superficial fungal infections

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Introduction / Overview :

  • Superficial fungal infections are skin infections caused by fungi (dermatophytes, yeast, mold) which are the source of various entities affecting the skin, appendages and mucous membranes
  • The source of infection may be :

Anthropophile : contamination interhumaine

zoophile : contact with animals

Géophile : from soil

➢ Or from commensal fungus of the skin or mucous membranes

Dermatophytoses (or dermatophytes)

Fromfinish :

  • Are disorders caused by dermatophytes, which are fungi filamentous keratinophilic keratinolytic that multiply two ways (sexual and asexual). On distingue 3 genres :

Trichophyton : with several species

Microsporum : with several species

epidermophyton : with one species (epidermophyton floceosum)

  • Dermatophytes attack the stratum corneum, hair and bristles, responsible for various clinical pictures (hairless skin damage, hair, nails and folds)

Dermatophytoses from the skin glabrous (outside folds)

  • Tinea corporis or Tinea circinata étaient appelées "herpes circiné" respecting leur aspect arrondi, circiné, all are pathogenic dermatophytes, can affect all ages
  • Clinique : after incubation for three weeks,  appears erythematous scaly spot, point, CASTROTHEODORICIENNE, Centrifugal evolution, leading to the formation of a round lesion, bidder 2 describe areas :

border :  erythematous scaly or vesicular erythematous,  active teeming with hyphae

Centre : slightly crumpled, on the mend

  • Diagnostic differential : can be done with contact dermatitis, psoriasis, the initial lesion of Gilbert's pityriasis ...
  • Exam mycological : is practiced primarily antifungal treatment or distance of it (more than one month break), bordering the lesions, which shows hyphae : This positive diagnosis can treat the patient and to begin epidemiological investigation
  • Culture : on Sabouraud medium, request 3-4 weeks to determine the genus and species in question
  • Treatment : Local if the lesions are limited (imidazole derivative, ciclopiroxolamine, Terbinafine). In case of extensive lesion, inflammatory or multiple lesions (more than 3), oral treatment can be employed 15 days to a month : griseofulvin, Terbinafine

Dermatophytoses of the great more

Type description : intertrigo inguino-crural dermatophytique

  • Was called "jock itch", condition that often affects adults with male
  • factors Contributing : heat, sweating, Synthetic clothing ...
  • Clinique : the start is effected by a scaly erythematous pellet into the inguinal fold, unilaterally, extending gradually realizing a web polycyclic edge (continuous or discontinuous), active with respect to the center which tends to heal. This aspect may bilateralize and extend back towards the inter-ply diaper, favored by the application of topical corticosteroids
  • Diagnostic differential : can be done with an inverse psoriasis, one intertrigo candidosique, erythrasma (condition that produces brownish webs spanning the 2 more, which the pathogen is a Gram (+) : Campylobacter minute, fluorescence coral-red under Wood's light is characteristic, antibiotic treatment is : erythromycin)
  • Exam mycological / Treatment : the same

Dermatophytoses of the small more

Type from description : intertrigo inter-toes

  • Once known as "athlete's foot", disease in adults with slight male predominance
  • factors Contributing : wear closed shoes, heat, sweating, swimming pools
  • Clinique : results in a simple crack in the bottom of the fold, bordée de lamelles de squames blanchâtres, being accompanied by intense itching and unpleasant odor, which can affect all areas especially the inter-toes 2 last (3e and 4th space). Intertrigo inter-toe may extend to the back of the toes and foot with dry and scaly circinations. One can have a bacterial infection with pain where it can be a gateway for erysipelas
  • Examn mycological / Treatment : the same

moth of please haired

  • Also known as "Tinea capitis", they are caused by dermatophytes that give hair parasitism, moths mainly affect children (rarely adults) and are common in developing countries
  • It exists 3 kinds of moths :

moth tondantes : comprising moths tondantes microsporic and moths tondantes trichophytic

moth inflammatory and suppuratives : Keri but Celse

moth faviques : Pleasant

  • Before a ringworm, we must do a good interview, a thorough clinical examination of the lesions and the rest of the body, realize if possible further examinations (Wood light, Direct mycological examination and culture), it can guide the epidemiological investigation and treat the patient and affected individuals if they exist
  • moth tondantes microsporic :

Agents :

  • Microsporum  canis :  dermatophyte zoophile,  most common in Algeria and in the Maghreb
  • Microsporum audouinii : dermatophyte anthropophile, seems more frequent in Europe
  • Microsporum langeronii : dermatophyte anthropophile, frequent in Africa
  • And other species ...

