Fungal Skin Infections

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SUPERFICIAL FUNGAL INFECTIONS (TINEAS)

CLINICAL DESCRIPTION

Infection with fungi species that are able to invade keratin containing tissues e.g., skin, hair and nails. Such species also known as dermatophytes. Skin manifestation due to dermatophytes are described by anatomical site where the infection has occurred e.g., tinea capitis is the infection on the scalp. Other infections include tinea unguium/onychomycosis (nails), tinea pedis (plantar aspect), tinea cruris (groins) and tinea corporis (rest of the body except those specified).

CLINICAL FEATURES

SIGNS AND SYMPTOMS
  • Pruritus
  • For non-bearing areas: well-defined plaques with active borders
  • Hair bearing areas: hair loss in tinea capitis
  • Scaling and ulceration may occur inter-digitally in tinea pedis.
INVESTIGATIONS
  • Mainly clinical
  • Examination of scales treated with Potassium hydroxide (KOH) can be done when necessary, e.g., when the clinical features are not characteristic.

TREATMENT

  • Instruct patients on the importance of treatment compliance in order to eradicate the infection
  • For localized lesions on non-hair bearing areas:
    • Topical antimycotics e.g., Clotrimazole cream 1 % 12 hourly for until lesions clear and then continue for another week after that to ensure clearance of the fungal spores
  • In extensive cases and those involving hairy areas:
    • Griseofulvin 500mg orally daily taken after a meal for 6 to 8 weeks
    • In Children: Griseofulvin 20mg/kg/dose for 6 to 8 weeks (maximum of 500 mg)

Notes:

  • Tinea corporis, cruris, pedis treat for 4 weeks
  • Tinea capitis treat for 6 weeks
  • Tinea unguium: (only if desired): requires longer duration. Refer
    • Fingernails: treat for 12 months
    • Toe nails: treat for 2 years
    • Clean footwear that may harbour fungal elements like sports shoes and stockings to get rid of spores

Alternative systemic antifungals

  • Give Ketoconazole 100mg PO daily for 2 weeks OR
  • Fluconazole 200mg PO daily for 2 weeks
  • Terbinafine 250mg PO daily for 2 weeks in adults and based on weight in children
  • Itraconazole 200mg PO daily for 2 -3 weeks

 Red Flag

  • Ketoconazole may cause liver toxicity when used for prolonged periods
  • In HIV (+) patients big and extensive lesions (giant tinea) may appear and often require systemic treatment.