Fungal Infections

This is a contagious fungal infection of the foot caused by Trichophyton mentagrophytes and T. rubrum most commonly.
Clinical features

• Itching of the foot
• Burning or stinging lesions with scaling borders between the toes
• Vesicular eruptions with white scaling between the 4th or 5th toes or the instep of the sole
• May be accompanied by vesicles on the palms and sides of fingers called ‘id’ reaction. The vesicles do not contain fungus and get better when the fungus is treated

Diagnosis Scrape the scales from the infected site and put on a glass slide with a drop of 20% KOH. On microscopy branching, fungal hyphae are seen.

Treatment

Drugs

• Miconazole 2% cream, topically twice daily
• Continue treatment for 2 weeks after the symptoms have cleared.

Supportive

• Keep feet dry all the time
• Wear open footwear
• Wear cotton socks, if need be
• Change socks daily

This is a condition which can be acquired from animal (Trichophyton verrucossum, Microsporum canis) or human contact (T. rubrum). It is characterised by itchy lesions appearing as scaly greyish patches with raised borders. It can affect any part of the body, with the most commonly affected parts being the arms, groin, buttocks, waist and the area under the breasts.

Treatment

Drugs

• Miconazole cream 2%, topically twice daily for 2 to 6 weeks.
• Fluconazole 200mg O.D. oral for 6 weeks
• Griseofulvin 500mg O.D. oral up to 2 weeks after lesions disappear

Supportive

• Maintenance of general hygiene
• Avoid sharing of personal items such as towels and clothes.

This is a fungal infection of the scalp which is especially common in children. It is caused by Trichophyton species – violaceum in Africa and Asia, T. rubrum in Europe. Non-inflammatory invasion of the hair shaft can occur due to Microsporum audouiini transferred by contact with barber shears, hats or M. canis from pets.

Clinical features

• Diffuse scaling of the scalp with no hair loss
• Circular scaly patches in the scalp with associated alopecia (hair loss)
• In severe cases, a boggy swollen mass with discharging pus and exudates called Kerion is due to animal fungus.

Diagnosis

Remove scales and broken hairs with a blunt scalpel and put it on a slide with Potassium Hydroxide 20%. The hair shaft is seen under the microscope full of fungal spores.

Treatment Drugs

• Griseofulvin, adults; 500mg orally daily as a single dose or in divided doses (in severe infection dose may be doubled, reducing when the response occurs), children; l0mg/kg body weight daily as a single dose or in divided doses continue till two weeks after the lesions disappear and hair is growing.

Supportive

• Maintenance of good general hygiene
• Avoid sharing of personal items such as towels and clothes
• Keep hair short

This is an infection of the skin caused by Candida albicans a yeast fungus which is a normal commensal occupying the gut. Under certain circumstances such as diabetes or other endocrine diseases or immunosuppressive states, it becomes pathogenic. The infection usually occurs in the skin folds such as, around the groin area, under the breasts, in the nail folds and axilla. In chronic or severe cases suspect HIV/AIDS.

Clinical features Moist, white curd-like papules and plaques form which are easily scraped off leaving red and raw-looking patches with clear edges.
Diagnosis Scrape off white patch and place on a glass slide with a drop of Potassium hydroxide (KOH). Hyphae and yeast are seen.
Treatment Drugs

• Miconazole cream 2%, topically twice daily.
  Continue treatment for 14 days after lesions have healed.

For nail infections, apply under occlusive dressing.

Supportive

• The patient should be advised to keep the skin dry
• Long-term antibiotic use should be avoided

Patients not responding to topical applications should be referred to a specialist.