Epidemiology : represented 16-20% leather scalp ringworm in Algeria, affecting 2 sexes, age of onset is between 6 and 10 years

Clinique : produces lesions erythematosquamous alopecia, round or oval, from 2-5 cm diameter, with clear limits, few, 2-4 on average. The hair, a scaly plaque, are broken to a few millimeters (4-6 mm) follicular orifices, making the appearance brush,  extraction to clip hair think they are accompanied bulb

Exam at the light from Wood : discloses a bright fluorescent green and

Exam mycological : direct examination shows a microspore type of parasitism (endo- ectothrix), characterized by a hair containing hyphae (intrapilaire) and surrounded by clusters of spores

Culture sure middle from Sabouraud : identifies the species 2-4 weeks

  • moth tondantes trichophytic :

Agents : always anthropophile

  • Trichophytum violaceum : dermatophyte anthropophile frequent in Algeria and around the Mediterranean
  • Trichophyton tonsurans : cosmopolite
  • Trichophyton soudanense : especially in Africa
  • And other species ...

Epidemiology : This is most common in Algeria, represented 76-80% of all tinea capitis, highly contagious, performing children in community outbreaks

Clinique : they realize small gray plates, alopecia, squameuses, irregularly shaped, with vague limits, a few millimeters in diameter, many even hundreds. Hair sick are cut close to the scalp, stuck in dander (pseudo comedones), extraction to clip hair find that they are not accompanied bulbs

Exam at the light from Wood : no fluorescence

Exam mycological : direct examination shows a type of parasitism endothrix (hair full of spores)

Culture sure middle from Sabouraud : identifies in question in this case 3-4 weeks

  • moth inflammatory and suppuratives (Keri but Celse) :

Agents : they are often zoophilic :

  • Trichophyton verrucosum : variety ochraceum
  • Trichophytum mentagrophyte

Epidemiology : rare, 2% of all moths in Algeria, non-contagious, as sporadic cases in breeding area (Cattle and horses) but also in urban areas

Clinique : it begins with an erythematous spot, leggerezza squameuse, from 2-5 cm diameter, which becomes inflamed and congestive from the 2nd week, it thickens and elevates, suppurates by all the follicular orifices, causing hair loss (appearance macaroon)

Exam at the light from Wood : no fluorescence

Exam mycological : direct examination shows that there 2 types of parasitism :

  • Mégaspore : characterized by a hair containing hyphae and spores of 4-8 µm, in chains outside of the hair
  • Microïde : look the same as the previous, but the spores are smaller

Culture sure middle from Sabouraud : identifies the species 2-4 weeks

Evolution :

  • Favorable : with a reverse order to the constitution of macaroon
  • Unfavorable : with definitive scarring alopecia
  • moth faviques (Pleasant) :

Agent : Trichophytum schonleinii : dermatophyte anthropophile, exclusive agent of ringworm

Epidemiology : less of 1% ringworm of the scalp, highly contagious

Clinique : begins with erythematous, scaly lesions, evolving into a typical aspect called "bucket favique" : it is a rounded shape crust, to raised edge 0.5 cm, its surface is depressed in the center, cup-shaped, its color is yellow saffron, It emerges from these lesions characteristic smell of a mouse, this cup is traversed by a favique hair which is never broken, however, it grows poorly, it lost its natural gloss and the appearance of dry hay

