Superficial Dermatophyte

Infections
Onychomycosis

JI ESLAO, JESSICA
JI PRUDENCIO, DEBBIE
 SUPERFICIAL FUNGAL INFECTIONS

 Most common of all mucocutaneous infections

- caused by overgrowth of transient or resident flora associated
with a change in the microenvironment of the skin
 DERMATOPHYTE

 Group of fungi capable of infecting nonviable

keratinized cutaneous structures

 ETIOLOGY
- 3 genera: Trichophyton, Microsporum, Epidermophyton
 ONSET
- Children: scalp infections (Trichophyton,
Microsporum)
- Young and older adults: intertriginous

 TRANSMISSION
- Another person
- Animals
- Soil
 CLASSIFICATION

 Dermatophytoses of keratinized epidermis (epidermal

dermatophytosis, epidermomycosis): Tinea facialis, tinea
corporis, tinea cruris, tinea manus, tinea pedis

 Dermatophytoses of nail apparatus (onychomychosis):

Tinea unguium (toenails, fingernails)

 Dermatophytoses of hair and hair follicle (Trichomycosis):

Dermatophytic folliculitis, Majocchi's (trichophytic)
granuloma, tinea capitis, tinea barbae.
 Dermatophytoses of Epidermis

 Most common dermatophytic infection

 May be followed/accompanied by dermatophytic
infection of hair/hair follicles and/or the nail
apparatus
TINEA PEDIS
 Dermatophytic infection
of the feet
 Erythema, scaling,
maceration, and/or bulla
formation
 Provides breaks in the
integrity of the epidermis
through which bacteria
can invade
TINEA MANUUM
 Chronic dermatophytosis
of the hand
 Unilateral, pruritic and
painful
 Well-demarcated scaling
patches, hyperkeratosis
and scaling confined to
palmar creases, fissures
on palmar hand
TINEA CRURIS
 Subacute or chronic
dermatophytosis of the
upper thigh and adjacent
inguinal and pubic regions
 Large, scaling, well-
demarcated dull
red/tan/brown plaques
 Central clearing, and
papules, pustules may be
present at margins
TINEA CORPORIS
 Trunk, legs, arms, and/or
neck
 Small to large scaling,
sharply marginated
plaques with or without
pustules or vesicles,
usually at margins
 Peripheral enlargement
and central clearing
produces annular
configuration with
concentric rings or
arcuate lesions
TINEA FACIALIS
 Dermatophytosis of the
glabrous facial skin
 Well-circumscribed
macule to plaque of
variable size
 Elevated border and
central regression; scaling
is often minimal
 Dermatophytoses of Hair

 Dermatophytes are capable of invading hair

follicles and hair shafts, causing dermatophytic
trichomycosis (tinea capitis, tinea barbae, and
dermatophytic folliculitis)
 Two types of hair
involvement are:
TINEA CAPITIS
 Predominantly a disease of preadolescent children
 Ectothrix or endothrix
 Scaling, diffuse or circumscribed alopecia
TINEA BARBAE
 Beard and moustache
areas with invasion of
the hair shaft
 Pustular folliculitis hair
follicles surrounded by
red inflammatory
papules or pustules,
often with exudation
and crusting
 Less follicular
involvement, there are
scaling, circular, reddish
patches
 ONYCHOMYCOSIS

 Any infection of the nail caused by dermtophyte

fungi, non-dermatophyte fungi, or yeast
 T. rubrum: 71%
 T. mentagrophytes: 20%
Distal and Lateral Subungal Onychomycosis

 Begins in the hyponychial area or nail fold

 Primary or secondary
 Superficial White Onychomycosis

 Surface of the dorsal nail

 Mold
 Proximal Subungal Onychomycosis

 Posterior nail fold (cuticle area) and migrates

along the proximal nail groove
 Involve underlying matrix proximal to the nail bed
and nail
 Associated with immunocompromised states
 DIAGNOSTIC TESTS

Definitive diagnosis requires

demonstration of fungal
pathogens by microscopic
examination or culture of skin,
nail, or hair scrappings from the
suspected lesions.
 1. Microscopy

• Wood's Lamp. Examination of lesions

involving the scalp or beard with a wood's
lamp may reveal fluorescent pteridine of
certain pathogens.
 Ectothrix – small or large arthroconidia
forming a sheath around the hair shaft
 Endothrix – arthroconidia within the hair
shaft
12/18/14
 Skin and nails.

 Skin scrapings
 Nail clippings of the entire thickness of
dystrophic areas of nail as proximal as
possible
 10-20% KOH
 2. Culture

• Specialization of superficial fungi is based on

macroscopic, microscopic and metabolic
characteristics of the organism.
• Sabouraud’s dextrose agar – nonselectuive
culture medium consisting of peptone,
dextrose agar and distilled water.
• Mycosel or mycobiotic agar – A selective
growth medium. It consists of Sabouraud’s
agar with cycloheximide (0.5 g/L) and
chloramphenicol (0.05 g/L)
12/18/14
12/18/14
PSORIASIS VS. DERMATOPHYTOSIS

12/18/14
CANDIDIASIS VS. ONYCHOMYCOSIS

12/18/14
12/18/14
ATOPIC DERMATITIS VS.
DERMATOPHYTOSIS
GRANULOMA ANULARE
DISEASE TREATMENT
TOPICAL TREATMENT SYSTEMIC
TREATMENT
Tinea capitis Only as adjuvant Griseofulvin, 20-25
Selenium sulphide mg/kg/day
Zinc pyrithione Fluconazole, 6 mg/kg/day
Povidone iodine Itraconazole, 3-5
Ketoconazole mg/kg/day
Terbinafine, 3-6 mg/kg/day
Tinea barbae Only as adjuvant Griseofulvin, 1 g/day
Topical antifungals Itraconazole, 200 mg/day
Terbinafine, 250 mg/day
Fluconazole, 200 mg/day
Tinea corporis/cruris Allylamines Adults:
Imidazoles Fluconazole, 150 mg/wk
Tolnaftate Itraconazole, 100 mg/day
Butenafine Terbinafine, 250 mg/day
Ciclopirox Griseofulvin, 500 mg/day
Children:
Griseofulvin, 10-20
mg/kg/day
Itraconazole, 5 mg/kg/day
DISEASE TOPICAL TREATMENT SYSTEMIC TREATMENT

Tinea pedis/manuum Allylamine Adults:

Azole Terbinafine, 250 mg/day
Ciclopirox Itraconazole, 200 mg
Benzylamine twice/day
Tolnaftate Fluconazole, 150 mg/wk
Undecenoic acid Children:
Itraconazole, 5 mg/kg/day

Onychomycosis Ciclopirox Terbinafine, 250 mg/day

Amorolfine Itraconazole, 200 mg/day
Fluconazole, 150-300 mg
once/wk
Thank You and Have a
Nice Day….. 12/18/14