This document provides information about superficial fungal infections. It begins by classifying fungal diseases into four groups based on pathogenicity: superficial mycoses, mucocutaneous mycoses, subcutaneous mycoses, and deep mycoses. Later pages discuss specific superficial fungal infections like tinea pedis, tinea cruris, tinea facialis, pityriasis versicolor, and tinea unguium/onychomycosis. Diagnosis involves clinical examination, microscopy of samples, and fungal cultures. Management consists of topical and oral antifungal agents as well as prevention through hygiene practices.
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Rosacea is a chronic (long-term) disease
that affects the skin and sometimes the eyes. The disorder is characterized by
redness, pimples, and, in advanced stages, thickened skin. Rosacea usually
affects the face. Skin on other parts of the upper body is only rarely
involved.
Scabies is a superficial epidermal infestation by the mite Sarcoptes scabiei var. hominis.
Etiologic Agent:
S. scabiei var. hominis. Thrive and multiply only on human skin, i.e., obligate human parasite.
Transmission
Skin-to-skin contact
Fomites: Mites can remain alive for >2 days on clothing or in bedding; hence, scabies can be acquired without skin-to-skin contact.
intimate personal contact, such as having sexual intercourse
Scabietic (Scabious) Nodule:Inflammatory papule or nodule ;burrow sometimes seen on the surface of a very early lesion.• Distribution : Areola, axillae, scrotum, penis.
Rosacea is a chronic (long-term) disease
that affects the skin and sometimes the eyes. The disorder is characterized by
redness, pimples, and, in advanced stages, thickened skin. Rosacea usually
affects the face. Skin on other parts of the upper body is only rarely
involved.
Scabies is a superficial epidermal infestation by the mite Sarcoptes scabiei var. hominis.
Etiologic Agent:
S. scabiei var. hominis. Thrive and multiply only on human skin, i.e., obligate human parasite.
Transmission
Skin-to-skin contact
Fomites: Mites can remain alive for >2 days on clothing or in bedding; hence, scabies can be acquired without skin-to-skin contact.
intimate personal contact, such as having sexual intercourse
Scabietic (Scabious) Nodule:Inflammatory papule or nodule ;burrow sometimes seen on the surface of a very early lesion.• Distribution : Areola, axillae, scrotum, penis.
Fungal infection of the skin, most common on the exposed surfaces of the body, namely the face, arms and shoulders.
Most common fungal diseases ; Ringworm. A common fungal skin infection that often looks like a circular rash.
Children's skin problems span nearly two decades from birth through adolescence. Several common pediatric skin conditions will be discussed including: diaper dermatitis, atopic dermatitis, warts, and acne.
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Toxicology
Volatile poisons
Ethyl alcohol (Ethanol)
It is colorless liquid with characteristic odor.
It is obtained from fermentation of food e.g. barley , bread or fruits.
The percentage of alcohol in beverages caries according to the type of alcoholic beverages.
Its most common ingested toxin throughout world,
Thousands of deaths occur due to overdose , suicide and accidental intake of alcohol.
Alcoholic beverage
The alcoholic content of different beverages are:
Beer:2-8%
Ligh wine:5-10%
Heavy wines:10-20%
Brany ,Rhum (rum),vodka and wisky:40-50% .
Absorption and elimination
Ethyl alcohol can be absorbed by the mucus membrane of the stomach and the upper part of the small intestine.
Absorption occurs more rapidly when its taken on an empty stomach. its delayed by the presence of food, especially fatty food.
After absorption : it reaches its maximal concentration in the blood after 0.5-1 hr.
About 90% of the amount absorbed is oxidized in the body into acetaldehyde and then into carbon dioxide + water +energy. the remaining 10% is excreted unchanged in the urine and breath.
The rate of oxidation of alcohol in the body after absorption is 0.1ml/hg/bodywt/hour.
The concentration of alcohol in the blood can be indirectly estimated by measuring its cocentration in alveolar air by aclometer.
Metabolism
Ethanol is oxidized to acetaldehyde by alcohol dehydrogenase and then metabolized into Co2 and water, this is considered the main path of metabolism , microsomal ethanol oxidizing system (MEOS) plays a minor rule.
