Superficial fungal skin infections can be caused by dermatophytes, Pityrosporum, or Candida. Dermatophyte infections (tinea) present in various forms depending on the infected area, such as tinea capitis affecting the scalp. Pityrosporum infection causes pityriasis versicolor, presenting as macules on the trunk that fluoresce under wood's light. Candidiasis can infect skin, nails, and mucous membranes. Diagnosis involves clinical examination, microscopy, culture, and wood's light testing. Topical and oral antifungals are used for treatment.
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
This slide implicates different fungal diseases in human bodies containing dermatophytoses, outline of dermatophytoses classification of dermatophytes and tinea, superficial dermatophytic infection including tinea pedis, unguium, manuum, crusis, corposis, faciei, capitis, incognito, and their treatments, deep dermatophytic infections including kerion, tinea barbae, majocchi granuloma and their treatments.
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.
Ring worm is one type of fungal infection occurring on the skin. There are circular, scaly and contagious eruptions on skin. There are various types of ring worm. Homoeopathy is the system of medicine which effect on immune system as well as whole human being. It treats gently and permanently in case of Ring worm. Dr. Viren D. Nimbark | Dr. Mrugank N. Meghani | Dr. Vaidehi K. Bhatt "Homeopathic Management of Ring Worm" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45228.pdf Paper URL: https://www.ijtsrd.com/medicine/dermatology/45228/homeopathic-management-of-ring-worm/dr-viren-d-nimbark
Lymphangitis is inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites. Lymphangitis most commonly develops after cutaneous inoculation of microorganisms into the lymphatic vessels through a skin wound or a distal infection complication.
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
This slide implicates different fungal diseases in human bodies containing dermatophytoses, outline of dermatophytoses classification of dermatophytes and tinea, superficial dermatophytic infection including tinea pedis, unguium, manuum, crusis, corposis, faciei, capitis, incognito, and their treatments, deep dermatophytic infections including kerion, tinea barbae, majocchi granuloma and their treatments.
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.
Ring worm is one type of fungal infection occurring on the skin. There are circular, scaly and contagious eruptions on skin. There are various types of ring worm. Homoeopathy is the system of medicine which effect on immune system as well as whole human being. It treats gently and permanently in case of Ring worm. Dr. Viren D. Nimbark | Dr. Mrugank N. Meghani | Dr. Vaidehi K. Bhatt "Homeopathic Management of Ring Worm" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45228.pdf Paper URL: https://www.ijtsrd.com/medicine/dermatology/45228/homeopathic-management-of-ring-worm/dr-viren-d-nimbark
Lymphangitis is inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites. Lymphangitis most commonly develops after cutaneous inoculation of microorganisms into the lymphatic vessels through a skin wound or a distal infection complication.
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Clinical immunology is the study of diseases caused by disorders of the immune system (failure, aberrant action, and malignant growth of the cellular elements of the system). It also involves diseases of other systems, where immune reactions play a part in the pathology and clinical features.
Dermatophytes are molds (multicellular filaments of organisms) that require keratin for nutrition and must live on stratum corneum, hair, or nails to survive. Human infections are caused by Epidermophyton, Microspores, and Trichophyton species.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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Superficial fungal skin infections.ppt
1. Superficial fungal skin infections
Objectives:
1- Identify the clinical types of dermatophytosis
2-Clarify types of antifungal and indications for each one
3-Identify Pityrosporum infection
4- Clarify risk factors for candidal infection
5-Identify the clinical types of candidiasis
2. Fungal diseases of the skin are fairly common and these diseases may be
superficial or deep.
The three superficial fungi that affect the skin are:
1. Dermatophyte infection (tinea or ringworm infection).
2. Pityrosporum infection (Pityriasis versicolor).
3. Candidiasis (moniliasis).
Dermatophytosis: (tinea or ringworm infection)
Dermatophytes are moulds that belonging to three genera of Fungi
imperfecti that affect the skin and appendages which are: Trichophyton,
microsporum and epidermophytone.
The microorganism may be transmitted or acquired from human
(anthrophilic), from animals (zoophilic) or from soil (geophilic).
