good , dermatology

1. Yeast Infection
By
Dr.Alaa Al-sahlany
Oct. 30, 2022

2. Pityriasis versicolor
Caused by malassaezia furfur and M. globosa,
are part of the normal follicular flora
Present with multiple hyperpigmentd or
hypopigmented patches with fine(fluffy or
furfuraceous) scale. Demonstration of this
associated scale may require scratching or
stretching the skin surface

3. Fluffy
Furfuraceous (bran-like)

6. Decreased pigmentation may be secondary to:
The inhibitory effects of dicarboxylic acids on
melanocytes (dicarboxylic acids result from
metabolism of surface lipids by the yeast) or
Decreased tanning, due to the ability of the
fungus to filter sunlight(work as a sunscreen).

7. More common during the summer months
owing to high temperature and humidity
Usually asymptomatic

8. Malassezia is lipophilic: therefore,
(1) seborrheic regions, in particular the upper trunk
and shoulders, are the favored sites of involvement
(2) adolescents are frequently affected.
Malassezia is dimorphic i.e. grow both as a yeast
and hyphae

9. Diagnosis
Dx: KOH examination of scale scraping which
shows “Spaghetti and meatballs” which are
hyphae and spores, respectively

10. Spaghetti and meatballs
Dermatophyte hyphae

11. Treatment
Topical treatment : selenium sulfide or
ketaocoazole shampoo applied daily for a week.
Others: Other imidazoles, zinc pyrithion, sulfur,
and benzyl peroxide
Systemic : itraconazole (200 mg/day) for a week,
fluconazole (300 mg) weekly for two weeks

12. Candidiasis(Candidosis or
Moniliasis)

13. C. albicans is a common inhabitant of the
gastrointestinal and genitourinary tracts, and
skin
C. albicans is an opportunistic organism. Under
the right conditions e.g. decreased immunity,
moisture and decreased competing flora, It can
cause lesions of the skin, nails, and mucous
membranes

14. Predisposing factors:
Diabetes mellitus
Xerostomia(saliva inhibit growth of candida)
Occlusion e.g. under adhesive plaster
Hyperhidrosis
Use of corticosteroids and broad- spectrum
antibiotics
Immunosuppression, including HIV infection

15. Diagnosis
Microscopical KOH examination show budding
yeast and pseudohyphae in stratum corneum
and superficial mucosa
Biopsy and Histological exam

16. Sabouraud culture . It takes about 4 days to
grow colonies

17. Clinical types

18. Oral candidiasis (Thrush)
The mucous membrane of the mouth may be
involved in healthy infant
In the newborn the infection may be acquired
from contact with the vaginal tract of the mother

19. (1)Pseudomembranous Candidiasis (Thrush):
White-to-creamy plaques on any mucosal surface.
Removal with a dry gauze pad leaves an ery-
thematous mucosal surface. Can involve dorsum
of tongue, buccal mucosa, hard/soft palate,
pharynx, esophagus.
(2) Erythematous (Atrophic) Candidiasis:
Smooth, red, atrophic patches(atrophic papillae)

20. (3) Hyperplastic candidiasis: white plaques that
cannot be wiped off.
It is often the first manifestation of AIDS.
Rx:
Topical:oral nystatin suspension or clotrimazole
troches that dissolve in the mouth
Systemic: fluconazole and itraconazole.

22. Angular Cheilitis(Perleche)
White plaques with slight erythema of the
mucous membrane at the angles of mouth.
Maceration and fissures may ensue
Is commonly related to C. albicans, but may be
caused by coagulase positive S. aureus and Gram-
negative bacteria. Similar changes may
nutritional deficiency e.g. riboflavin and iron.

