Fungal Infections Reena Doshi

Two major groups Candida Dermatophyte

Candidiasis: Genital Women > Men Itchy, sore vulvovaginitis White plagues on mucous membranes White ‘cheesy’ discharge

Candidiasis: Genital

Candidiasis: Intertrigo Red, moist, glazed, itchy Submammary, inguinal, axillary folds Occasionally between digits

Candidiasis: Intertrigo

Candidiasis: Oral Babies, pts with poor oral hygiene, elderly with false teeth Sore mouth Poor feeding White plaques on buccal mucosa – wipe off Angular stomatitis

Candidiasis: Oral

Candidiasis: Nappy Babies Nappy area

Candidiasis: Chronic paronychia Wet workers Chronic nail bed inflammation

Candidiasis: Systemic Immunosupressed pts esp. HIV,malignancy Red skin nodules

Candidiasis: Systemic

Tinea infections… Obtain scrapings/clippings before starting treatment

Tinea Corporis: Ringworm Trunk/limbs Plaques with scaling and erythema – esp. at edges Lesions enlarge slowly and clear centrally

Tinea Corporis: Ringworm

Tinea Cruris Groin, upper thigh (scrotum) Common in athletes Men > Women Red plaque with scaling esp. at the edge – central clearing with active edge Assoc. with tinea pedis

Tinea Cruris

Tinea Pedis: Athletes Foot Feet Young > Old Men > Women Itchy maceration between toes esp. 4 th /5th RFs: Swimming Occlusive footwear Hot weather Communal showers

Tineqa Pedis

Tinea Capitis Hair and scalp Defined inflammed scaly areas May have alopecia with broken hair shafts

Tinea Capitis

Tinea Unguium Nails Old > Young Toenails > Fingernails Distal to proximal spread Thickening, yellowing and crumbling of nail plate Assoc with tinea pedis

Tinea Unguium

Management: Topical Genital Imidazole cream, pessaries Nail If 1-2 nails only: lacquer or paint (1-2x/week) Skin Imidazole cream, spray, powder Terbinafine cream Mouth Tongue deposits-brush bd Oral pastilles, suspensions, gels eg nystatin, miconazole

Management: Systemic Recurrent, systemic, extensive or resistant infection Genital candida: 200mg fluconazole stat Oral/mucocutaneous/systemic candida: Eg. Oral fluconazole (1-2/52)

Management: Systemic Dermatophyte – Oral terbinafine or itraconazole daily Skin: 2-4/52 Nails: 3/12

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