Clinical types:
The clinical classification usually depends on the site of involvement:
1. Tinea capitis:
Is infection of the scalp by dermatophytes in which there is
invasion of the hair shaft by the microorganism, it may be
3. transmitted from animals (microsporum canis) or from human and it
is more in children (rare in infants and adults).
Four clinical variants of Tinea capitis are present, two of them are of
the non inflammatory type (not lead to scar formation) and the other
two types are of the inflammatory type (lead to scar formation).
A. Scaly (gray patch) type: (Non inflammatory)
Where there is a circular patch (patches) of hair loss with easily
broken off hair, the area is of dull gray colour with fine scales and a
fairly sharp .
B. Black dot type: (Non inflammatory)
Where the affected infected hairs are broken at the surface of the
scalp leading to black discoloration, the disease presents with
patches of hair loss with minimal scales and a low grade folliculitis
may be seen.
C. Kerion celsii: (Inflammatory type)
The most sever form of reaction, it presents as painful boggy
inflammatory mass with hair loss, the hair follicles may show
4. discharging pus with sinus formation in some occasions, thick crustation
with matting of hair may be commonly seen, it may be multiple and
lymphadenopathy is usually seen.
Scarring as well as permanent alopecia may be seen. A short course of
systemic steroid can be given in this type (with the proper oral
antifungal drug) to decrease the severity of inflammation and to
decrease the risk of scarring.
D. Favus: (Inflammatory type)
Is characterized by the presence of a yellowish cup shape crustation
(scutula) which had mousy odor and developed around the hair which
pierce it centrally.
Extensive patchy hair loss with scarring and atrophy among patches of
normal hair usually result.
DDX:
I. Any cause of alopecia like alopecia areata, trichotillomania,
traumatic hair loss …….etc.
II. Seborrheic dermatitis.
III. Psoriasis.
IV. Lichen planus.
5. Wood's light, which was traditionally used to diagnose scalp
ringworm, can detect infection with only Microsporum sp. The
greenish fluorescence seen under the light is due to an ectothrix
infection of hairs, in which fungal spores form a sheath on the
outside of the hair. T tonsurans causes an endothrix infection
with the spores inside the hair shaft, and there is no
fluorescence.
Diagnosis therefore relies on mycological analysis of scalp scale
and broken off infected hairs. Samples for analysis can be
obtained by scraping the affected area with the blunt side of a
scalpel (to avoid slicing through the infected hairs) on to a piece
of paper. This technique requires some practice.
.
6.
7. 2. Tinea barbae:
It is infection of the beard and the moustache areas of the face in adult
males with invasion of the coarse hairs.
Clinically, there is an inflammatory pustular folliculitis and
the beard or moustache hair are surrounded by papules or pustules
with exudation or crustation, the hair in the affected area is loss and
easily removed and the disease is usually unilateral.
DDX:
I. Carbuncle.
II. Bacterial folliculitis.
III. Acne.
8. 3. Tinea faciei:
Is an infection of the skin of the face (excluding the male
moustache and beard areas). Erythema is usually present with or without
scales and the border of the lesions are usually indistinct, the lesions
may be rounded with raised margin and pustules may present.
DDX:
I. LE.
II. PLE.
III. Seborrheic dermatitis.
IV. Contact dermatitis.
9. 4. Tinea corporis: (Tinea circinata)
Is an infection of the glabrous skin including the neck, the trunk
and the extremities excluding the palms, the soles, the groin, the face,
the scalp and the beard.
Clinically, there is annular (circinate) plaque (plaques) which is
characteristic , usually sharply marginated with raised edge and
central clearing and the terminal hair in the affected parts may be
invaded.
DDX:
I. Seborrheic dermatitis.
II. Psoriasis.
III. Disciod eczema.
IV. Pityriasis rosea.
V. Syphilis.
VI. Lichen simplex chronicus
10. 5. Tinea manum: Is
a ringworm infection of the palm, different clinical forms are
present as hyperkeratosis of palms which are affected diffusely
(the commonest) and it may be unilateral in about one half of
the patients. The disease
may presents also as exfoliative scaliness or as vesicular patches
DDX:
I. Eczema.
II. Psoriasis.
III. Syphilis.
IV. Pityriasis rubra pilaris.
V. Familial palmar hyperkeratosis.
VI. Reiter’s disease.
VII. Lichen planus.
11. 6. Tinea cruris:
Is a groin infection with ringworm, it is more in males, it increases
with humidity, in hot weather, in those wearing tight shorts ….…etc.