Because of mucosal and hepatic metabolism , the oral dose yields a lower blood ethanol level than in equivalent
Administered I.V dose.
METHYL ALCOHOL (Methanol)
Methyl alcohol is widely used in industry and laboratories and hospitals as a solvent. Many cases of poisoning occurs due to adulteration of ethyl alcohol by adding methyl alcohol, or methyl alcohol is taken as a substitute for ethyl alcohol .
Metabolism
Methyl ALCOHOL is metabolized mainly in the liver by dehydrogenases to formaldehyde and formic acid, both are more toxic than methanol leading to blindness and acidosis .
Fatal Dose :
60-150 mls 15 mls is enough to cause visual effect.
Action:
retinal edema , optic atrophy , CNS depression, cyanosis, metabolic acidosis , neuritis optic and blindness
Fatal Period : variable
Fomepizole
Hormonal contraception (Combined Hormonal Contraceptives)Naji Majid Ahmed
Combined Hormonal Contraceptives :
includes:
Combined Oral Contraceptives (Pills)
Contraceptive vaginal ring
Transdermal patch
2. Progestogen Only Contraceptions(POC):
includes:
Progestogen-only pill(POP)
Implant
Progestogen-only injectable
Progestogen-releasing intrauterine system(LNG–IUS)
Missed pills:
If one pill is missed, anywhere in the pack (ie more than 24 and up to 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
The rest of the pack should be taken as usual.
No additional contraception is needed.
The seven-day break is taken as normal.
Emergency contraception is not needed if just one pill has been missed. However, it should be considered if other pills have been missed recently, either earlier in the current packet, or at the end of the previous packet.
Missed pills:
If two or more pills are missed (ie more than 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
Any earlier missed pills should be left.
The rest of the pack should be taken as usual and additional precautions (eg, condoms or abstinence) should be taken for the next seven days.
The next step then depends on where in the packet the pills are missed:
The next step then depends on where in the packet the pills are missed:
If the pills are missed in the first week of a pack (pills 1-7): emergency contraception should be considered if the patient had unprotected sex in the pill-free interval or the first week of the pill packet. She should finish the packet and have the usual pill-free interval.
If the pills are missed in the second week of a pack (pills 8-14): there is no need for emergency contraception as long as the pills in the preceding seven days have been taken correctly. The packet should be finished and the usual pill-free interval taken.
If the pills are missed in the third week of a pack (pills 15-21): the next pack of pills should be started without a break - ie the pill-free interval is omitted. If taking a packet with dummy/placebo pills, these should be discarded, and the new packet started. Emergency contraception is not required.
If more than seven pills are missed, the woman should start again as if starting for the first time. (Exclude pregnancy, and start a new pack on the first day of the next menstrual period.)
Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
Classification Of Melanoma
I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
Etiology And Pathogenesis
The etiology and pathogenesis of cutaneous melanoma are unknown.
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Six Signs of Malignant Melanoma (ABCDE Rule):
A- Asymmetry in shape—one-half unlike the other half.
B- Border is irregular—edges irregularly scalloped, notched, sharply defined.
C- Color is not uniform; mottled—haphazard display of colors; all shades of brown, black, gray, red, and white.
D- Diameter is usually large.
E- Elevation is almost always present and is irregular—surface distortion is assessed by side-lighting. others use E for Enlargement— a history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
Lentigo Maligna Melanoma (LMM)
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Basal Cell Carcinoma (BCC)
BCC is the most common cancer in humans.
Caused by UVR; PTCH gene mutation in most cases.
Clinically different types: nodular, ulcerating, pigmented, sclerosing , and superficial.
BCC is locally invasive, aggressive, and destructive but slow growing, and there is very limited (literally no) tendency to metastasize.
Skin Lesions: There are five clinical types:
1- Nodular
2- Ulcerating
3- Sclerosing (Cicatricial),
4- Superficial,
5- Pigmented.
Cutaneous And Mucocutaneous Leishmaniasis
Modes of Transmission :
Vector-borne: by bite of infected female sandflies (2–3 mm long), which become infected by taking blood meal from infected mammalian host.
Other modes: congenital and parenteral (i.e., by blood transfusion, needle sharing, laboratory accident).
