FUNGAL SKIN INFECTIONS
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Transcript FUNGAL SKIN INFECTIONS
FUNGAL SKIN INFECTIONS
Liz McKensey
Presentation
24yr old male
Recent holiday in Spain
Painful, scaling, flaking, itchy lesions on feet
Between fourth and fifth digits
Thinks his friend has a similar problem
Diagnosis
Pompholyx-type eczema
b. Tinea pedis
c. Cellulitis
d. Eczema
a.
Diagnosis
Pompholyx-type eczema
b. Tinea pedis
c. Cellulitis
d. Eczema
a.
Treatment options
Advise on general hygiene and avoid occlusive footwear +
Itraconazole 100mg od po for 1-2 months
b. Terbinafine (topical) tds for 1-2 weeks
c. Terbinafine 250mg od po for 1-2 months
d. Clotrimazole (topical) tds for 1-2 weeks
a.
Treatment options
Advise on general hygiene and avoid occlusive
footwear +
a. Itraconazole 100mg od po for 1-2 months
b. Terbinafine (topical) tds for 1-2 weeks
c. Terbinafine 250mg od po for 1-2 months
d. Clotrimazole (topical) tds for 1-2 weeks
Presentation
37 year old female
Type I DM
Pain and infection of the right foot
First started 3 to 4 days ago
Initially blisters + weeping between toes of the right foot
only
Recently bought a second-hand pair of tennis shoes at a
garage sale and has been wearing the shoes without socks
Treatment
Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1 week
b. Itraconazole 100mg od po for 1-2 months
c. Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1-2 weeks + antifungal treatment
d. Hospital admission for IV antibiotics
a.
Treatment
Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1 week
b. Itraconazole 100mg od po for 1-2 months
c. Phenoxymethylpenicillin 500mg qds po +
flucloxacillin 500mg qds po for 1-2 weeks +
antifungal treatment
d. Hospital admission for IV antibiotics
a.
Presentation
44yr old female
Works as beauty therapist
Asymmetrical whitening + yellow/black discolouration of
the nails
Also some changes of fingernails but toenails worse
Diagnosis
a. Psoriasis
b. Senile ischaemia
c. Onychomycosis
d. Eczematous eruptions (contact dermatitis)
Diagnosis
a. Psoriasis
b. Senile ischaemia
c. Onychomycosis
d. Eczematous eruptions (contact dermatitis)
Treatment
Topical amorolfine for 3 months
b. Itraconazole 200mg bd po for 1 week per month for 3-6
months or Terbinafine 250mg od po for 3-6 months
c. Topical + oral
d. No treatment
a.
Treatment
Topical amorolfine for 3 months
b. Itraconazole 200mg bd po for 1 week per month
for 3-6 months or Terbinafine 250mg od po for 3-6
months
c. Topical + oral
d. No treatment
a.
Psoriasis
Contact dermatitis
Presentation
16yr old male
Slightly itchy asymmetrical scaly patches on the torso sparing
the face, hands, feet, and groin
Started in the axilla
Concerned he has ‘caught something’ from his new girlfriend
Diagnosis
a. Psoriasis
b. Pityriasis rosea
c. Tinea versicolor
d. Tinea corporis
Diagnosis
a. Psoriasis
b. Pityriasis rosea
c. Tinea versicolor
d. Tinea corporis
Treatment
Clotrimazole 1% tds top for 1-2 weeks
b. Terbinafine 1% bd top for 1-2 weeks
c. Compound benzoic acid ointment tds top for 1-2 weeks
d. Any of the above
a.
Treatment
Clotrimazole 1% tds top for 1-2 weeks
b. Terbinafine 1% bd top for 1-2 weeks
c. Compound benzoic acid ointment tds top for 1-2 weeks
d. Any of the above
a.