Clinically, there are erythematous plaques with sharp margin extending
from the groin to the thigh with scales. Vesiculation may occur, the lesions
may be inflammatory with pustule formation and the lesions may extend to
the abdomen, the buttocks, the perineum .
DDX:
I. Candidal infection.
II. Erythrasma.
III. Flexural Psoriasis.
IV. Seborrheic dermatitis.
V. Contact dermatitis.
VI. Intertrigo.
12. 7. Tinea pedis: (Athlete foot)
Is an infection of the feet with dermatophytes, it is fairly
common especially among the athletes and those wearing socks and
shoes for prolonged periods, increased in swimming bathes …..etc.
Many clinical forms are present, the commonest is :
Interdigital form which is characterized by peeling, maceration and
fissuring affecting the lateral toe cleft and sometimes spread to the
undersurface of the toes, itching is common.
Hyperkeratosis (which is chronic and resists treatment) where the soles,
the heels and the sides of the feet are affected, hyperhydrosis increases
the severity of the symptoms.
Associated nail infection is common and this form may simulate
other causes of plantar hyperkeratosis.
13. Vesicular or the vesiculobullous form
which may be extensive and maceration as well as fissuring
is present (bacterial infection may follow).
DDX:
I. Erythrasma.
II. Candidiasis.
III. Soft corn.
IV. Contact dermatitis.
14. 8. Tinea unguium: Is
nail plate invasion by ringworm infection where there is nail plate
discoloration, subungual hyperkeratosis, nail destruction
……etc. Three variants
are present: A. Proximal
subungual onychomycosis. B. Distal
subungual onychomycosis.
C. White superficial onychomycosis.
15. 9. Tinea incognito: (Steroid modified tinea) Where
the classical features of the disease are lost due to topical or systemic
corticosteroid.
Clinically, there is suppression in the inflammatory response with
diminution in the raised margin and loss of scales , skin discoloration
can be seen at the affected site with or without pustulation, later, the
affected site may also show atrophy, striae, telengectasia ….etc due to
prolonged use of corticosteroids. The history is important in diagnosing
this condition.
16. Dermatophytid: (Id reaction)
Is a non infective cutaneous eruption represents an allergic response to a
distant focus of fungal infection.
The essential criteria for diagnosis:
1. Previous ringworm infection which becomes highly inflamed before
the appearance of the rash. (kerion , tinea pedis)
2. A distinctive eruption which is demonstrably free of ringworm.
3. Spontaneous disappearance of the rash when ring worm infection
settle with or without treatment.
Many clinical variants of id reaction are present like:
1. Lichenoid papules.
2. Pompholyx like eruption on palms and soles.
3. Erythema multiforme.
4. Erythema nodosum.
5. Urticaria.
6. Erysipelas like eruption.
7. Folliculitis.
8. Morbiliform rash.
9. Scarletiniform rash.
17. DX:
1. Clinical.
2. Wood’s light examination: Used for Tinea capitis only.
Infection with Microsporum species shows a brilliant green color and with
Trichophyton schoenleinii (favus) shows a paler green color. Pityriasis
versicolor fluoresce pale white yellow fluorescence
It is important in detecting subclinical infection, in assessing response to
treatment and in assessing spontaneous cure.
3.Direct examination: By
doing scraping for scales or taking hair or nail for examination and add 10
– 30 % KOH (potassium hydroxide) we can see hyphae under microscope.
4. Culture: As
Sabouraud’s glucose media or DTM …….etc and this needs 1 – 2 weeks to
give the needed result
18. Treatment:
1. Control of infection and avoidance of the predisposing or the
causative factors are important (like increased perspiration,
increased humidity and increased maceration).
2.Topical treatment:
May be used alone or in association with the oral therapy. A.
Imidazole group, which is a broad spectrum antifungal as
clotrimazole, miconazole, econazole, oxiconazole ….etc. B.
whitfield ointment, which is a combination of benzoic acid and
salicylic acid in 2:1 ratio.