Incubation Period: Inversely proportional to size of inoculum: shorter in visitors to endemic area. OWCL:
L. tropica major : 1–4 weeks.
L. tropica , 2–8 months.
acute CL: 2–8 weeks or more.
Pediculosis capitis
Pediculosis corporis
Pediculosis pubis
Three types of lice:
Head lice: Pediculus humanus capitis (2-3 mm long)
Body lice: Pediculus humanus humanus (2.3-3.6 mm long)
Pubic lice (crabs): Phthirus pubis (1.1-1.8 mm long)
Sites of predilection
Head lice nearly always confined to scalp, especially occipital and postauricular regions.
Rarely, head lice infest beard or other hairy sites. Although more common with crab lice, head lice can also infest the eyelashes ( pediculosis palpebrarum ).
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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2. Page 2
Fungal diseases are classified into 4
groups:
According To Pathogenicity:
1• Superficial mycoses
2• Mucocutaneous mycoses
3• Subcutaneous mycoses
4• Deep mycoses/SYSTEMIC MYCOSIS
3. Page 3
Who is at risk?
• Anyone with a weakened immune system may
be more likely to contract a fungal infection, as
well as anyone who is taking antibiotics.
• Cancer treatment and diabetes may also make a
person more prone to fungal infections.
4. Page 4
Transmission
- Most commonly from another person less
by direct skin-to-skin contact
- From animals such as dogs or cats
- Least commonly from soil (Environmental).
5. Page 5
Diagnosis ?
1) Clinical Diagnosis (Skin lesion )
2) Laboratory Examinations :
Direct Microscopy :Sampling
Wood Lamp : Darken room and illuminate
affected site with Wood lamp
Fungal Cultures : Specimens collected
From scaling skin lesions, hair, nails.
6. Page 6
Management
1) Prevention : Apply powder containing
imidazoles to areas prone to fungal
infection after bathing.
2) Topical antifungal
3) Systemic antifungal agents
7. Page 7
Superficial fungal infections
Superficial fungal infections of the skin are
one of the most common dermatologic
conditions seen in clinical practice.
8. Page 8
fungal infections
Superficial fungal infections are caused by numerous
fungi that are capable of superficially invading
the following:
1.Skin
2.Mucosal sites
3.These fungi are commensural organisms that frequently
colonize normal epithelium.
4.Infections can extend more deeply in the
immunocompromised host.
10. Page 10
3▪ These fungi are commensural organisms that
frequently colonize normal epithelium.
•Dermatophytes: infect keratinized epithelium,
hair follicles, and nail apparatus
•Candida Albacans: Yeast infection
• Malassezia species: Require a humid
microenvironment and lipids for growth.
12. Page 12
Dermatophytoses of Hair
1) Tinea Capitis
2) Tinea Barbae
3) Dermatophytic Folliculitis
4) Majocchi Granuloma
13. Page 13
Tinea Pedis
• Dermatophytic infection of the feet
• Clinical findings: erythema, scaling,
maceration, and/or bulla formation
14. Page 14
EpidemiologyEpidemiology
• Age of Onset :
Late childhood or young adult life. Most
common, 20–50 years.
• Sex : Males > females.
• Predisposing Factors : Hot, humid
weather; occlusive footwear; excessive
sweating.
15. Page 15
• Transmission :
Walking barefoot on contaminated floors.
Arthrospores can survive in human scales
for 12 months.
16. Page 16
Clinical Manifestation
• Duration : Months to years or lifetime .
• Skin Symptoms :
Usually Asymptomatic
Pruritus
Pain with bacterial superinfection.
17. Page 17
Skin Lesions
4 Types :
1. Interdigital Type
Two patterns:
• Dry scaling
• Maceration, peeling, fissuring of toe
webs. Hyperhidrosis common.
• Most common site: between fourth and
fifth toes. Infection may spread to
adjacent areas of feet.
20. Page 20
2. Moccasin Type :
• Well-demarcated erythema with minute
papules on margin, fine white scaling, and
hyperkeratosis(confined to heels, soles,
lateral borders of feet).
21. Page 21
3. Inflammatory/Bullous Type :
•Vesicles or bullae filled with clear fluid .
•Pus usually indicates superinfection with S.
aureus infection or GAS.
