Fungal Infections
Fungal infections Natural defence against fungi y Fatty acid content of the skin y pH of the skin, mucosal surfaces and body fluids y Epidermal turnover y Normal flora Predisposing factors y Tropical climate y Manual labour population y Low socioeconomic status y Profuse sweating y Friction with clothes, synthetic innerwear y Malnourishment y Immunosuppressed patients HIV, Congenital Immunodeficiencies, patients on corticosteroids, immunosuppressive drugs, Diabetes Fungal infections: Classification y Superficial cutaneous: y Surface infections eg. P.versicolor, Dermatophytosis, Candidiasis, T.nigra, Piedra y Subcutaneous: Mycetoma, Chromoblastomycosis, Sporotrichosis y Systemic: (opportunistic infection) Histoplasmosis, Candidiasis Of these categories, Dermatophytosis, P.versicolor, Candidiasis are common in daily practice Pityriasis versicolor y Etiologic agent: Malassezia furfur Clinical features: y Common among youth y Genetic predisposition, familial occurrence y Multiple, discrete, discoloured, macules. y Fawn, brown, grey or hypopigmented y Pinhead sized to large sheets of discolouration y Seborrheic areas, upper half of body: trunk, arms, neck, abdomen. y Scratch sign positive PITYRIASIS VERSICOLOR P.versicolor : Investigations y Wood’s Lamp examination: y Yellow fluorescence y KOH preparation: Spaghetti and meatball appearance Coarse mycelium, fragmented to short filaments 2-5 micron wide and up to 2-5 micron long, together with spherical, thick-walled yeasts 2-8 micron in diameter, arranged in grape like fashion. P.versicolor: Differential diagnosis y Vitiligo y Pityriasis rosea y Secondary syphilis y Seborrhoeic dermatitis y Erythrasma y Melasma Treatment P. versicolor Topical: y Ketoconazole , Clotrimazole, Miconazole, Bifonazole, Oxiconazole, Butenafine,Terbinafine, Selenium sulfide, Sodium thiosulphate Oral: y Fluconazole 400mg single dose y Ketoconazole 200mg OD x 14days yGriseofulvin is NOT effective.
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