FUNGAL SKIN INFECTIONS
Liz McKensey
Presentation
 24yr old male
 Recent holiday in Spain
 Painful, scaling, flaking, itchy lesions on feet
 Between fourth and fifth digits
 Thinks his friend has a similar problem
Diagnosis
Pompholyx-type eczema
b. Tinea pedis
c. Cellulitis
d. Eczema
a.
Diagnosis
Pompholyx-type eczema
b. Tinea pedis
c. Cellulitis
d. Eczema
a.
Treatment options
 Advise on general hygiene and avoid occlusive footwear +
Itraconazole 100mg od po for 1-2 months
b. Terbinafine (topical) tds for 1-2 weeks
c. Terbinafine 250mg od po for 1-2 months
d. Clotrimazole (topical) tds for 1-2 weeks
a.
Treatment options
 Advise on general hygiene and avoid occlusive
footwear +
a. Itraconazole 100mg od po for 1-2 months
b. Terbinafine (topical) tds for 1-2 weeks
c. Terbinafine 250mg od po for 1-2 months
d. Clotrimazole (topical) tds for 1-2 weeks
Presentation
 37 year old female
 Type I DM
 Pain and infection of the right foot
 First started 3 to 4 days ago
 Initially blisters + weeping between toes of the right foot
only
 Recently bought a second-hand pair of tennis shoes at a
garage sale and has been wearing the shoes without socks
Treatment
Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1 week
b. Itraconazole 100mg od po for 1-2 months
c. Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1-2 weeks + antifungal treatment
d. Hospital admission for IV antibiotics
a.
Treatment
Phenoxymethylpenicillin 500mg qds po + flucloxacillin
500mg qds po for 1 week
b. Itraconazole 100mg od po for 1-2 months
c. Phenoxymethylpenicillin 500mg qds po +
flucloxacillin 500mg qds po for 1-2 weeks +
antifungal treatment
d. Hospital admission for IV antibiotics
a.
Presentation
 44yr old female
 Works as beauty therapist
 Asymmetrical whitening + yellow/black discolouration of
the nails
 Also some changes of fingernails but toenails worse
Diagnosis
a. Psoriasis
b. Senile ischaemia
c. Onychomycosis
d. Eczematous eruptions (contact dermatitis)
Diagnosis
a. Psoriasis
b. Senile ischaemia
c. Onychomycosis
d. Eczematous eruptions (contact dermatitis)
Treatment
Topical amorolfine for 3 months
b. Itraconazole 200mg bd po for 1 week per month for 3-6
months or Terbinafine 250mg od po for 3-6 months
c. Topical + oral
d. No treatment
a.
Treatment
Topical amorolfine for 3 months
b. Itraconazole 200mg bd po for 1 week per month
for 3-6 months or Terbinafine 250mg od po for 3-6
months
c. Topical + oral
d. No treatment
a.
Psoriasis
Contact dermatitis
Presentation
 16yr old male
 Slightly itchy asymmetrical scaly patches on the torso sparing
the face, hands, feet, and groin
 Started in the axilla
 Concerned he has ‘caught something’ from his new girlfriend
Diagnosis
a. Psoriasis
b. Pityriasis rosea
c. Tinea versicolor
d. Tinea corporis
Diagnosis
a. Psoriasis
b. Pityriasis rosea
c. Tinea versicolor
d. Tinea corporis
Treatment
Clotrimazole 1% tds top for 1-2 weeks
b. Terbinafine 1% bd top for 1-2 weeks
c. Compound benzoic acid ointment tds top for 1-2 weeks
d. Any of the above
a.
Treatment
Clotrimazole 1% tds top for 1-2 weeks
b. Terbinafine 1% bd top for 1-2 weeks
c. Compound benzoic acid ointment tds top for 1-2 weeks
d. Any of the above
a.