C. Cicloperox olamine. D.
Tolnaftate.
E. Naftifine. F.
Castellani’s paint.
G. Others.
Topical treatment is not effective in treating scalp and nail infection.
19. 3. Oral treatment:
I. Griseofulvin: Is a penicellium derivative, it is fungistatic drug acts on
dermatophytes only, it is given orally with fatty meal in a dose of 10 – 20
mg/kg/day, it presents in micronized and ultra micronized forms. It
may lead to headache, photosensitivity reaction .
Main indications are:
A. Tinea unguium.
B. Tinea capitis.
C. Failure of topical treatment.
D. Wide spread infection.
E. Tinea incognito.
F. Chronic infection with tinea
manum
Skin infection for 2 – 6 weeks (4
weeks).
Hair infection for 2 – 4 months (6 - 12
weeks).
Finger nail infection for 4 – 8 months
(6 months).
Toe nail infection for 10 – 18 months
(12 months).
20. .
II. Ketoconazole:
Which is hepatotoxic.
III. Triazole group:
As flouconazole and itraconazole. IV.
Allylamines: As
terbinafine.
II, III and IV are used for shorter duration than that of
griseofulvin.
4. Others:
Like antihistamines, antibiotics for secondary bacterial infection,
drying agents like potassium permanganate for vesicular lesions,
antifungal powder …….etc.
21.
22. Pityriasis versicolor:
Is a mild chronic infection of the skin . The disease doesn’t affect the hair
shaft, the nails or the mucous membranes.
Etiology:
Malassezia fur fur which represents the mycelial phase of the lipophilic
yeast Pityrosporum orbiculare (a normal flora), is the cause.
Clinical features:
The disease of young adults affecting face ,trunk, neck and the abdomen.
extremities…etc. It is widely spread in immune compromised people .
It is sharply demarcated macules (and or patches), sometimes slightly
erythematous, mild itching , characterized essentially by fine branny scales.
The eruption showed large confluent areas, scattered oval patches
brownish color in pale skin patients and hypopigmented in dark skin
patients (so named versicolor ).
23. Diagnosis:
1. Clinical.
2. Wood’s light examination: a pale (golden) yellow fluorescence.
3. Direct examination of the scales with KOH:
Showed a spherical spores and coarse thick hyphae leading to what
called a spaghetti and meat balls appearance.
DDX:
1. Vitiligo.
2. Seborrheic dermatitis.
3. Pityriasis rosea.
4. Secondary syphilis.
5. Tinea circinata.
6. Pityriasis alba.
24. Treatment:
Vary from days to weeks according to the type of the treatment.
A. Topical:
1. Selenium sulphide shampoo or lotion (2.5%).
2. Topical imidazoles.
3. Ketoconazole shampoo
4. Others:
As Whitfield ointment, topical terbenafine, sulphur preparation, zinc
pyrethrine shampoo ….………..etc.
B. Systemic (Oral):
Especially for widespread and resistant cases.
1.Ketoconazole.
2.Triazoles as flouconazole and itraconazole.
25. Candidiasis (Moniliasis)
Is an infection caused by yeast like fungi called Candida
albicans and occasionally by other species of candida.
It usually affects the skin, the mucous membranes and
sometimes the nails (not the hair) . Candida can be a normal
commensal flora that presents in the gut, the vagina, the skin
and the mouth.
Risk factors for candidal infection:
1. Increased moisture and humidity.
2. Extremes of ages.
3. AIDS and other immune suppressed conditions.
4. Malignancies.
5. Debilitated and malnourished conditions.
6. DM.
7. Corticosteroids.
26. 8. Prolonged use of certain antibiotics like tetracycline.
9. Multiple surgeries.
10. Pregnancy.
Laboratory diagnosis:
1. Direct examination with KOH:
Showed buds (spores) with pseudohyphae and occasionally a
true hyphae.
2. Gram stain:
Showed a Gram positive staining.
3. Culture:
In Sabaroud’s media.
