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Common
Fungal Skin Infections
• Superficial fungal infections of
the skin are one of the most
common dermatologic
conditions seen in clinical
practice.
Fungi: Common Groups
• Tinea infections
TINEA Infection
• ITRACONAZOLE
– Pulse rx Itraconazole - 1wk/mth 200mg bid
– Itraconazole 200mg od
• FLUCANAZOLE
– Fluconazole 150mg once weekly
T.Pedis
TINEA CAPITIS - KERION
Gray Patch
Rx-Tinea Capitis
• MUST use oral Rx- prolonged course
–Griseofulvin-20mg/kg/od x 6-8/52
Terbinafine-250mg od x 4/52
–Flucanazole-50mg-150mg/wk x 4-6/52
Rx-Tinea Capitis
Adjunctive Measures
• Antibiotics
• NO STEROIDS
Other Fungal Infections
Tinea Manuum
Dry hyperkeratotic
Palmer aspect
Dorsal aspect
Tinea Barbae
Tinea Faciei
• Infection of the
skin of the face
excluded
moustache &beard
areas
Peri-oral dermatophytosis
Investigation:
- Microscopy of scrapings
• General Measures
• Non-specific Keratolytics
-eg Whitfield’s ointment
Specific Antifungal Rx
• Griseofulvin
• Azoles-
-Imidazole eg ketoconazole (liver toxicity: oral prep)
topical preps
-Triazole eg itraconazole,fluconazole
• Allylamines eg terbinafine, naftifine
TOPICAL Rx
• Localized disease of skin
– extend rx for 3-5/7 after apparent cure
– 1% clotrimazole less effective
• Nail disease
• Tinea Capitis
For Systemic Fungal Infections
FDA approved drugs for empirical therapy
Drug Dosing regimen used in controlled trials
Ampho B 0.6 – 1.0 mg/kg/day (IV)
__________________________________________________
Liposomal 3 mg/kg/day (IV)
Ampho B
________________________________________________
Itraconazole 400 mg/day/or two days then 200 mg/d for
5-12 days (IV), followed by oral solution
400 mg/day for 14 days
__________________________________________________
Caspofungin 70 mg day 1, then 50 mg/daily
In BPKIHS D-OPD
COMMON FUNGAL PROBLEMS: All types
Rx: prescribed:
1. Hygiene teaching.
2. Antifungal:
a. Topical: Ketaconazole, Clotrimazole,
Butrinazole
b. Oral: Fluconazole, Ketaconazole, itrazole
Thank You
7. Yeasts
• Pityrosporum.
• Candida.
• Ordinarily commensals.
• Can become pathogens under
favourable conditions.
Pityriasis Versicolor
• Asymptomatic
hypopigmented
scaly macules
Like Dubi
Pityriasis Versicolor
8. Tinea Versicolor
(In Head)
Dandruff
Tinea Versicolor
Skin infection caused by a yeast
Warm and humid environment
Tinea Versicolor
S/S
- oval or irregularly shaped spots
- pale, dark , or pink in color
- sharp border
- itching, worsens with heating and
sweating
Tx
- Topical antifungal medications
Management
• Many Rx
• No Rx eradicates yeast permanently
• NONSPECIFIC
• Keratolytics
– whitfield onit, sulphur
• Antiseptics
– selenium sulphide, Na thiosulphate
Antifungal Rx
Azoles-oral/topical
• Ketoconazole 200mg od x7
• Itraconazole 200mg od x 7
• Fluconazole 300mg-400mg stat
• Terbinafine tabs for P.V
9. Candidiasis
o Candida sp- commensal of GIT
o Precipitating Factors
Endocrinopathy
Immunosuppression
Fe/Zn deficiency
Oral antibiotic Rx
o Oropharyngeal candidiasis is marker for AIDS
Candidiasis
• Oropharnygeal
• Candidal intertrigo-breasts, groin
• Chronic Paronychia - nail fold infection
• Vaginitis/balanitis
Risk Factors for Candidiasis:
▪ Post-operative status
▪ Cytotoxic cancer chemotherapy
▪ Antibiotic therapy
▪ Burns
▪ Drug abuse
▪ GI damage
Candidal Intertrigo
• Moist folds
• Erythematous patch
with satellite lesions
Management
• Rx underlying disorder
• Reduce moisture-
– Wt loss, cotton underwear
– Absorbent/antifungal powder eg Zeasorb AF
• Rx partner in recurrent genital candidiasis
• Rx-Nystatin
Azoles
• Oral antifungal (itraconazole): immune
suppressed
10. Chronic Paronychia
• Infection of nail fold
• Wet alkaline work
Excess manicuring
• Damage to cuticle
• Swelling of nail fold
(bolstering)
• Nail dystrophy
Chronic Paronychia
• Keep hands dry /Wear gloves
• Long term Rx
• Oral Azoles
• Antifungal solution-(high alcohol content)
• +/-Broad spectrum antibiotics-cover staph
Rx Summary
• Tinea capitis should be treated with
systemic therapy.
• Griseofulvin in a dose of 10-20 mg per
kg for six weeks to 8weeks is the first-
line treatment of Tinea capitis.
• Ketoconazole 2-4mg per kg for ten
days, itraconazole and terbinafine
(Lamisil) are good alternatives.
• Griseofulvin should be taken after fatty meal.
• Topical treatment can be added to decrease
the transmission and accelerate resolution.
• Whitefield ointment is preferred in the
absence of secondary bacterial infection.
• Other family members should also be
examined and treated.
• Small and single lesion can be treated with
topical agents. Clotrimazole 1%, ketoconazole
2%, meconazole 1%. BID for two weeks
• Systemic: ketoconazole 2-4mg per kg
of weight for 10 days. Itraconazole and
fluconazole are choices if available.
Griseofulvin is also effective for the
treatment of Tinea corporis.
• Topical anti fungal creams or
ointments applied regularly for 4 - 6
wks.
• Systemic treatments provide better skin
penetration than most topical preparations,
Itraconazole, terbinafine and griseofulvin
are good choices for oral therapy.
• Itraconazole and terbinafine are more
effective than griseofulvin. Once-weekly
dosing with fluconazole is another option,
especially in noncompliant patients.
• Personal hygiene (foot hygiene) is highly
advised.
Thank You