Dermatophyte Infections

DERMATOPHYTE INFECTIONS
Dr Krishna Badal, MD
Etiology
Genera Skin Hair Nails

Trichophyton + + +
Microsporum + + -
Epidermophyton + - +
Dermatophytes
• Keratophilic fungi
• Affects the Superficial layers of skin: epidermis
• Transmitted by contact with infected persons and

animals.
Predisposing Factors
• Poor nutrition
• Poor Hygiene
• Tropical climate
• Atopy
• Contact with infected animals, people, fomites
• Debilitating disease
Clinical Features
• Types
– Tinea Capitis
– Tinea Corporis
– Tinea Cruris
– Tinea Barbae
– Tinea Pedis
– Tinea mannum
– Tinea unguium (onychomycosis)
Clinical Features
• Typical Lesion:
– Annular/ arcuate plaque
– Centrifugal spread (from trunk to extremities)
– Edge: papulovesicles, pustules, scaling
– Centre: relatively clear
Tinea Capitis
• Age: childhood, 3-7 yrs
• Transmitted by Fomites: hairbrushes, hats, Barbers’
instruments
• Common in over crowding, poor living conditions
• Produces:
– Discoid patch, partial alopecia
– Pluckable hair
Tinea Capitis: 3 patterns
• Non-inflammatory
– Caused by anthropophilic dermatophytes
– Leads to partial alopecia, peripheral scaling
– Hair become- lustureless, broken, pluckable,
Grey/black
Tinea Capitis: 3 patterns
• Kerion
– Caused by Zoophilic fungus (eg: M. canis)
– Leads to boggy swelling, pustules and lymphadenopathy
• Favus
– Caused by T. schoenleinii
– Number of yellowish, circular, cup-shaped crusts
(scutula) grouped in patches like a piece of honeycomb
– Foul-smelling
Kerion
Favus
Tinea capitis
• Differential Dx:
• Alopecia: no scaling
• Psoriasis: no loss of hair; silvery scaling
• Seborrheic dermatitis: diffuse hair loss
Differential Diagnoses:
Alopecia areata
Psoriasis
Seborrheic keratosis
Tinea Corporis
• All ages
• Hot, humid climate
• Seen in trunk, limbs
• Features:
– Asymptomatic/ mild pruritus
– Macules, papules --- centrifugal spread
– Annular, arcuate lesions
Tinea corporis
Tinea Cruris
• Also known as “Jock itch”

• Seen in groin, thighs, scrotum
• Common in hot climates
• Features:
– Maceration, friction
– Lesions with clear margins
Tinea cruris (groin) – jock itch
Tinea Barbae
• Adult men
• Beard area
• Features:
– Superficial scaling, erythematous
– Annular border
– Deeper infection- similar to kerion
– Loss of facial hair
Tinea barbae
Tinea Pedis
• Tinea of feet area
• Common
• Common during summers, rainy season
• Men> women
• 3 patterns:
– Intertrigo (athlete’s foot)
– Papulosquamous
– Vesiculo- bullous
Tinea pedis
Tinea pedis
Tinea Manuum
• Erythema,
hyperkeratosis, scaling
of hands
• Unilateral involvement
usually
Tinea Unguium (Onychomycosis)
• It is a fungal infection of the nail.
• Causes:
– Dermatophytes, candida and other molds
• Features:
– Nail becomes thickened and discoloured: white, black,
yellow or green.
– Nail can become brittle, with pieces breaking off or nail got
lost from the toe or finger completely.
• There are four classic types of onychomycosis:
– Distal subungual onychomycosis is the most common
form of tinea unguium, and is usually caused
by Trichophyton rubrum, which invades the nail bed and
the underside of the nail plate.
– White superficial onychomycosis is caused by fungal
invasion of the superficial layers of the nail plate to form
"white islands" on the plate. It accounts for only 10
percent of onychomycosis cases.
– Proximal subungual onychomycosis is fungal penetration
of the newly formed nail plate through the proximal nail
fold. It is the least common form of tinea unguium in
healthy people, but is found more commonly when the
patient is immunocompromised.
– Candidal onychomycosis is Candida species invasion of the
fingernails, usually occurring in persons who frequently
immerse their hands in water. This normally requires the
prior damage of the nail.
Tinea unguium
Complications
• Tinea incognito: modified tinea by steroid

application
• Cicatricial alopecia
D/D
• Alopecia areata, Psoriasis, Pityriasis capitis
(seborrheic dermatitis)
• Discoid eczema
• Candidal intertrigo
• Psoriasis of nails
Investigations
• KOH prep
• Cultures
• Wood’s light (lamp):
– A Wood’s lamp is a small handheld device that uses black
light to illuminate areas of skin.
– The light is held over an area of skin in a darkened room.
The presence of certain bacteria or fungi, or changes in the
pigmentation of the skin will cause the affected area of the
skin to change color under the light.
Treatment
• Maintain local hygiene and dryness
• Avoid synthetic clothes
• Prophylactic talc
• Drugs:
– Imidazoles:
• Clotrimazole, miconazole, sulconazole, Ketoconazole
– Triazoles:
• Fluconazole, itraconazole
• TOPICAL THERAPY: should be applied for at least 2 weeks.
• SYSTEMIC THERAPY: may be indicated for tinea corporis in
extensive skin infection, immunosuppression and resistance to
topical antifungal therapy. Itraconazole is mainly used.
Treatment
• Terbinafine:
– mainly used for onychomycosis, 6 weeks for finger nails
and 12 weeks for toe nails
• Griseofulvin:
– Also for onychomycosis
– Used for much longer, 6-12 months, less effective than
terbinafine
Questions
1. Classify dermatophytes.
2. What are the predisposing factors of dermatophyte
infections?
3. Mention different types of dermatophyte infections.
4. What are the different types of tinea capitis? Write the
differential diagnosis of tinea capitis.
5. Write about onychomycosis. What is the treatment?
6. How do you confirm the diagnosis of dermatophyte
infection?
7. How do you manage a case of dermatophyte infection?

Dermatophyte Infections

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Dermatophyte Infections

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DERMATOPHYTE INFECTIONS

Genera Skin Hair Nails

• Affects the Superficial layers of skin: epidermis

• Transmitted by contact with infected persons and

• Also known as “Jock itch”

• Tinea incognito: modified tinea by steroid

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