27. Clinical types:
Oral thrush:
Presents with a sharply defined patches of grayish white
pseudomembranes which when removed showed an Underlying
erythematous base, it affects the buccal epithelium, the tongue, the gums or
the palate and in sever cases the thrush extends to the pharynx or the
esophagus with erosions and ulcerations in some occasions. It is commonly
seen in infants, in old age people, in immune compromised people and it is
considered as the commonest secondary infection in those with AIDS.
28. Angular cheilitis: (Perleche)
It Presents with ill defined thick areas, slight erythema, maceration and
transverse fissuring at the oral comissures, crustation may be also seen. The
disease is usually bilateral and moisture can be an important factor. This
condition can be caused by causes other than Candidiasis as riboflavin
deficiency, iron deficiency anemia, Staphylococcal infection, ill fitted dentures or
due to atrophy of the alveolar ridges in old age people.
29. Candidal intertrigo:
Presents with erythema, moist exudation starting deep in the skin folds
with an irregular edge with pustules that ruptured later and become
erosions. The presence of satellite lesions (pustules or papules) is classical
and itching is usual. This condition may simulate tinea, seborrheic
dermatitis, flexural psoriasis and erythrasma
Candidal paronychia:
It affects housewives whom hands are frequently immersed in water
(chronic). Typically, several fingers are commonly affected leading to red
swollen nail folds with loss of cuticle , detachment of nail fold from the
dorsal surface of the nail plate ,pain and tenderness. Nail dystrophy, brown
nail plate discoloration, transverse ridging and onycholysis can be seen
30. Erosio interdigitale blastomysetica:
Presents with macerated white skin of the webs between fingers with
central fissuring and a raw erythematous bases. It usually affects the
third finger web, it is more in diabetic patients, in housewives and those
working in moist environments. On the feet, the fourth space is largely
affected and it may be difficult to distinguish from tinea pedis
Candidal onychomycosis:
There is onycholysis, paronychia , complete nail plate destruction and
nail dystrophy (in some occasions).
31. Napkin’s Candidiasis:
It usually affects the skin of the buttock and the genitalia of infants,
usually due to wet diaper.
Classically, there are pustules, vesicles, maceration, irregular border
and satellite lesions
Granuloma gluteale infantum:
It represents a peculiar reaction to candidal infection.
Potent topical steroids, microorganisms other than candida may also
lead to this condition. There is bluish or brownish nodules following
napkin’s eruption of the napkin area ( buttocks, genitalia, upper
thighs and pubic area).
32. Candidal vulvovaginitis:
Presents with itching, irritation or burning sensation with thick
white creamy discharge as well as erythema of the vaginal
mucous membranes and the vulval skin that may spread to the
perineum. It is more in pregnant and it is largely confined to the
sexually active people and the condition may be recurrent and
chronic
Perianal candidiasis:
Anal pruritis usually leads to suspicion of candidiasis.
The patient usually presents with perianal dermatitis ,erythema,
maceration, pruritus and burning sensation.
33. Congenital candidiasis:
Appears during the passage of the fetus through an infected birth
canal at delivery and the rash appears within hours of delivery with
macules that changed into pustules which later dry and desquamate.
Chronic mucocutaneous candidiasis:
Is a persistent candidal infection of the mouth, the skin and the nails
that’s refractory to the conventional topical therapy. It presents
with oral thrush, paronychia, cutaneous involvement as well as
perleche ………….etc. It may be associated with different varieties of
other types of infection.
Others:
As conjugal balanitis, glossitis ……….etc.
34. Treatment:
1. General principles: Be
aware of the possible risk and susceptibility factors both localized and
generalized.
2. Therapeutic agents:
A. Local (Topical): May
present in a cream, lotion, lozenge, suspension, chore, vaginal tablets,
vaginal pessary and even in an ointment form. Includes:
1. Imidazole group.
2. Nystatin.
3. Naftifine.
4. Cicloperox olamine.
5. Natamycin.
35. B. Systemic:
1. Amphoterecin B.
2. Nystatin.
3. Ketoconazole.
4. Terbenafine.
5. Triazoles as flouconazole and itraconazole.
6. Flucytosine.
Onychomycosis as well as chronic mucocutaneous candidiasis
are usually respond to systemic and not to topical therapies.