Exam in the light of Wood : discloses a greenish fluorescence

Exam mycological : favique shows a type of parasitism : hair full of hyphae and air bubbles with no spores

Culture sure middle from Sabouraud : identifies the species

  • Treatment of the moth :

Measures General : combs and brushes of the patient must be cleaned or burned, shaving the hair achieved and near the plate with a disposable razor, stripping crusted lesions is needed, clean towels, pillowcases and sheets and then the board. For kérions, not incise because it delays healing and may cause blood contamination

  • The school crowding remains mandatory for anthropophilic tinea

Treatment local : local antifungal, lotion, 2x / d and antifungal shampoo

Treatment through way General :

  • griseofulvin : at a dose of 20-25 mg / kg / day and 1 g / day in adults, pendant 6-8 weeks, is a fungistatic and also has anti-inflammatory action, must be taken in mid-meal, very active on teinges microsporic and inflammatory

Effects secondary : rash cutané, nausea

  • Terbinafine : fungicide, at a dose of 125 mg / day in children 20 at 40 kg 62.5 mg / day if it weighs less than 20 kg 250 mg / day in adults, monitoring the blood counts and liver enzymes, very effective against tinea trichophytic
  • Itraconazole

Onyxis dermatophytic

  • It is a violation of the nails by dermatophytes, onyxis the dermatophyte is isolated without peri-onyxis
  • They are often found involved : Trichophyton red, Trichophyton violoaceum
  • Toenails are affected more than hands
  • There are also triggers : climate, intra-family transmission, sports, individual factors ...
  • The nail involvement may take 4 aspects, depending on the fungus penetration path in the nail unit :

Onychomycose it-latérale

Onychomycose proximal : reaches the matrix

Leuconychie superficial : corresponds to an interference of the surface portion of the nail plate without involvement of the nail bed

Onychodystrophie total : is the final step in the destruction of nail fungus by

  • Evolution : chronic, up step by step the other nails
  • Treatment : on the achievement of the nail fungus isolated and cultured : you can settle for a local treatment if the nail involvement is limited (Amorolfine in solution or in solution ciclopiroxolamine), oral treatment is necessary in case of matrix damage or skin lesions (Terbinafine). Duration of treatment : several months

Levuroses

Non-pathogenic yeasts can usually become in special circumstances : Mallassezia, Candida albicans

Candidoses mucocutaneous superficial

  • These are skin conditions, mucous, phanériennes, caused by yeast-like fungi of the genus Candida including the species albicans is the most offending
  • factors Contributing : diabetes, obesity, immunodépression, steroids ...
  • Candidoses oropharyngées : Those are :

Perlèche :  resulting in a painful crack from the bottom of the labial commissure, covered with a white coating, uni- or bilateral, it is contagious, they are different from other perlèches (infectious to commonplace germs,  syphilitic,  Irritant dermatitis ...)

Chéilite candidosique : inflammation of the lips peeling and sometimes cracks, subacute or chronic

Stomatitis candidosique : inflammation of the oral mucosa, diffuse or localized, being in 3 forms (erythematous, pseudo-membraneuse (muguet) or hyperplastic) which are accompanied by sensation of dryness of the mouth and burning sensation, of burns when feeding (especially acid), infant feeding refuses

  • intertrigos candidiasis :

of the great more : infection extends symmetrically mirrored on the edge folds, performing red tablecloths, homogeneous and varnished, in peripheral, these lesions are lined with whitish pustules and sometimes an aspect of "desquamative collar", the lesions are very itchy with a burning sensation or pain, the base is cracked

  • factors Contributing of the adults : obesity, diabetes, maceration, lack of hygiene ...

of the small more : candidiasis concern the first or second inter-toes plantar spaces, in hands, achieving key 3rd or 4th interdigital space and look for candidiasis under the covenant, here again, one diabetes research, predisposing factors general and especially local (moisture hands in restaurants, the cookers, safety shoe port ...)