Note: Extensive skin infections may require oral therapies
e.g.terbinafine 250mg daily for four week or itraconazole
100mg daily for 15 days
Psoriasis
Pityriasis Rosea
Presentation
8yr old Afro-Carribean male
Presents with scaly patches on scalp
Started two weeks ago, but mum worried now because ‘his
hair is falling out’
Two close friends off school for the last few days with similar
problem
Diagnosis
a. Kerion
b. Tinea capitis
c. Folliculitis decalvans
d. Bacterial pyodermas
Diagnosis
a. Kerion
b. Tinea capitis
c. Folliculitis decalvans
d. Bacterial pyodermas
Treatment
Clotrimazole 1% tds top for 4 weeks
b. Itraconazole 100mg od po for 4 weeks
c. Griseofulvin 1g od po (15-20mg/kg for kids)
d. Itraconazole 100mg od po for 4 weeks + clotrimazole 1%
tds top for 1 week
a.
Treatment
Clotrimazole 1% tds top for 4 weeks
b. Itraconazole 100mg od po for 4 weeks
c. Griseofulvin 1g od po (15-20mg/kg for kids)
d. Itraconazole 100mg od po for 4 weeks +
clotrimazole 1% tds top for 1 week
a.
True or false
Tinea capitis can lead to scarring alopecia (and permanent hair
loss)
Tinea capitis requires systemic antifungal treatment for
therapeutic success
Tinea capitis is very infectious so that children may have to be kept
away from school
If tinea capitis is suspected clinically then it is important to
confirm or refute this diagnosis by further investigation (e.g.
taking skin scrapings and hair for fungal elements)
Asymptomatic carriers should be treated with topical antifungals
alone
Presentation
The previous boys classmate
Diagnosis
a. Abscess (staph aureus)
b. Cellulitis
c. Kerion
d. Pustular dermatosis
Diagnosis
a. Abscess (staph aureus)
b. Cellulitis
c. Kerion
d. Pustular dermatosis
Treatment
Griseofulvin 1g od po for 8 weeks
b. Griseofulvin + prednisolone
c. Griseofulvin + prednisolone + flucloxacillin
d. Surgery
a.
Treatment
Griseofulvin 1g od po for 8 weeks
b. Griseofulvin + prednisolone
c. Griseofulvin + prednisolone + flucloxacillin
d. Surgery
a.
Presentation
22yr old male
Concerned he has Michael Jackson’s disease!!
Reports that he has been quite itchy all over
On examination he has multiple well-demarcated, scaly, oval-
to-round hypopigmented macules occasionally forming into
larger patches
Mostly on upper trunk and arms, some areas on neck also
States he usually has a good tan and admits to often using
tanning oils when away on holidays
Diagnosis
a. Postinflammatory pigmentary change
b. Pityriasis rosea
c. Tinea versicolor
d. Vitiligo
Diagnosis
a. Postinflammatory pigmentary change
b. Pityriasis rosea
c. Tinea versicolor
d. Vitiligo
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Ketoconazole shampoo od used as body wash for 7 days
c. Itraconazole 100mg od po for 2 weeks
d. All of the above
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Ketoconazole shampoo od used as body wash for 7 days
c. Itraconazole 100mg od po for 2 weeks
d. All of the above
a.
Vitiligo
Presentation
32yr old male
135kg
Describes a brownish red rash with ‘pimples’ around the
border on the inside of his thighs/groin
‘Feels like it is burning and incredibly itchy at times’
Reports nothing on penis or scrotum
Also reports itchy flaky skin between toes
Diagnosis
Candida intertrigo
b. Contact dermatitis
c. Tinea cruris
d. Psoriasis
a.
Diagnosis
Candida intertrigo
b. Contact dermatitis
c. Tinea cruris
d. Psoriasis
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Clotrimazole 1% + hydrocortisone 1% (cream) top tds for
7 days
c. Clotrimazole cream 1% top tds + itraconazole 100mg od
po for 7 days
d. Any of the above
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Clotrimazole 1% + hydrocortisone 1% (cream) top tds for
7 days
c. Clotrimazole cream 1% top tds + itraconazole 100mg od
po for 7 days
d. Any of the above
a.
Candida Intertrigo