真菌性皮肤病 真菌性皮肤病 Dermatomycoses

一 皮肤癣菌病 dermatophytoses

Dermatophyte Infection hair cutaneoushorny layer nail plate dermatophytosis

According to different parts ： tinea capitis tinea corporis tinea cruris tinea manum tinea pedis onychomycosis tinea barbae

dermatophytids metabolite of trichophyton blood circulation; dermato-allergic reaction out of focus

etiology Trichophyton human Microsporum infection Epidermophyton animal dermatophytosis

1 Leading dermatophytes in our country

dermatophytes invasion hair root 、 hair strunk 、 nail plate 、 cutaneous corneum stratum tinea barbae onychomycosis tinea corporis tinea of feet and hands

the relationship between characters of dermatophytes and clinic Character: because of keratinophilic Clinic: prone to invade stratum coreum. Character: Growing in o C Clinic: happening at summer or autumn..

the relationship between characters of dermatophytes and clinic Character: Needing moderate humidity Clinic: infections exist at the moist and sweaty places Character: develop from center to peripheral Clinic: lesions looks like the ring.

the relationship between characters of dermatophytes and clinic Character: growing rapidly Clinic: lesions happening after one week commonly Character: having nothing to do with sun light Clinic: able exist in UV,but fearing dry and high temperature Character: carbon and nitrogen are neccessary Clinic:DM 、 using long-term corticosteroids and thick lamina corticalis are easy to infect.

the relationship between characters of dermatophytes and clinic 、 soil and animal are susceptibe. Character: human 、 soil and animal are susceptibe. different infected sources, different clinical appearance Clinic: different infected sources, different clinical appearance

tinea corporis of cruris Primary lesions ： papule 、 blister 、 papulovesicle

tinea cruris

differential diagnosis ： circumduction erythema 、 pityriasis rosea 、 neurodermatitis 、 eczema

treatment ： topical treatment : Compound Benzoic Acid liniment （ tinea corporis ） Bid  ×2-4weeks Compound Resorcinol Liniment (tinea cruris) Bid  ×2-4weeks 3 ％ miconazole cream 、 terbinafine cream 、 ketoconazole cream etc (tinea corporis and cruris) Bid  ×2-4weeks. Generalized corporis tinea Sporanox 200mg/d/ adult ×1 Terbinafine 0.25g qd ×1-2weeks Fluconazol 0.15g qw ×1-2weeks

Tinea of hands and feet EEfinition: finger and toe web and palma, metatarsus infect dermatophyte are called tinea of hands and feet. 1>.thick horny layer in hands and feet 2>.easily scrape 3>. sweaty, damp stuffy in feet. inducing dermatophytosis of hands and feet.

Clinical grouping scale- blister type 、 maceration -erosion mode 、 hyperkeratotic pattern scale- blister type

角化过度型 hyperkeratotic pattern maceration -erosion mode

differential diagnosis ： extremity eczema 、 pompholyx 、 exfoliative keratolysis

Tinea of hands and feet treatment 1 、 scale- blister type soaking with 10 ％ glacial acetic acid Compound Benzoic Acid liniment miconazole cream pulvis pro pedibus ext 2 、 maceration -erosion mode Compound Resorcinol Liniment miconazole cream and pulvis pro pedibus ext slight effusion:radiomycin anthraco paste miconazole cream and pulvis pro pedibus considerable effusion: 0.5 ％ fradiomycin FL 、 miconazole cream and pulvis pro pedibus second infection ： using the antibiotic 3 、 hyperkeratotic pattern Whitfield ointment 、 miconazole cream companion with rhagades : carbamide lip etc. note to ringworm of hand: avoidance miscellaneous physical o chemical stimulus.

tinea capitis ： both dandruff and hair are infected dermatophytes. clinical manifestation: papule ;blister; scale; pustule.

clinical appearance susceptible population : favus child or adult. tinea alba child. black dot tinea child or adult. cutaneous lesion : favus papule,pustule, scutulum, atrophic scar. tinea alba seborrheic dermatitis’ scale child and mother patch black dot tinea seborrheic dermatitis’ scale ;macula sick hair ： favus dry and no luster, easy brisement, different leng. tinea alba brisement part from 2-4mm patient’scalp. 。 black dot tinea fracture part from patient’scalp. Wood light ： favus dark green fluorescence tinea alba bright green fluorescence black dot tinea no fluorescence

direct microscope ： Microsporum lanosum 、 Microsporum corrosion Trichophyton violaceum Trichophyton tonsurans. fungus culture

course of disease course of disease favus slow proceeding ; favus slow proceeding ; inability autotherapy ; scar inability autotherapy ; scar tinea alba rapid proceeding ; adolescent age autotherapy; no scar adolescent age autotherapy; no scar black dot tinea slow proceeding inability autotherapy minority scar inability autotherapy minority scar

Kerion Definition: a deep, pustular type of tinea resembling a carbuncle or kerion is observed on the glabrous skin, which is a topical allergic response. Clinical manifestation: one or several manifest inflammation abscesses with overt edge feel fluctuant, hair become loosening and broken off easily. Common lingering effects are scar and nonvolatile alopecia. Differential diagnosis: dandruff eczema seborrheic dermatitis amianth pityriasis psoriasis alopecia areata.

prevention and cure of tinea capitis prevention and cure of tinea capitis 1.overdose terbinafine : <20kg 62.5mg qd 2w at least 20kg ∽ 40kg 125mg qd 2w at least 20kg ∽ 40kg 125mg qd 2w at least > 40kg 250mg qd 2w at least > 40kg 250mg qd 2w at least fluconazol: 3 ∽ 6mg/kg/d, 2w at least itraconazole: 3 ∽ 6mg/kg/d, 2w at least.

2.drug for external: miconazole cream ext,bid ×2m 3. shampoo: sulfur soap/d, ×2m 4. shaving head: cutting all hairs,qw ×2m. 5.megatemperature disinfection: towel, sheeting,pillowcase, comb etc. Kerion: forbidding incision and drainage. prevention and cure of tinea capitis prevention and cure of tinea capitis

Onychomycosis Definition: it is difined as the infection of the nail by fungus and represents up to 30 ％ of diagnosed superficial fungal infections. Definition: it is difined as the infection of the nail by fungus and represents up to 30 ％ of diagnosed superficial fungal infections. Clinical appearance: thick nail plate nail segregation colouration alteration and breakage,etc. Clinical appearance: thick nail plate nail segregation colouration alteration and breakage,etc.

prevention and cure of onychomycosis 1. removing morbid nails: wafering mornid nails after painting 40 ％ carbamide cream, then getting rid of them. 2. drug for external: 30 ％ glacial acetic acid or 2 ％ miconazole tincture, ext bid ×3 ∽ 6m 3. overdose : terbinafine : 0.25g qd ×3 ∽ 4m fluconazol: 0.15g qw ×3 ∽ 4m fluconazol: 0.15g qw ×3 ∽ 4m itraconazole: 0.2g qd 1w/m ×3 ∽ 4m itraconazole: 0.2g qd 1w/m ×3 ∽ 4m