Candidoses    anogenital :     the citizens,      vulvites,     vulvo-vaginite,     balanoposthitis. They are often accompanied by contributing factors

Peri-onyxis and onyxis : condition that affects mostly women, Fingernails are most often affected, favored by the manipulation of sweet products and aggravated by contact with household products. The disease begins with a peri-onyxis red and inflammatory, painful and suppurating, the cuff pressure is welling pus, achieving nail is secondary,  resulting in spots (whitish,  yellowish, greenish), the nail plate is thickened

  • Exam mycological :

Exam  direct :  from different samples,  lets see budding yeast or pseudo-filamentous

Culture sure middle from Sabouraud : can be observed in 24-48 colonies creamy whitish

  • Treatment of the Whengonehis :

At level cutaneous : an antifungal topical treatment only (ciclopiroxolamine, azoles), if the lesions are important, oral fluconazole is used for 15 days

Sure the mucous : C. albicans is saprophyte, leading to only treat lesions on which the crop has isolated many colonies with a positive direct examination

  • Candidoses mouthparts : locally can be used Amphotericin B, keep in mouthwashes or local Miconazole, if the lesions are important, must be added oral fluconazole, we must also eliminate the causes and predisposing verify proper dental hygiene

Reaching nail : systemic therapy : Fluconazole for months, with or without local treatment (Amorolfine)

Pityriasis Versicolor (PV)

  • This is a very common epidermolysis, cosmopolite, benign, it is due to lipophilic yeasts Malassezia, these yeasts are commensal of human skin
  • More common in adolescents and young adults
  • It is recurrent because there are predisposing factors (often difficult to control) : genetic (likely), lipid (preferential involvement of areas rich in oil glands), sweat secretion (physical activity,  uniform occlusive harbor,  weather),  hormone (hypercorticisme, pregnancy)
  • Clinique : produces finely scaly blotches, of whitish, yellow chamois, round or oval, sometimes polycyclic, drawing real maps, with lesions hypo- or hyper-pigmented, no pruritus, The lesions are mainly in seborrhoeic areas (face, cou, upper part of the thorax because it is a lipophilic yeast), the leaning pressure of squama causes its detachment (sign Chip), achromiante the shape is very visible after tanning,  there pigmented forms,  dark brown or black, erythematous
  • Exam mycological direct : after a tape test (an adhesive is spread on the skin is peeled off and the outermost layer, then microscopically observed), reveals clusters in grapes
  • Culture : identifies the species in question
  • Exam Wood's light : greenish yellow fluorescence
  • Treatment : antifungal imidazole or foaming gel or sulfide Selenium (2.5%), in resistant forms, ketoconazole (200 mg, per the, pendant 10 days)
Ringworm parasitism hair Lampe Wood Dermatophyte Transmission
microspore microspore : filaments few intrapilaires, spore 2 μm, sheath around the hair Fluorescence verte

M. cudouinii
M. largeronii
M. rivalierii
M. ferrugineum

Anthropophile :
Europe
Africa
Asia
microspore M. canis zoophile (chat, dog), cosmopolite
trichophytic  Endothrix : spore 4 μm, intrapilaires, numerous, short hair broken No fluorescence T. soudanense T. violaceum T. tonsurans T. rosaceum Anthropophile : Black Africa North Africa Cosmopolitan Portugal
Inflammatory

Microide : chainlets spores, extrapilaires, from 2 μm No fluorescence T. mentagraphytes zoophile : dog, horse, lapin, guinea pig
Mégaspore : extrapilaires chainlets spores, 5-6 μm T. ochraceum zoophile : BOVID
other types T. violaceum T. soudanense M. gypseum Anthropophile Anthropophile Géophile
Pleasant favique : intrapilaires filaments only, Non-broken hair Fluorescence verte T. schonleinii Anthropophile :            North Africa

M = Microsporum / T = Trichophyton

  griseofulvin Itraconazole Fluconazole Terbinafine
Dermatophyte ++ ++ + +++
yeasts ++ ++ +-
molds ++ ++
Malassezia ++ +

++ = effective / + = Ineffective / – ineffective