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
• 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.
• 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
• 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
• 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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