DERMATOLOGY FUNGAL & MYCOBACTERIAL INFECTIONS OF THE SKIN

DERMATOPHYTES Microscopic view of Trichophyton

TINEA CORPORIS Multiple, red Sharply marginated Minimal scaling Several weeks duration Trunk of a child Microsporum was isolated on fungal culture; contracted from pet guinea pig.

TINEA CORPORIS Sharply marginated Hyperpigmented plaques Months duration Back, buttocks, thigh Associated tinea cruris & tinea pedis present.

TINEA CAPITIS Large, round, hyperkeratotic plaque of alopecia due to breaking off of hair shafts close to surface

KERION Kerion Extremely painful, boggy, purulent inflammatory lesion on the scalp Associated retroauricular, tender lymphadenophathy

TINEA BARBAE Scattered, discrete follicular pustules & papules in moustache area; mistaken for S. aureus folliculitis.

TINEA BARBAE Confluent, painful papules, nodules, & pustules on upper lip. Sharply marginated erythema and scaling on the cheeks, eyelids, eyebrows, and forehead.

TINEA MANUUM Erythema and scaling of the right hand, which was associated with bilateral tinea pedis. In time, onychomycosis occurs on the fingernails.

TINEA MANUUM

TINEA CRURIS Erythematous, scaling plaques on the medial thighs, inguinal folds, pubic area. The margins are raised and sharply marginated.

TINEA CRURIS

TINEA PEDIS Interdigital macerated type - webspace between 4 th & 5 th toes is hyperkeratotic and macerated

TINEA PEDIS Bullous type - ruptured vesicles, bullae, erythema, and erosion on the plantar aspect of the great toe

TINEA PEDIS Interdigital dry type - interdigital space between toes shows erythema & scaling

TINEA PEDIS Moccasin-pattern

TINEA VERSICOLOR Sharply marginated brown macules on the trunk. Fine scale was apparent when lesions were abraded with edge of a microscope slide. Multiple, small-to-medium-sized, well-demarcated hypopigmented macules on the back of a tanned individual with white skin

CANDIDA: Intertrigo Small peripheral "satellite" papules and pustules that have become confluent centrally, creating large eroded area in the submammary region.

CANDIDA: Vulvitis Erythematous lesions becoming confluent on the vulva with erosions and satellite pustules on the thighs.

CANDIDA: Diaper rash

MUCOCUTANEOUS CANDIDIASIS Persistent candidiasis in an immunocompromised infant manifesting as erosions covered by scales and crusts, oropharyngeal candidiasis, and widespread infection of the trunk

CUTANEOUS TB Tuberculosis verrucosa cutis Crusted and hyperkeratotic plaque arising at the site of inoculation in an individual previously infected with M. tuberculosis. No associated lymphadenopathy.

LEPROSY Tuberculoid type Well-defined, hypopigmented, slightly scaling, anesthetic macules and plaques Lepromatous type Nodules & thick plaques on dorsum on fingers, wrists, & forearms, with hypopigmentation of overlying skin. Note symmetry of involvement & loss of tissue of fingertips.

LEPROSY

All That Is Round Is Not Fungal … You don't just get a fungal infection… Exposure? person or animal with active infection, or to soil that contains significant numbers of pathogenic organisms Susceptibility? Heredity, steroid use, risk factors or other immunosuppressive factors You won't know these things if you don't ask… You won't ask if you don't consider other differentials…

All That Is Round Is Not Fungal … Fungal infection? Yes! Tinea corporis

All That Is Round Is Not Fungal … Fungal infection? No! Nummular eczema Scale is uniform - only on leading edge of tinea NE lesions on skin areas with few oil glands (tibia, trunk, and thighs) Especially during cold weather.

All That Is Round Is Not Fungal … Fungal infection? Yes! Tinea corporis

All That Is Round Is Not Fungal … Fungal infection? No! Urticaria

All That Is Round Is Not Fungal … Fungal infection? No! Erythema multiforme

All That Is Round Is Not Fungal … Fungal infection? No! Lichen planus

All That Is Round Is Not Fungal … Fungal infection? Yes! Tinea corporis