Stream 1 General Dermatology - Fungal disorders

Topics to be covered in the Certificate Course.

Variants of Candida
 Variants of Tinea
 Steroid modified tinea
Onychomycosis

Tinea corporis has a spreading scaling edge with healing in the centre. If it involves hair follicles there may be persistent red areas around the follicle and sometimes a small pustule at the edge. Tinea capitis involving the scalp will cause damage to the hair with breaking of the hair at different levels. It will also involve the scalp surface giving rise to redness and scale. These features help to differentiate it from other causes of hair loss such as alopecia areata where there is no scale and the surface is smooth and the hairs tend to come out from the base. A kerion is a peculiar type of fungal infection of the scalp usually caused by an animal fungus. It is characterised by a marked inflammatory reaction that looks like a big abscess. The word kerion is Greek for honeycomb indicating the nature of the draining pustular abscesses. This is a scarring process so it is important to diagnose it early. It needs treatment surprisingly with both oral steroids to suppress the inflammation and an oral anti fungal such as Griseofulvin to kill off the dermatophyte fungus. 

Tinea faciei is often complicated by having topical steroids applied to it. The topical steroids will reduce the inflammation but it will not get rid of the fungus and so the lesion will slowly extend in size but it may not have the typical scaly edge and it may not have the inflammatory reaction you would expect from say an animal fungus but once the topical steroid is stopped it certainly will flare up.

Tinea pedis or athlete’s foot is common in people who sweat a lot or who do not dry between their toes properly. A lot of students will have this condition. It causes fissuring and scaling in the web spaces between the toes but you can get the dryer hyperkeratotic type that affects the heels and the soles of the feet giving prominent skin markings and thickening of the epidermis and you can get the hypersensitivity type which gives small little vesicles under the skin like a pompholyx eczema.