What is Fungal Infection ?

  • Tinea/ ringworm infection
  • Candida Infection
  • Pityriasis Versicolor

Tinea/ Ringworm Fungal Infection

  • Restrict to dead keratinised tissue
  • Stratum corneum of epidermis- Skin fungus
  • Fully keratinised hair shaft- Hair fungus
  • Nail plate/bed- Nail fungus

Tinea corporis

  • Trunk and limbs
  • Erythematous, scaly, circular lesions
  • Sharply marginated with raised margin
  • Central resolution is common
  • Less inflammatory

Treatment for fungal infection

  • Mild- Topical Terbinafine applied twice daily, 2 weeks
  • Extensive- Oral Terbinafine 250mg OD 2-4weeks
  • Oral Itraconazole 200mg OD 2-3weeks

Tinea capitis

  • Scalp fungal infection
  • Predominantly children
  • Adults with AIDS

Symptoms of scalp fungal infection

  • Gray patch- scaling with patchy hair loss
  • Black dot- formation of black dots as the affected hair breaks at the surface of scalp
  • Diffuse pustular- scattered pustules
  • Kerion- most severe, painful inflammatory mass with loose hair

Scalp Fungal infection cure

  • Griseofulvin 10-20mg/kg/day with meals, 6-8weeks

Terbinafine

  • weight > 40 kg 250mg OD
  • 20-40kg 125mg OD
  • 10-20 kg 62.5mg OD

Selenium sulphide or Ketaconazole shampoo to prevent spread

Kerion

  • Removal of crusts- wet compresses
  • Coexistent bacterial infection must be treated
  • Oral steroid can be used early in treatment course

Tinea barbae

  • Fungal infection of beard and moustache
  • Highly inflammatory pustular folliculitis, exudation and crusting
  • Dry, reddish, scaly lesions enclosing lustreless hair stumps

Treatment of skin fungus

  • Terbinafine, Itraconazole 4-6 weeks plus topical

Tinea faciei

  • Skin fungal infections on Face
  • Terbinafine, Itraconazole 4-6 weeks plus topical

Tinea pedis/ Foot fungus

  • Skin Fungal infections of foot

Symptoms of foot fungus

  • Intertriginous dermatitis- peeling, maceration and fissuring affecting lateral toe clefts
  • Scaling hyperkeratotic variety- Dry type infection
  • Vesicular, pustular

Tinea manuum

  • Fungal infections on hand
  • Hyperkeratosis of palms and fingers
  • Unilateral

Tinea cruris

  • Skin fungal infection of Groin

Steroid-modified tinea/ Tinea incognito

  • Oral or topical steroid
  • Clinical picture altered
  • Raised margin diminished
  • Scaling lost
  • Nodules
  • Bruise-like brown discoloration

Treatment for tinea infection

  • Use a weaker steroid early in course
  • warn patient of rebound

Fungal nail infection/ Onychomycosis

  • Nail fungus symptoms
  • Streak or patch of discoloration, white or yellow at the free edge of nail plate, often near lateral nail fold
  • Dorsal surface of nail plate is eroded, well-circumscribed powdery white patches, away from free edge

Treatment of nail fungus

  • Fingernail fungus
  • Terbinafine 250mg/day, 6 weeks
  • Terbinafine 250mg BD for 7days/month, 2-3 months
  • Itraconazole 400mg/day for 7 days/month, 2-3 months

Toenail fungus

  • Terbinafine 250mg/day, 12weeks
  • Terbinafine 250mg BD for 7days/month,3-4 months
  • Itraconazole 400mg/day for 7 days/month, 3-4 months

Topical treatment for nail fungus

  • Amorolfine 5% nail lacquer once a week applied after abrading the nail
  • Ciclopyroxolamine 8% nail lacquer applied daily
  • Avulsion of nail or removal of infected areas