Fungal infections

Pityriasis versicolor
also called tinea versicolor
a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed
Pityrosporum ovale)
Features:
1) most commonly affects trunk
2) patches may be hypopigmented, pink or brown (hence versicolor)
3) scale is common
4) mild pruritus

Predisposing factors:
1) occurs in healthy individuals
2) immunosuppression
3) malnutrition
4) Cushing's

Management:
1) topical antifungal e.g. terbinafine or selenium sulphide
2) if extensive disease or failure to respond to topical treatment then consider oral
itraconazole

Tinea
Tinea is a term given to dermatophyte fungal infections.
Three main types of infection are described depending on what part of the body is infected
1) tinea capitis - scalp
2) tinea corporis - trunk, legs or arms
3) tinea pedis - feet

Tinea capitis (scalp ringworm)

a cause of scarring alopecia mainly seen in children
if untreated a raised, pustular, spongy/boggy mass called a kerion may form
most common cause is Trichophyton tonsurans in the UK and the USA
may also be caused by Microsporum canis acquired from cats or dogs
Diagnosis: lesions due to Microsporum canis green fluorescence under Wood's lamp*.
However the most useful investigation is scalp scrapings
Management (based on CKS guidelines):
1) Oral antifungals:
Terbinafine for Trichophyton tonsurans infections and
Griseofulvin for Microsporum infections.
1

2) Topical ketoconazole shampoo should be given for the first two weeks to reduce
transmission

Image showing a kerion

Image showing tinea corporis

Image showing tinea

corporis. Note the well
defined border

Tinea corporis (ringworm)

causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From
contact with cattle)
well-defined annular, erythematous lesions with pustules and
papules may be treated with oral fluconazole
Tinea pedis (athlete's foot)
characterised by itchy, peeling skin between the
toes common in adolescence
*lesions due to Trichophyton species do not readily fluoresce under Wood's lamp

Fungal nail infections

Onychomycosis is fungal infection of the nails. This may be caused by:
1) dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
2) yeasts - such as Candida
3) non-dermatophyte moulds

Features:
1) 'unsightly

' nails are a common reason for presentation

2) thickened, rough, opaque nails are the most common finding

Investigation:
1) nail clippings
2) scrapings of the affected nail

Management:
1) treatment is successful in around 50-80% of people
2) diagnosis should be confirmed by microbiology before starting treatment
A) Dermatophyte infection:
1) oral terbinafine is currently recommended first-line
2) Oral itraconazole as an alternative.
3) Six weeks - 3 months therapy is needed for fingernail infections whilst toenails
should be treated for 3 - 6 months
B) Candida infection:
1) mild disease should be treated with topical antifungals (e.g. Amorolfine)
2) more severe infections should be treated with oral itraconazole for a period of 12
weeks