Section of Dermatology
• ' Tinea' is derived from the Latin word meaning clothes-moth which the Romans thought wasresponsible for this condition.
• It is caused by a superficial fungus that colonizes keratin (hair, nails and the stratum corneum) • There are three genera of dennatophytes infecting the skin: Microsporum. Epidermophyton andTrichopyton • Tinea infections often result from damage • Occlusion increases the local temperature and hydration of the skin, leading toimpaired barrier function.
• This probably explains why tinea pedis is a disorder of the shod and not those who go barefoot
• The margin is most active with a tendency • Tinea corporis (body)• Tinea cruris (groin) • In tinea capitis, there is scaling and • Tinea pedis (feet)• Tinea unguium (nails)• Tinea incognito (tinea masked by steroids) • Scrapings should be taken from the skin and • Whifield's ointment (3% benzoic acid. 3% • Allylamines e.g terbinafine (Lamisil).
mouth, gemtalia, flexures and nails usually the oropharynx. gastrointestinal tract or vagina in 80% of normal individuals.
• Nystatin. This is a polyene antibiotic. It is too toxic to use parenterally hut is effective topically.
• Extremes of age. menses and pregnancy • Amphotericin. Tills is another polyene antibiotic.
• latrogenic factors, for example antibiotics, It is used in a similar manner to nystatin.
oral contraceptives, steroids
• Imidazoles. These are easy to use topically. They have a broad spectrum, being also effectiveagainst tinea and pityriasis versicolor.
Ketaconazole is effective orallv.
• Fluconazole. This is a broad spectrum triazole that • Pityriasis versicolor is an infection of the skin is effective against dermatophytes, most Candida caused by a yeast that is ordinarily a commensal species and pityriasis versicolor. It may be given • Irtraconazole. This is a broad spectrum triazolc that • It is caused by the yeasts Pitvrosporum orbiculare is effective against dermatophytes, candida species and pityriasis versicolor. It is given orally.
• The yeasts become pathogenic and produce • Amphotericin B Very toxic therefore reserved lor pseudohyphae - in this state the organism is • The yeast is an opportunist, and growth in • The condition starts as a rnacule which grows insiduously and coalesces with other increase in environmental temperature and
• The macules may be darker or lighter than • It is a disorder of the healthy, but the • Topical glucocorticostcroids account for • P. versicolor occurs usually on the front of • Imidazoles - these are all effective topically light; the affected areas fluoresce a yellow • Oral therapy - Ketaconazole. fluconazolc THIS CONDITION
• Chromoblastomycosis is a chronic, warty cutaneous and subcutaneous infection with a • Chromoblastomycosis is caused by fungi that are saprophytic in wood or soil and are found in ruralareas.
• The organism enters via a wound (e.g. a splinter) and is most common in males who work outsidebare-legged.
• Skin biopsy is helpful in diagnosis.
• Scabies is an infestation with Sarcoptes • Surgical excision is used for early lesions or • It is transmitted from one individual to • Itraconazole is effective . often combined another by prolonged physical, and usually • Terbinafine is reported as being effective.
• Amphotericin intralesionally and • The burrow is visible early but itching is delayed a • The burrow is a serpiginous. linear track, a few millimetres long with a black dot visible at one • The itching results from an allergic reaction to the • Ivermectin. This is the only oral treatment.
• Papules are found between the fingers, elbows, buttocks, axillae, around the nipples and on thegenitalia.


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