How to recognise and treat Common Superficial Fungal Infections Dr Lilianne Scholtz (MBBCh)
Types of superficial fungal infections Ringworm (Tinea) Candida (Thrush) Body Groin Feet Skin Nappy rash Vagina
Ringworm
Ringworm Circular pattern Looks like worm but caused by Dermatophytes Live in and on keratin Produce keratinase Produce an inflammatory & allergic type reaction
Caused by dermatophytes, not worms!
Classical ringworm lesion Red and scaly spreading border Central clearing Blisters (bullae)
Ringworm
Ringworm of the body (Tinea corporis)
Ringworm of the body (Tinea corporis) Usually in hairless areas Asymmetrical distribution
Ringworm in darker skin
Ringworm in darker skin
Ringworm in darker skin
Some other conditions that can be confused with ringworm of the body
Can you identify this? Psoriasis Autoimmune disease Silvery scales Bleed when lifted Thickened lesions Treat with steroids, coal tar, PUVA, etc.
Can you identify this? Eczema Red, dry, scaly Very itchy Thickened Symmetrical distribution History of allergy Treat with steroids
Can you identify this? Tinea versicolor Fungus infection Depigmented Scales appear when skin is stretched More apparent in summer months Antifungal shampoos
Tinea versicolor
Can you identify this? Ptyriasis rosea Viral infection Herald or mother patch Christmas tree distribution Clears on its own
Ptyriasis rosea
Ringworm of the groin (Tinea cruris or jock itch) Called jock itch because it is VERY itchy
Ringworm of the groin (Tinea cruris or Jock itch) Groin and between legs Symmetrical, scrotum spared More common in men Cross infect from athlete s foot VERY itchy
Ringworm in bum area
Athlete s foot (Tinea pedis)
Athlete s foot (Tinea pedis) 4 different types: Interdigital Vesicular Moccasin Ulcerating
Athlete s foot Interdigital type Webspaces Usually between 3 rd /4 th or 4 th /5 th toes Itchy, blistery, red
Athlete s foot Vesicular or blister type Instep of foot Extends into webspaces of toes
Athlete s foot Moccasin type Moccasin distribution On the soles and sides of feet
Athlete s foot Two feet one hand syndrome
Athlete s foot Ulcerating type Ulcers covering feet and toes Smells bad Bacterial infection
Ringworm on other parts of the body
Ringworm of the face (tinea faciei)
Ringworm of the face (tinea faciei)
Ringworm of the beard (Tinea barbae)
Ringworm of the hand (Tinea manuum)
Ringworm of the hand (Tinea manuum)
Ringworm of the scalp (Tinea capitis)
Ringworm of the nails (Tinea inguum or onychomycosis)
Treatment of ringworm Antifungal creams, e.g. miconazole, clotrimazole, terbinafine Scalp and nail infections are treated with oral medicines
Using Miconazole as an example Type of ringworm Body & groin Athlete s foot Schedule Apply twice daily x 2 weeks Apply twice daily x 1 month Rule of thumb: continue to apply for at least 1 week after infection clears NB: no occlusive dressings! Miconazole can be used in all age groups
Tips for preventing ringworm Don't share clothing, sport kit, towels or sheets Wear slip-slops in changing rooms Shower after any contact sport Change socks and underwear at least once a day Athlete's foot: put socks on before underwear to prevent spread to groin Keep skin clean and dry Treat pets
Candida infections Skin (Intertrigo) Nappy rash Vulvovaginal candidiasis
Candida skin infection: Intertrigo & nappy rash Red, inflamed, itchy Involves skin folds Satellite lesions Blistering, crusting
Intertrigo Warm, dark, moist areas Involves skin folds Satellite lesions
Intertrigo Warm, dark, moist areas Involves skin folds Satellite lesions
Intertrigo Involves scrotum (vs. ringworm that doesn t) Involves skin folds Satellite pustules
Ringworm of the groin (Tinea cruris or Jock itch) Groin and between legs Symmetrical, scrotum spared Perianal (around anus) More common in men Cross infect from athlete s foot VERY itchy
Candida nappy rash Warm, dark, moist areas Involves skin folds Satellite lesions
Nappy rash: difference between Candida and dermatits Thrush Skin folds Yes No Satellite lesions Yes No Dermatitis Cause Candida Irritation (e.g. urine) Bacterial, Candida superinfection
Can you identify this?
Treatment: antifungal creams Condition Intertrigo Treatment e.g. Miconazole twice daily x 2 weeks Nappy rash e.g. Miconazole twice daily x 2 weeks Mild cortisone cream if severe inflammation Avoid barrier cream until infection has settled
Vulvovaginal candidiasis (VVC)
VVC - causes Candida is a normal commensal in our gut and vagina Kept in check by lactobacilli Lactobacilli overpowered by Candida in pregnancy, antibiotic use, diabetes, HIV, etc
Vulvovaginal Candidiasis (VVC) symptoms (BID) Burn Urine Intercourse Itch Most specific Discharge Cottage cheese Not offensive
Vulvovaginal Candidiasis (VVC) Signs and symptoms non-specific 2 in 3 women with VVC are misdiagnosed Easily confused with bacterial vaginosis (a mixed bacterial infection) BV is associated with infertility, preterm labour and low birth weight X X
How to tell the difference VVC Bacterial vaginosis Vulva & vagina Red, swollen Normal Itchy YES No Discharge Cottage cheese Milky, white/grey Smelly NO YES, FISHY
See the difference VVC BV Antifungal Metronidazole
Acute vs. recurrent VVC Acute Recurrent Frequency Infrequent 4+ episodes per year Cause C. albicans Treating wrong bug, e.g. BV Resistant bug, e.g. non-albicans Underlying condition, e.g. diabetes, HIV, cancer Treatment 1 course 6 months
Treatment of acute vs. recurrent VVC Regimen Acute 1 Course of cream, vaginal tablets or oral tablets Recurrent Double course vaginal cream/tablets (10-14 days) or Triple course of oral tablets (3 doses, 72 hrs apart) and 6 Months of maintenance
Treatment of VVC using Clotrimazole vaginal tablets Acute Clotrimazole 100 mg x 6 nights or Clotrimazole 2 x 100 mg x 3 nights or Clotrimazole 500 mg STAT Recurrent Clotrimazole 100 mg x 12 nights and Clotrimazole 500 mg weekly x 6 months
VVC treatment continued Condition Severe infection but not recurrent Pregnancy Sexual partners Treatment Double course vaginal cream/tablets (10-14 days) or Triple course of oral tablets (3 doses, 72 hrs apart) Azole vaginal creams x 7 days Treat only if symptomatic
VVC prevention tips Wipe from front to back Avoid douches, foam baths, vaginal perfumes, soaps Treat vaginal dryness Oestrogen cream for postmenopausal women
In conclusion Ringworm: Raised red spreading border Central clearing Asymmetrical distribution Spares the scrotum
In conclusion Intertrigo/nappy rash: Involves skin folds Satellite lesions Involves the scrotum
In conclusion Vaginal thrush: Burn Itch Discharge (non-offensive)
Thank you