22. Page 22
4. Ulcerative Type :
Extension of interdigital tinea pedis onto
dorsal and plantar foot.
23. Page 23
Diagnosis ?
1) Clinical Diagnosis (Skin lesion )
2) Laboratory Examinations :
• Direct Microscopy :In bullous type, examine
scraping from the inner aspect of bulla roof for detection of
hyphae.
Wood Lamp
Fungal Cultures : for fungal and bacteria
24. Page 24
Management
• Tinea pedis can be treated with topical or oral
antifungals or a combination of both.
topical agents are used for 1-6 weeks.
Antifungal agent :
Topical antifungal :
• Miconazole (Micatin)
• Ketoconazole (Nizoral)
• Econazole (Spectazole)
• Oxiconizole (Oxistat)
Systemic antifungal :
•Fluconazole :150-, 200-mg tablets;
oral suspension (10 or 40 mg/mL)
•Ketoconazole : 200-mg tablets
25. Page 25
Secondary prophylaxis:
Important in preventing recurrence T.pedis. Daily washing
of feet while bathing with benzoyl peroxide bar is effective
and inexpensive. Antifungal powders, alcohol gels.
26. Page 26
Subacute or chronic dermatophytosis of
the groin, pubic regions, and thighs.
“Always” associated with tinea pedis, the
source of the infection.
Synonym : “Jock itch.”
Tinea Cruris
27. Page 27
Epidemiology And Etiology
• Age of Onset :
Adult.
• Sex :
Males > females.
• Etiology :
Trichophyton rubrum, T.mentagrophytes .
29. Page 29
Clinical Manifestation
• Duration: Months to years. Often, history
of long-standing tinea pedis and prior
history of tinea cruris.
• Skin Symptoms: Often none. In some
persons pruritus .
30. Page 30
Skin Lesions
• Large, scaling, well-demarcated dull red
/brown plaques
• Papules, pustules may be present at margins .
32. Page 32
Management
Antifungal AgentsAntifungal Agents
Topical :
Systemic : If recurrent, if dermatophytic
folliculitis is present, or if it has failed to
respond to adequate topical therapy. See
“Management,”(before )
33. Page 33
Management
• Prevention:
After eradication of tinea cruris, tinea pedis, and
tinea unguium, reinfection can be minimized by
wearing shower shoes when using a public or
home (if family members are infected) bathing
facility; using antifungal powders; benzoyl
peroxide wash; alcohol gels.
34. Page 34
Dermatophytosis of the glabrous facial
skin
Well-circumscribed erythematous patch
More commonly misdiagnosed than any
other dermatophytosis.
Synonym : ((Tinea faciei))
Tinea Facialis
35. Page 35
Epidemiology And Etiology
• Age of Onset:
More common in children.
• Etiology:
T. tonsurans associated with tinea
capitis in black children and their parents.
T.mentagrophytes, T. rubrum most
commonly; also M. audouinii, M. canis.
38. Page 38
Skin Lesions
1. Well-circumscribed macule to plaque of variable
size; elevated border and central regression
39. Page 39
2. Scaling is often minimal but can be
pronounced.
3. Pink to red.
4. In black patients,
hyperpigmentation.
5. Any area of face but
usually not symmetric.
41. Page 41
• Epidermal dermatophytosis, often associated with
dermatophytic folliculitis.
• Occurs after the topical application of a
glucocorticoid preparation to a site colonized or
infected with dermatophyte.
• Occurs when an inflammatory dermatophytosis is
mistaken for psoriasis or an eczematous
dermatitis .
Tinea Incognito
42. Page 42
• Lesions are usually aymptomatic but may
be very pruritic or even painful.
• Involved sites often have exaggerated
features of epidermal dermatophytoses,
being a deep red or violaceous with
follicular papules or pustules.
• Epidermal atrophy caused by chronic
glucocorticoid application may be present.
• Systemic antifungal therapy may be
indicated due to deep involvement of the
hair apparatus.
46. Page 46
Dermatophytoses of Hair
Trichomycosis
1) Tinea Capitis
2) Tinea Barbae
3) Dermatophytic Folliculitis
4) Majocchi Granuloma
47. Page 47
Dermatophytoses of Hair
• Dermatophytes are capable of invading
hair follicles and hair shafts, causing
dermatophytic trichomycosis .