Note: Extensive skin infections may require oral therapies
e.g.terbinafine 250mg daily for four week or itraconazole
100mg daily for 15 days
Psoriasis
Pityriasis Rosea
Presentation
 8yr old Afro-Carribean male
 Presents with scaly patches on scalp
 Started two weeks ago, but mum worried now because ‘his
hair is falling out’
 Two close friends off school for the last few days with similar
problem
Diagnosis
a. Kerion
b. Tinea capitis
c. Folliculitis decalvans
d. Bacterial pyodermas
Diagnosis
a. Kerion
b. Tinea capitis
c. Folliculitis decalvans
d. Bacterial pyodermas
Treatment
Clotrimazole 1% tds top for 4 weeks
b. Itraconazole 100mg od po for 4 weeks
c. Griseofulvin 1g od po (15-20mg/kg for kids)
d. Itraconazole 100mg od po for 4 weeks + clotrimazole 1%
tds top for 1 week
a.
Treatment
Clotrimazole 1% tds top for 4 weeks
b. Itraconazole 100mg od po for 4 weeks
c. Griseofulvin 1g od po (15-20mg/kg for kids)
d. Itraconazole 100mg od po for 4 weeks +
clotrimazole 1% tds top for 1 week
a.
True or false
 Tinea capitis can lead to scarring alopecia (and permanent hair




loss)
Tinea capitis requires systemic antifungal treatment for
therapeutic success
Tinea capitis is very infectious so that children may have to be kept
away from school
If tinea capitis is suspected clinically then it is important to
confirm or refute this diagnosis by further investigation (e.g.
taking skin scrapings and hair for fungal elements)
Asymptomatic carriers should be treated with topical antifungals
alone
Presentation
 The previous boys classmate
Diagnosis
a. Abscess (staph aureus)
b. Cellulitis
c. Kerion
d. Pustular dermatosis
Diagnosis
a. Abscess (staph aureus)
b. Cellulitis
c. Kerion
d. Pustular dermatosis
Treatment
Griseofulvin 1g od po for 8 weeks
b. Griseofulvin + prednisolone
c. Griseofulvin + prednisolone + flucloxacillin
d. Surgery
a.
Treatment
Griseofulvin 1g od po for 8 weeks
b. Griseofulvin + prednisolone
c. Griseofulvin + prednisolone + flucloxacillin
d. Surgery
a.
Presentation
 22yr old male
 Concerned he has Michael Jackson’s disease!!
 Reports that he has been quite itchy all over
 On examination he has multiple well-demarcated, scaly, oval-
to-round hypopigmented macules occasionally forming into
larger patches
 Mostly on upper trunk and arms, some areas on neck also
 States he usually has a good tan and admits to often using
tanning oils when away on holidays
Diagnosis
a. Postinflammatory pigmentary change
b. Pityriasis rosea
c. Tinea versicolor
d. Vitiligo
Diagnosis
a. Postinflammatory pigmentary change
b. Pityriasis rosea
c. Tinea versicolor
d. Vitiligo
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Ketoconazole shampoo od used as body wash for 7 days
c. Itraconazole 100mg od po for 2 weeks
d. All of the above
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Ketoconazole shampoo od used as body wash for 7 days
c. Itraconazole 100mg od po for 2 weeks
d. All of the above
a.
Vitiligo
Presentation
 32yr old male
 135kg
 Describes a brownish red rash with ‘pimples’ around the
border on the inside of his thighs/groin
 ‘Feels like it is burning and incredibly itchy at times’
 Reports nothing on penis or scrotum
 Also reports itchy flaky skin between toes
Diagnosis
Candida intertrigo
b. Contact dermatitis
c. Tinea cruris
d. Psoriasis
a.
Diagnosis
Candida intertrigo
b. Contact dermatitis
c. Tinea cruris
d. Psoriasis
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Clotrimazole 1% + hydrocortisone 1% (cream) top tds for
7 days
c. Clotrimazole cream 1% top tds + itraconazole 100mg od
po for 7 days
d. Any of the above
a.
Treatment
Clotrimazole cream 1% top tds for 7 days
b. Clotrimazole 1% + hydrocortisone 1% (cream) top tds for
7 days
c. Clotrimazole cream 1% top tds + itraconazole 100mg od
po for 7 days
d. Any of the above
a.
Candida Intertrigo