This document discusses fungal infections of the skin, including deep and superficial fungal infections. Deep fungal infections include mycetoma, sporotrichosis, chromoblastomycosis, and subcutaneous zygomycosis. Superficial fungal infections include dermatophyte infection, pityriasis versicolor, and candidiasis. Dermatophyte infection is caused by Trichophyton, Microsporum, and Epidermophyton fungi and commonly manifests as tinea pedis (athlete's foot), tinea unguium (nail fungus), tinea manuum, tinea cruris, and tinea corporis. Tinea capitis typically affects children. Diagnosis involves

1. Dermatology

2. Fungal infections of skin:
1. Deep fungal infections
2. Superficial fungal infections

3. Deep Fungal Infections:
1. Mycetoma
2. Sporotrichosis
3. Chromoblastomycosis
4. Sub cutaneous zygomycosis

4. Superficial Fungal infections:
1. Dermatophyte infection
2. Pityriasis versicolor
3. Candidiasis

5. Dermatophyte Infection:
Cause
1. Trichophyton - skin, hair and nails
2. Microsporum - skin and hair
3. Epidermophyton - skin and nails
• Dermatophytes invade only onto Stratum corneum and
the inflammation caused is the outcome of delayed
hypersensitivity or the metabolic products of fungus.
• Severity of infection: Zoophilic fungi > Anthropophilic
fungi

6. Tinea pedis (Athelete’s foot):
• M/c type
• Organisms :
a. Trichophyton rubrum (m/c and most stubborn)
b. Trichophyton mentagrophytes var. interdigitale
c. Epidermophyton floccosum
• Clinical pattern:
a. Soggy interdigital scaling, particularly in 4th & 5th
interspace (all three organisms)
b. Diffuse dry scaling of soles (usually T. rubrum)
c. Recurrent episodes of vesication (T. mentagrophytes var.
interdigitale or E. floccosum)

8. Tinea unguium:
Nail shows following changes :
• Yellow-brown discoloration & thickening of nail plate that
crumbles easily and so appears tunnelled.
• Subungual hyperkeratosis
• Onycholysis
Patterns:
 Distal/lateral Subungual variety (m/c)
Superficial white variety
 Proximal subungual variety.

10. Tinea manuum:
• Often associated with Tinea pedis
• Lesions manifest as unilateral, well-defined plaques or as
diffuse erythema of the palms with accumulation of fine
scales in the creases.

12. Tinea cruris:
• Common
Sites :
• Groins, Genitalia, Pubic area, Perineal and Perianal areas
Predisposing factors:
•Summer & Rainy seasons
• Occlusion; use of synthetic clothes
• Males > Females
• Adults > Children

13. Tinea cruris:
Morphology:
• Arcuate or annular, sharply demarcated plaques with
peripheral scaling, papulovesiculation and pustulation.
• Chronic lesions may show hyperpigmentation, nodulation
and lichenification in centre.

15. Tinea corporis:
Sites : Glabrous skin, except palms, soles and groins
Variants:
• Tinea incognito ( modified by steroid therapy)
• Tinea faciae ( Cheeks of children)
• Tinea barbae ( Inflammatory swelling with alopecia, in
beard region)

17. Diagnostic features of T. corporis/cruris:
•Itchy dermatosis
• Annular/ arcuate lesions
• Peripheral papulovesiculation & scaling with a relatively
clear centre

18. Tinea capitis:
• Usually a disease of children
• Anthropophilic fungi – bald and scaly areas, with minimal
inflammation and hairs broken off 3-4mm from scalp
• Zoophilic fungi – induce more intense inflammation with
boggy swelling, pustulations and lymphadenopathy.
Patterns:
• Noninflammatory tinea capitis
• Inflammatory tinea capitis
• Favus (T. schoenleinii/ cicatricial alopecia)

20. Diagnostic features of T. capitis:
• Patient usually children
• Non-inflammatory/inflammatory patch of alopecia
• Easy, painless pluckability of hair

21. Complications of Tinea:
• Dermatophytide reaction
• Cicatricial alopecia

22. Investigations :
• Microscopic Examination
• Culture (SDA )
• Wood’s light

23. Treatment :

24. Factors determining treatment modalities :
• Site of lesions
• Extent of lesions
• Chronicity
• Patient compliance

25. General Measures :
• Keeping area dry
• Avoid use of synthetic clothes
• In recurrent infection, prophylactic use of antifungal
talc.

26. Systemic Therapy recommended in :
• Extensive dermatophytic infections
• Tinea unguium
• Tinea capitis

27. Topical Agents :
• Azole derivatives : Broad spectrum; Miconazole,
Clotrimazole & ketoconazole mainstay of therapy
• Allylamines : Rapid response. Terbinafine, butenafine
• Morpholines : Amorolfine

28. Systemic Therapy :
• Terbinafine
• Griseofulvin
• Itraconazole

29. Terbinafine :
• Fungicidal
• Indications – Dermatophytic infections [ DOC for
extensive tinea infection and tinea unguium; ineffective
in pityriasis versicolor and candidal infection.]
• Dose – 250mg OD. With development of resistance,
500mg OD being used.
•S/Es – GI side effects, Alteration in tastes and skin
rashes

30. Griseofulvin :
• Fungistatic
• Indications – resurgent use, with development of
resistance to terbinafine. [DOC in T. capitis; ineffective
in pityriasis versicolor and candidal infection.]
• Dose – 10mg/kg daily of ultramicronized formulation,
after fatty meal
• S/Es – may cause persistant headdache, GI side effects
and skin eruptions. (Common cause of photosensitive
reaction)
• Avoid in – Pregnants and in pt. with liver failure,
porphyria and systemic lupus.

31. Itraconazole :
• Fungistatic
• Indications – broad-spectrum antifungal agent,
effective in dermatophytic infections, pityriasis versicolor
and candidal infection. (Generally used in
onychomycosis)
• Dose – 200-400 mg, to be taken with meals
•S/Es – GI side effects and hepatotoxicity.
• Avoid in – Children, Pregnant and lactating women.

32. References :
• Illustrated Synopsis of Dermatology and
Sexually Transmitted Diseases. Khanna Neena
• Textbook of Clinical Dermatology. Sehgal
Virendra N.

33. Thank You !