• Two types of hair involvement are
seen:
Dermatophytic folliculitis
48. Page 48
Tinea Capitis
• Dermatophytic trichomycosis of the scalp.
• Synonyms : Ringworm of the scalp
49. Page 49
Epidemiology And Etiology
• Age of Onset:
school-age children. Most common at 6–
10 years of age; less common after age
16. In adults it occurs most commonly in a
rural setting.
• Race:
Much more common in blacks than in
whites.
50. Page 50
• Etiology:
90% of cases of tinea capitis caused by
T. tonsurans
most cases were caused by: M. audouinii .
Less commonly :
M. gypseum, T.mentagrophytes, T. rubrum.
51. Page 51
Transmission
• Person-to-person, animal to-person, via
fomites.
• Spores are present on asymptomatic
carriers, animals, or inanimate objects.
• Risk Factors: For favus : debilitation,
malnutrition, chronic disease .
54. Page 54
2. Endothrix Tinea Capitis:
“Black dot” tinea capitis :
Broken-off hairs near surface give
appearance of “dots” (swollen hair shafts) in
dark-haired patients. Dots occur as affected
hair breaks at surface of scalp. Tends to be
diffuse and poorly circumscribed.
56. Page 56
Kerion :
• Inflammatory mass in which remaining
hairs are loose.
• Characterized by boggy, purulent,
inflamed nodules and plaques
• Usually extremely painful; drains pus from
multiple openings, like honeycomb.
57. Page 57
Kerion An extremely painful, boggy, purulent inflammatory
nodule on the scalp of this 4-year-old child.
58. Page 58
Tinea capitis: favus Extensive hair loss with atrophy,
scarring, and so-called scutula, i.e., yellowish adherent
crusts present on the scalp; remaining hairs pierce the
scutula. Trichophyton schoenleinii was isolated on culture.
59. Page 59
Diagnosis ?
1) Clinical Diagnosis (Skin lesion )
2) Laboratory Examinations :
• Direct Microscopy :Specimens should include hair
roots and skin scales.
Fungal Cultures : for fungal and bacteria
With brush-culture technique .
60. Page 60
Management
1. Prevention : Ketoconazole or selenium
sulfide shampoo may be helpful in eradicating
the asymptomatic carrier state.
2. Topical antifungal : Topical agents are
ineffective in management of tinea capitis.
Duration of treatment should be extended until
symptoms have resolved and fungal cultures
negative.
61. Page 61
3. Oral antifungal agents :Griseofulvin is
considered the drug of choice in the United States.
Short term terbinafine, itraconazole, and
fluconazole have been shown to be comparable in
efficacy and safety to griseofulvin .
4. Adjunctive therapy : -Prednisone
-Systemic antibiotics
5. Surgery: Drain pus from kerion lesions.
62. Page 62
Tinea Versicolor
Pityriasis Versicolor (PV)
•Chronic asymptomatic scaling
epidermomycosis
• Associated with the superficial overgrowth
of the hyphal form of Malassezia furfur
63. Page 63
Clinical findings:
▪ Well-demarcated scaling patches
▪ Variable pigmentation: hypo- and
hyperpigmented; pink Most commonly
on the trunk.
64. Page 64
Epidemiology And Etiology
• Age :
Young adults
• Etiology :
M. furfur (previously known as
Pityrosporumovale, P. orbiculare )
65. Page 65
Predisposing Factors
1)Warm season or climates; tropical climate
2)Hyperhidrosis; aerobic exercise
3)Oily skin
4)Glucocorticoid treatment
5)Immunodeficiency
6)Application of lipids such as cocoa butter
7)predisposes young children to PV
66. Page 66
Clinical Manifestation
Duration : Months to years .
Skin Symptoms:
Usually none.
Occasionally, mild pruritus.
Individuals with PV usually present because
of cosmetic concerns about the
dyspigmentation.
67. Page 67
Skin Lesions
• Macules, sharply marginated round or oval in
shape, varying in size.
DDx ?
68. Page 68
Pityriasis versicolor:
Hyperpigmented
A 23-year-old obese black female
with discoloration of the neck for 1
year. Sharply marginated brown
scaling macules on the left side of the
neck.
