Dermatology Power point slides Useful, Important & Easy Way To Understand The Chapter

1. DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu

2. Dermatophytes are a group of fungi invading the
dead keratin of skin, hair, nails.
The infection can be Anthropophilic (spread from
person-to-person), Zoophilic ( animal to person),
Geophilic(soil to person).
• Fungal infections are also called Mycosis.
• 4th most common skin disease in the world.
• Causative organism :- A) Epidermophyton
B) Trichophyton
C) Microsporum

3. Depending on the site:
 Tinea capitis : Head
 Tinea faceii : Face
 Tinea barbae : Beard area
 Tinea corporis : Body
 Tinea cruris : Groin area
 Tinea manuum : Hand
 Tinea pediis : Leg
 Tinea unguium ( onychomycosis) : Nails
 Tinea incognito : Fungal infection that can’t be recognize
by area naked eye, which should be diagnosed by KOH
preparation.

4. Skin scraping over a glass slides
Add 2-3 drops of KOH (10%)
Wait for 10-15 mins
Observe under microscope
Fungal
Hype : topical in skin or environment
Yeast : Inside body, blood, organ

5.  KOH preparation- for detection for fungal hyphae,
spores. ( sample collection from plucked hairs, skin
scraping, nail clipping)
 Wood’s lamp-365 nm used mainly for the diagnosis of
T. capitis
 Fungal culture- Sabouraud glucose agar

7. 1. Superficial mycosis :- Infection is limited to outermost
layers of skin/hair. e.g tinea versicolar
2. Cutaneous mycosis :- Infection extends deeper into the
epidermis & also invade into hair & nail e.g
Dermatophytes
3. Subcutaneous mycosis :- Infection involves dermis,
subcutaneous tissue, muscles or fascia, usually the
infection is introduced by piercing injury.
4. Systemic mycosis :- Infection involves the internal organ &
viscera as lungs, liver, brain etc

8.  Risk factors :
i. Inappropriate antibiotic use ( topical /systemic)
ii. Lack of proper hygiene/sanitation
iii. Weakened immune system
iv. Other chronic diseases as Diabetes Mellitus/ Liver
disease/ kidney disease
HIV/AIDS
Drugs
Steroids

9. 1. Dermatophytes can survive solely off of human
stratum corneum, which provides a source of
nutrition.
2. Dermatophyte infections involve three main steps:
 Adherence to keratinocytes,
 Penetration through and between cells,
 Development of a host response

10.  Tinea capitis is a dermatophytosis of the scalp and
associated hair.
 It may be caused by any pathogenic dermatophyte
from the genera Trichophyton and Microsporum
excepting T. concentricum.
 most commonly found in children aged 3 to 14 years
old.
 Is transmitted from the sharing of fomites such as cap,
comp, scarf

11. Classification:
1. Non-inflammatory- Grey patch and Black-dot
 appear as well-defined, round hyperkeratotic, scaly areas of alopecia,
due to the breaking off of hairs
 Remaining hairs and scales exhibit green fluorescence under Wood's
light
2. Inflammatory- Kerion, Favus
 The spectrum of inflammation ranges from a pustular
folliculitis to kerion
Grey patch Black dot

12. Kerion
 It is a boggy, inflammatory mass studded with broken hairs and follicular
orifices oozing with pus.
 Caused by : M. canis and M. gypseum.
 results in scarring alopecia.
 Inflammatory lesions are usually pruritic, and may be associated with pain,
posterior cervical lymphadenopathy, fever.
Favus
 Tinea favosa or favus (Latin, “honeycomb”) is a chronic dermatophyte infection
of the scalp, glabrous skin, and/or nails characterized by thick yellow crusts
(scutula) within the hair follicles, which lead to scarring alopecia

13.  Griseofulvin remains the drug of choice, (esp Microsporum)
although oral therapy with terbinafine, itraconazole, or
fluconazole appears to have similar efficacy.
 Ultramicrosize griseofulvin treatment schedules (10-20
mg/kg) :
 Adults: 250 mg by mouth twice daily for 6 to 12 weeks.
Children: 20 mg/kg of body weight for 6 to 12 weeks
Alternative
 Itraconazole can be used in children as continuous therapy at
a dose of 3 to 5 mg/kg daily for four to six weeks or as pulse
therapy at a dose of 5 mg/kg daily for one week each month
for two to three months.
 Fluconazole 6 mg/kg/day for six weeks in children

