Management of Common Fungal

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Management of Common Fungal Bacterial Skin
Infections

• Dr. Sandra McLeod
• Consultant Dermatologist
• Skin Clinic
• KPH/NCH

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Superficial Fungal Infections

• DERMATOPHYTES. aka Tinea
• YEASTS
• -Pityrosporum.
• -Candida sp.

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TINEA Infections

• T.Corporis- ringworm of body
• T.Cruris- groin
• T.Pedis- foot
• T.Unguium- nail
• T.Capitis scalp

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T.Corporis

• Itchy
• Annular patch
• Well defined edge
• Scaling more obvious at edges(central clearing)

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T.Pedis
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TINEA CRURIS

• Often assoc with T.pedis
• Jock itch
• Tight hot sweaty groin eg athletes, obese,in lycra

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• Onycholysis
• Subungual hyperkeratosis
• Dystrophy/
• pigmentary changes

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TINEA CAPITIS - KERION
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TINEA CAPITIS Black dot
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Management

• General Measures
• Non-specific-
• Keratolytics -eg Whitfields ointment
• -Irritant

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Specific Antifungal Rx

• Griseofulvin
• Azoles-
• -Imidazole eg ketoconazole ( liver toxicity,
  oral prep)
• topical preps
• -Triazole eg itraconazole,fluconazole
• Allylamines eg terbinafine, naftifine
• Ciclopiroxolamine

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TOPICAL Rx

• Localized disease of skin
• extend rx for 3-5/7 after apparent cure
• 1 clotrimazole less effective
• Sprays solutions
• tinea pedis /hairy areas
• Limited nail disease
• Batrafen nail lacquer

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ORAL Rx

• Extensive disease
• Nail disease
• Tinea Capitis

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Regimes-Tinea Unguium

• TERBINAFINE
• Terbinafine250mg od
• ITRACONAZOLE
• Pulse rx Itraconazole - 1wk/mth 200mg bid
• Itraconazole 200mg od
• FLUCANAZOLE
• Fluconazole 150mg once weekly

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Rx-Tinea Capitis

• MUST use oral Rx- prolonged course
• Griseofulvin-20mg/kg/od x 6-8/52
  Terbinafine-62.5mg-250mg od x 4/52
• Flucanazole-50mg-150mg/wk x 4-6/52

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Rx-Tinea CapitisAdjunctive Measures

• Shampoo- antifungal/ antiseptic/antidandruff
• Antibiotics
• NO STEROIDS

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Yeasts

• Pityrosporum.
• Candida.
• Ordinarily commensals.
• Can become pathogens under favourable conditions.

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Pityriasis Versicolor

• Ppted by heat, sweat, steroids
• Asymptomatic
• scaly macules
• Chest, back, face

hypopigmented
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P.Versicolor

• Hyperpigmented

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Management

• Many Rx
• No Rx eradicates yeast permanently
• NONSPECIFIC
• Keratolytics
• whitfield ung, sulphur
• Antiseptics
• selenium sulphide, Na thiosulphate
• CHEAP, smelly, messy, irritant, slower

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Antifungal Rx

• Azoles-oral/topical
• Ketoconazole 200mg od x7
• Itraconazole 200mg od x 7
• Fluconazole 300mg-400mg stat
• FORGET terbinafine tabs for P.V

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P.V-tougher than you think!

• High recurrence
• Hypopigmentation post-rx UVB helpful
• Prophylaxis

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Candidiasis

• Candida sp- commensal of GIT
• Precipitating Factors
• Endocrinopathy
• Immunosuppression
• Fe/Zn deficiency
• Oral antibiotic Rx
• Oropharyngeal candidiasis is marker for AIDS

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Candidiasis

• Oropharnygeal
• Candidal intertrigo-breasts, groin, web spaces
• Chronic Paronychia - nail fold infection
• Vaginitis/balanitis

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Candidal Intertrigo

• Moist folds
• Erythematous patch with satellite lesions

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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

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Chronic Paronychia

• Infection of nail fold
• Wet alkaline work Excess manicuring
• Damage to cuticle
• Swelling of nail fold (bolstering)
• Nail dystrophy

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Chronic Paronychia

• Keep hands dry /Wear gloves
• Long term Rx
• Oral Azoles
• Antifungal solution-(high alcohol content)
• /-Broad spectrum antibiotics-cover staph/GNB

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Bacterial Infections

• Impetigo
• Folliculitis- furuncles ,carbuncles
• Cellulitis
• Erythrasma-
• Secondarily infected skin disorders

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Folliculitis
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Erythrasma

• Obese
• Diabetic
• Erythromycin 250 mg qid x 2 weeks
• Azoles less effective