The velvety texture and
hyperpigmentation
of the skin of the neck is
acanthosis nigricans associated with
obesity.
69. Page 69
Pityriasis versicolor:
Hyperpigmented
A 36-year-old male with
pigmented patches on trunk and arms for
several years. Multiple pink, well
demarcated scaling macules becoming
confluent on the upper and lateral trunk,
neck and arm.
70. Page 70
Laboratory Examinations
• Direct Microscopic Examination of
Scales Prepared with KOH :
Filamentous hyphae and globose yeast
forms,termed spaghetti and meatballs ,
• Wood Lamp: Blue-green fluorescence of
scales.
72. Page 72
Tinea Unguium/Onychomycosis
• is a fungal infection of the nail. This condition
may affect toenails or fingernails, but toenail
infections are particularly common.
73. Page 73
Epidemiology And Etiology
• Age :
Children or adults.
• Etiology :
• Between 95 and 97% caused by T. rubrum and T.
mentagrophytes. Much less common: Epidermophyton
floccosum, T. violaceum, T. schoenleinii, T. verrucosum
(usually infects only fingernails).
• Sex :
Somewhat more common in men.
74. Page 74
Geographic Distribution
• Worldwide. Etiologic agent varies in
different geographic areas. More common
in urban than in rural areas (associated
with wearing occlusive footwear).
75. Page 75
Transmission
transmitted from one individual to another,
by fomite or direct contact,
commonly among family members.
Some spore forms (arthroconidia) remain
viable and infective in the environment for
up to 5 years.
76. Page 76
Risk Factors
Diabetes mellitus.
Treatment with immunosuppressive drugs.
HIV/AIDS
For toenail onychomycosis, most
important factor is wearing of occlusive
footwear .
77. Page 77
• Approximately 80% of onychomycosis occurs on
the feet, especially on the big toes .
3 Types :
1 . DLSO: (distal and lateral subungual type)
White patch is noted on the distal or lateral
undersurface of the nail and nail bed, usually
with sharply demarcated borders. In time,
whitish color can become discolored to a brown
or black hue.
Clinical Manifestation
80. Page 80
2. SWO : (superficial white Onychomycosis)
A white chalky plaque is seen on the
proximal nail plate, which may become
eroded with loss of the nail plate
81. Page 81
3. PSO : (proximal subungual onychomycosis )
A white spot appears from beneath
proximal nail fold. In time, white
discoloration fills lunula, eventually moving
distally to involve much of undersurface of
the nail.
82. Page 82
Laboratory Examinations
• All clinical diagnoses of onychomycosis should
be confirmed by laboratory testing .
• Nail Samples:
For :
DLSO: distal portion of involved nail bed;
SWO: involved nail surface;
PSO: punch biopsy through nail plate to involved nail bed.
83. Page 83
• Direct Microscopy :
Direct microscopic examination of nail samples is
used to confirm the clinical diagnosis.
• Fungal Culture
• Histology of Nail Clipping :
Indicated if clinical findings suggest onychomycosis
after negative KOH wet mounts. PAS stain is
used to detect fungal elements in the nail. Most
reliable technique for diagnosing
onychomycosis .
84. Page 84
Management of Tinea Unguium
1. Debridement :
is the medical removal of dead, damaged, or infected
tissue to improve the healing potential of the remaining
healthy tissue.
86. Page 86
2. Topical agents :
Available as lotions and lacquer. Usually not
effective except for SWO.
Ciclopirox (Penlac) nail lacquer: monthly
professional nail debridement
recommended.
87. Page 87
3. Systemic agents :
such as itraconazole appear effective in the
treatment of onychomycosis
Itraconazole:
200 mg/d for 6 weeks (fingernails),
12 weeks (toenails) (continuous therapy).
88. Page 88
Indications for Systemic Therapy
Fingernail involvement,
limitation of function,
pain (thickened great toenails with pressure on
nail bed, ingrowing toe nails).
physical disability.
potential for secondary bacterial infection.
difficulty in trimming nails .
89. Page 89
• SOURCE: From FITZPATRICK’S COLOR ATLAS
AND SYNOPSIS OF CLINICAL DERMATOLOGY
SIXTH EDITION