Athlete's foot (Tinea pedis )
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  • Tinea pedis
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  • Tinea manuum
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  • Tinea corporis caused by M. canis following contact with infectious cat Tinea corporis
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  • Tinea of the groin showing typical erythematous lesions on the inner thighs Tinea of the buttocks Tinea cruris
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  • Tinea barbae
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  • Tinea capitis caused by M. canis following contact with infectious cat Tinea capitis showing extensive hair loss caused by M. canis
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  • Favus Special form of tinea capitis Onychomycosis Fungal infection of nail The term "tinea unguium" is used specifically to describe dermatophytic onychomycosis
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  • FavusTinea capitis showing alopecia
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  • Tinea of the nails caused by T. rubrum
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  • 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
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  • Hyphal elements seen in skin scraping preparation
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  • Dependant on the clinical setting Topical or oral antifungal
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  • 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
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  • Onychmycosis Intertrigo Mucocutaneous candidiasis Thrush Vulvo-vaginitis
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  • Intertrigo caused by Candida albicans
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  • Red macerated rash under pendulous breasts is a common presentation of cutaneous candidiasis
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  • This condition should not be considered a primary Candida infection as it preceded by an irritant dermatitis
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  • Skin, subcutaneous tissues, fascia and bone Localized Trauma More in tropics Mycetoma, chromomycosis and sporotrichosis
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  • Mycetoma
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  • Sporotrichosis A 60-year-old woman developed multiple subcutaneous nodules and abscesses on her right hand and forearm 7 days after finger thorn prick
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  • Sporotrichosis
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  • Classical Chromoblastomycosis: Fonsecaea pedrosoi De Hoog, Centraalbureau voor Schimmelcultures
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  • Nodulose chromoblastomycosis (Senegal): Fonsecaea pedrosoi De Hoog, Centraalbureau voor Schimmelcultures
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  • Difficult Surgical excision Itraconazole and other antifungal