14. Tinea pedis Tinea corporis Tinea Cruris
( Athlet’s foot)

15.  Caused by malassezia furfur.
 Most common in the teenage and adolescent age group.
Clinical features :
 The lesions are small, multiple macules
 The lesion are usually hypopigmented then surrounding
normal skin
 Sometimes lesions may be reddish brown
 Itching is present
 The lesion may have papulo-vesicular margin where the
lesion is present in the area having skin folds.

16. Lab investigations :
i. CBC : ↑ Lymphocytes (15-20%) / Basophils(0-1%)
ii. Random blood sugar
iii. Renal or liver function tests
iv. KOH
Treatment :
A. General measures :
i. Improvemenet of personal hygiene
ii. Proper use of systematic or topical antibiotics
iii. Daily changing of undergarments

17. B. Medical treatment :
1. Antifungal :
i. Topical
 Used for skin lesion
 Can be used as single agent if the lesion is not extensive.
E.g
Cortimazole 1 %
Miconazole 2%
Ketoconazole 2%
Terbinafine 2%
ii. Systemic :
 Used when the lesions are extensive & if systemic disease is
present.
E.g
fluconazole 150 mg once a week for 6 months
Itraconazole 200 mg for 2 wks
Terbinafine 250 mg for 2 wks

18. 2. Keratolytic agents :
 Whitfield ointment (2% benzoic acid + 1% salicyclic acid )
used to dissolve upepermost layer of skins so it helps in
cleaning the infection & better drug penetration.
3. Antihistamine : given for itching
 Cetrizine 10 mg OD HS
 Levocetrizine 5 mg OD HS

19.  Extensive spread of lesion
 Secondary bacterial infection
 Sepsis
 Septic shock
 Presence of risk factors like DM, chronic renal
disease, liver disease

20. Introduction :
 Candidiasis is an infection caused by a group of yeast.
 There are more than 20 species of Candida, the most common
being Candida albicans.
 These fungi live on all surfaces of our bodies.
 grow particularly in warm and moist area
Predisposing factors :
 Moisture-area of occlusion & prolonged immersion in water
 Obesity
 Pregnancy and OCP use
 weakened immune systems due to such conditions as HIV/AIDS,
 Diabetes
 taking steroid medications
 chemotherapy.

21. A. Acute mucocutaneous candidiasis
I. Candidal paronychia
II. Genital candidiasis
III. Oral candidiasis
IV. ballanitis
B. Chronic mucocutaneous candidiasis
C. Systemic candidiasis- seen in severe illness, leucopenia,
immunosupression

22. Oropharangeal candidiasis:
 Symptoms are a cottony feeling in the
mouth, loss of taste, and sometimes pain
on eating and swallowing.
 Presents as whitish papules & plaques
which can be easily scraped revealing
erythematous base
 Esophagitis- The hallmark is
odynophagia

23.  symptoms are primarily itching and discharge.
 Dyspareunia, dysuria, and vaginal irritation also
may be present.
 Physical examination -vaginal erythema and
discharge, which is classically white and curd-like
but may be watery.

24. Balanitis
 Balanitis can present as white patches on the penis in
association with severe burning and itching.
Paronychia
 is an inflammation involving the lateral and posterior
fingernail folds.
 Predisposing factors include overzealous manicuring, nail
biting, thumbsucking, diabetes mellitus, and occupations
in which the hands are frequently immersed in water.
 Can be acute and chronic.
 Acute paronychia is usually bacterial, characterized by
the onset of pain and erythema of the posterior or
lateral nail folds, with subsequent development of a.
superficial abscess.
 Chronic paronychia candida may be the sole pathogens, or
be found with other opportunists such as proteus or
pseudomonas.

25.  Candidal intertrigo- topical azoles
 Candidal paronychia
 acute- systemic antibiotics
 chronic- oral antifungal, topical azoles
 Genital candidiasis- imidazole pessary or oral azole