Fungal Infections

Disorders resulting from infection of the skin by fungal organisms.

Epidemiology:

Fungal infections are quite common and affect all age groups. Children typically get a scalp infection while adults most commonly get infected in the intertriginous areas.

Men and women are equally affected as are the various races. Immunosuppressed individuals and persons who live in humid, warm climates are at an increased risk to develop these infections.

Dermatophytic infections are spread from contact with infected fomites, contact with an infected dog or cat or from the soil / ground.

Physical Exam:

Tinea pedis (most common form)
Several clinical presentations are common. Patients with interstitial disease present with macerating and scaling between the toes. Patients with diffuse plantar involvement present with scaling on the soles, extending to the sides of the feet in a moccasin distribution. A pustular variety exists and resembles an allergic contact dermatitis.

Tinea corporis (ringworm)
Patients present with annular, erythematous lesions with elevated, scaly borders. These lesion often have an area of central clearing. Fusion of multiple lesions may result in a gyrate pattern.

Tinea faciale
Lesions are erythematous, asymmetric, well circumscribed patches / plaques with elevated borders. Pustules are occasionally seen with this type. Tinea faciale is much more common in children, animal handlers and users of topical steroids.

Tinea cruris (jock itch)
Lesions are erythematous with raised, scaly serpitiginous borders. Lesion commonly affected the groin and inner thigh and have a polycyclic arrangement. Men are affected more often than women with a humid environment and tight clothing increasing the risk of developing this disease.

Tinea capitis
Commonly presents as patchy alopecia with minimal inflammation and abundant scale. Thick yellow crusts of skin debris (favus) may be present in more severely affected individuals. Severe involvement may present as a boggy, purulent, inflamed, painful plaque or nodule (kerion).

Differential Diagnosis:

Seborrheic dermatitis, psoriasis, contact dermatitis, phototoxic drug eruption, intertrigo, erythrasma, eczematous dermatitis

Treatment:

Prevention of further exposure is an important in controlling future outbreaks. A KOH prep may be done to confirm the diagnosis. Identification of the infectious organism(s) can be achieved with culture.

• Topical antifungals

Systemic antifungals - Itraconazole, terbinafine, griseofulvin