1. fungal infections
Cutaneous: dermatophytes, pityriasis versicolor, candidiasis.
Subcut.: mycetoma
Systemic: histoplasmosis, candidiasis, aspergillosis

2. Dermatophytes=ringworm=tinea
3 genera: trichophton, microsporum, epidermophyton.
All give similar clinical picture.
Invade keratin only.
Zoophilic, anthropophilic and geophilic
Clinical features depend on the site

3. Tinea pedis
* swimming pools, occlusive footwear. * clinically: interdigital scaling diffuse scaling of sole recurrent vesicles of the sole mostly 3rd toe web, itchy , painful or asymptomatic

4. Interdigital scaling

5. Diffuse scaling of foot

6. Bullous tinea pedis

7. Tinea unguium (onychomycosis)
Toe nail more common than finger nail due to spread from a near focus of tinea pedis
Free edge becomes yellow proximal invasion with darkening of color
Thickening of the nail plate and onycholysis

8. onychomycosis

9. Bilateral big toe nail discoloration
Main clinical finding ?
Bilateral big toe nail discoloration
Diagnosis ?
Onychomycosis [T. unguium]
Prove the Dx.
Nail clipping for KOH exam. & culture

10. Tinea corporis
Erythematous scaly plaque, grow peripherally and clear centrally annular configuration
=active border
Close inspection vesicles and pustules

11. Tinea cruris Affects inguinal folds, mostly men, summer
Erythematous plaque, scale, active border, not affects scrotum, vesicles and pustules
Differential diagnosis:
*Flexural ps.
*candidiasis: satellite papules, pustules
*seborrheic derm.:

12. T. cruris

13. Tinea faciei Erythematous annular plaque- face Diff. diag.:
* seborr. Derm.: nasolabial, eyebrows, eyelashes, ears
* Rosacea: bilateral, telangiectasia.

14. Tinea capitis Patch of hair loss, scales, easily epilated hair.
Usually children
Zoophilic spp.: Intense inflamm., boggy swelling, pustules = kerion
Diff. diag.:
alopecia areata: no inflamm.
trichotillomania: psych. upset, broken hair

15. Non-scarring scaly patches with hair loss
Clinical findings ?
Non-scarring scaly patches with hair loss
Diagnosis ?
Tinea capitis
Type of T. capitis ?
Gray patch non-inflammatory T. capitis
Confirm the diagnosis ?
KOH / Culture / Wood’s lamp
Treatment ?
Gresiofulvin 10mg/kg/day/6weeks

16. Kerion Diagnosis ? Cause ? Zoophilic Fungi Treatment ? Griseofulvin
This boy presented with a hemispherical crusted mass with hair loss on the lower part of the scalp of one month duration.
Diagnosis ?
Kerion
Cause ?
Zoophilic Fungi
Treatment ?
Griseofulvin

17. Investigations Skin scraping, nail clipping, hair plucking + KOH
Culture on sabouraud’s dextrose agar
wood’s light green fluorescence in some cases of T. capitis

18. Treatment
Topical imidazoles ex. Clotrimazole, miconazole, econazole Few patches of T corporis, facei, cruris and pedis.
Systemic therapy ex. Griseofulvin, terbinafine, imidazoles ex. Fluconazole, ketoconazole, itraconazole
Tinea capitis, t. unguium, t.incognito, wide spread t. corporis, pedis and feciei

19. Candidiasis Opportunistic inf.
Predisposing: age extremes, D.M, low immunity, ill fitted denture, obesity, antibiotics, pregnancy, malignancy.
Oral thrush: whitish patches, removal erythem. base
Angular stomatitis: whitish patches, soreness
Intertrigo: (inguinal, axilla, under the breasts) erythematous patches, satellite papules and pustules
Erosio interdigitale: eroded patch affects the webs

20. investigations Swab or scrapping for microscope exam yeasts Culture
Treatment
● Correction of underlying pred. factor
● Topical azoles
● Nystatin or amphotericin
● Fluconazole, itraconazole

21. Interdigital erythema, fissuring and maceration
Clinical findings ?
Interdigital erythema, fissuring and maceration
Interdigital (Flexural) Candidiasis
Diagnosis ?

22. Oral thrush

23. Angular stomatitis

24. Intertriginous candidiasis

25. Pityriasis versicolor
Affects young adults, hot humid climate
Pityrosporum orbiculare, Keratinophilic and lipophilic.
Brownish or hypopigmented round patches, with fine scales
Upper trunk, upper arms, neck.
Tend to recur.

26. Pityriasis versicolor
Brownish patches
with branny scales
on the upper trunk
Pityriasis versicolor

27. Pityriasis versicolor

28. investigations Usually it is a clinical diagnosis Scrapping.
Wood’s light lemon yellow

29. treatment Topical: azoles: *ketoconazole shampoo * other azole creams
selenium sulphide shampoo
● Systemic : fluconazole, ketoconazole,
itraconazole

30. Antifungal therapy
* Imidazoles: clotrimazole, miconazole econazole, ketoconazole. topical broad spectrum * Triazoles: itraconazole, fluconazole systemic broad spectrum * griseofulvin: systemic…dermatophytes * nystatin: topical and systemic..candidiasis

31. Summary T. pedis: interdigital scaling; diffuse scaling or bullae
T. unguium: yellow free edge proximal invasion with darkening. Onycholysis.
T. cruris and corporis: eryth. Scaly. With active boarder.
T. capitis: patchy hair loss with inflamm.

32. Summary Oral thrush: whitish patches
Angular stomatitis: whitish patches, soreness
Intertrigo: erythematous patches, satellite papules and pustules
Erosio interdigitale: eroded patch
Pityriasis versicolor:Brownish or hypopigmented round patches, with fine scales