23. Drooling in persons with malocclusion caused by
ill fitting denture or overlap of angles of mouth in
edentulous elderly are predisposing factors.
RX: Topical anticandidal

26. Candidal vulvovaginitis
Overgrowth of candida can cause the labia to be
erythematous
There might be a pruritus, burning and curd-like
discharge
Pregnancy, OCP and tamoxifen treatment are a
predisposing factors

28. About 20% of asymptomatic women are vaginal
%
carriers. During pregnancy, this rises to 40
Candidiasis can be sexually transmitted and this
is probably most important in recurrent
infections(more than 3 episodes per year)
Rx: vaginal suppositories containing nystatin or
imidazole. Single-dose oral fluconazole is an
alternative

29. Balanitis and Balanoposthitis
Balanitis is more common in the uncircumcised
man
The skin is erythematous and glazed with
pustules and erosions
Rx: topical anticandidal agents or single dose
oral fluconazole. Treatment of sexual partner is
essential

31. Candidal intertrigo
Can involve groins or armpits; intergluteal cleft;
under large breasts; under overhanging
abdominal folds; or in the umbilicus.
Red moist patches surrounded by a fringe of
macerated epidermis (“collarette” scale).

32. Tiny pustules and papules are observed closely
adjacent to the patches, termed “satellite or
daughter” lesions
Rx: Topical anticandidal preparations are usually
effective. Oral anti-candidal agents are
alternative

36. Diaper candidiasis
Differentiated from contact dermatitis by:
(1) Involvement of the folds
(2) Occurrence of many small erythematous
“satellite” or “daughter” lesions scattered along
the edges of the larger patch(es)
Rx: Topical anticandidal agents are effective.
Recurrent cases may be associated with gut
colonization and need Rx with oral nystatin

38. Perianal candidiasis
May present as a pruritus ani
Pruritus and burning can be very severe
Characterized by erythema, maceration and less
commonly fissure
Rx: topical anticandidal agents are effective. Oral
antifungals are alternative

40. Candidal paronychia
Redness, edema, and tenderness of the proximal
and lateral nail folds
Usually the fingers are affected more than toes
Patients commonly have an atopic background
Frequently seen in diabetics and those who work

41. Two types:
Acute: usually caused by staph. aureus
Chronic: multifactorial i.e. Irritant dermatitis and
candidiasis
Rx: Avoidance of chronic exposure to water and
irritants and bringing the diabetes under control
in addition to topical steroids in combination with
topical anti-candidal agents

42. Acute paronychia
Chronic paronychia

44. Erosio interdigitalis blastomycetica
Oval shaped area of macerated white skin
associated with fissures and raw red skin at the
center on the web between fingers
Nearly always between the middle and ring
fingers
Moisture beneath the ring predispose to
infection

46. On the feet it is the fourth web space that is
most often involved
Clinically, this may be indistinguishable from
tinea pedis
Rx: drying and topical anticandidal agents

48. Antifungals
Comment
Spectrum of
action
Antifungal agent
In general, the longest course
of treatment is for tinea
unguium followed by tinea
capitis followed by other types
of dermatophytosis
Griseofulvin is the first choice
for treatment of tinea capitis
(4-12 weeks course)
Imidazoles and allylamines are
the first choice for treatment
of tinea unguium but
griseofulvin is not used for
tinea unguium because it
require a long course (4-6
months to one year)
Dermatophytes, Candida
and Pityrosporum
Imidazoles e.g. ketoconazole,
itraconazole, fluconazole,
clotrimazole:
Dermatophytes
Allylamines e.g. terbinafin
Candida only
Polyenes e.g. amphotericin B
and nystatin
Dermatophytes only
Griseofulvin

51. Antifungals
Comment
Spectrum of
action
Antifungal agent
Griseofulvin is the first choice
for treatment of tinea capitis
(4-12 weeks course)
Imidazoles and allylamines are
the first choice for treatment
of tinea unguium
Dermatophytes, Candida
and Pityrosporum
Imidazoles e.g. ketoconazole,
itraconazole, fluconazole,
clotrimazole:
Dermatophytes
Allylamines e.g. terbinafin
Candida only
Polyenes e.g. amphotericin B
and nystatin
Dermatophytes only
Griseofulvin

53. Candidid(id reaction)
They are much less common than the reactions
seen with dermatophytosis.