Management

Dermatophytosis

Dermatophytes digest keratin and so can cause infection of skin and keratiniszed structures - hair & nails. Tinea corporis, pedis, capitis, unguium

Causes

• Dermatophyte Fungi: Trichophyton, Microsporum, and Epidermophyton.
• Warm and Moist Environments: Fungi thrive in warm, humid conditions.
• Direct Contact: From infected people, animals, or surfaces.
• Immunocompromised State: Weakened immune system increases susceptibility.
• Poor Hygiene: Lack of proper skin and nail hygiene.

Clinical Presentations

• Tinea Corporis (Ringworm): Circular, red, scaly lesions.
• Tinea Cruris (Jock Itch): Rash in the groin area, extending to inner thighs.
• Tinea Pedis (Athlete’s Foot): Itchy, scaly rash on feet, especially between toes - up to 15% of population
• Tinea Capitis: Scalp involvement causing hair loss and scaling.
• Tinea Unguium (Onychomycosis): Fungal nail infection, causing discoloration and thickening.

Superficial candidiasis

Usually commensal in mouth, vagina and GI tract

Causes

• Immunosuppression (steroid inhalers)
• Antibiotic treatment (opportunistic)

Clinical Presentation

• Oropharyngeal: white patches on erythematous background (plaque).
• Skin: usually in folds interdigital (intertrigo)

Malassezia

Commensals of greasy skin

Presentation:

• Pityriasis versicolor: scaly hypo/hyperpigmented rash with scaling

• Seborrheic dermatitis: scaling of face, scalp, anterior chest
• Malassezia Folliculitis: follicular rash on back and shoulders ($\Delta \Delta$) Acne vulgaris

Sometimes difficult to differentiate with Acne vulgaris

Management

1. Topical Antifungals: (e.g., Clotrimazole, Miconazole) for localized infections.
2. Oral Antifungals: (e.g., Terbinafine, Fluconazole) for extensive or severe infections.
3. Proper Hygiene: Keep affected areas clean and dry; avoid shared items.
4. Address Contributing Factors: Control moisture, especially in sweating-prone areas.

Complications/Red Flags

• Secondary Bacterial Infection: Scratching may lead to bacterial superinfection.
• Chronic or Recurrent Infections: Suggest potential underlying factors.
• Spread to Other Areas: Especially without proper treatment.