Selling a Product or Service

1. Selling a Product or Service FUNGAL SKIN INFECTIONS II IHAB YOUNIS, M.D.

2. B. Cutaneous mycoses • Infections that extend deeper into the epidermis, as well as hair and nail and caused by dermatophytes: • Tinea capitis • Tinea corporis • Tinea manus • Tinea cruris • Tinea pedis • Tinea unguium

3. Tinea capitis Etymology: L. [caput] head

4. Tinea capitis is the most common pediatric dermatophyte infection worldwide • The age predilection is believed to result from the presence of Malassezia furfur which is part of normal flora, and from the fungistatic properties of fatty acids of short and medium chains in postpubertal sebum

5. Hair invasion by dermatophytes • Ectothrix invasion: Arthroconidia on the exterior of the hair shaft. The cuticle of the hair is destroyed and infected hairs fluoresce under a Wood’s lamp • Endothrix hair invasion: Arthroconidia within the hair shaft only. The cuticle of the hair remains intact and infected hairs do not fluoresce under a Wood’s lamp

6. Hair Ectothrix Conidia Hair Endothrix Conidia

7. Types

8. 1-Scaly type: • Erythematous papule(s) around the hair shaft appear initially • Subsequently, one or several patches of scaly alopecia are seen where the hairs are broken just above the level of scalp • The hair looks lusterless as it is covered with arthrospores

9. 2-Black dots type: • It is an endothrix infection, so hairs become notably fragile and break easily at the level of the scalp • The rest of the infected follicle looks like "black dots". Variable degrees of scaling and inflamm-ation are seen

10. 3-Kerion : • Scattered painful pruritic pustular folliculitis generally associated with regional lymphadenopathy and even fever • In about 2-3 %, boggy nodules studded with broken hairs and purulent sticky material "kerion" appear • Scarring alopecia develops subsequently

11. 4-Favus :Etymology: L. honeycomb • Dense masses of mycelium and epithelial debris forming yellowish cup-shaped crusts called scutula • The scutulum develops at the surface of a hair follicle with the shaft in the center of the raised lesion

12. Removal of these crusts reveals an oozing,moist, red base • After a period of years, atrophy of the skin occurs leaving a cicatricial alopecia and scarring

13. Tinea corporis (circinata)

14. Etiology • Affects the glabrous skin (ie, skin regions except the scalp, groin, palms, and soles) • T rubrum is the most common infectious agent in the world • May result from contact with infected humans, animals, or inanimate objects (eg contact with sports facilities)

15. Clinically • Patients can be asymptomatic or pruritic • Begins as an erythematous, scaly plaque that may rapidly worsen and enlarge • Central resolution causes the lesion to be annular

16. Scales, crusts, vesicles, and papules often develop, especially in the advancing border

17. Infections due to zoophilic or geophilic dermatophytes may produce a more intense inflammatory response than those caused by anthropophilic fungi

18. Majocchi granuloma manifests as perifollicular, granulomatous nodules typically in a distinct location, which is the lower two thirds of the leg in females

19. Tinea imbricata (Imbricate= Ovelapping) is recognized clinically by its distinct scaly plaques arranged in concentric rings

21. Tinea Cruris Crus=Fold

22. Etiology • Transmitted by fomites, such as contaminated towels or hotel bedroom sheets • Autoinoculation occurs in 50 % of cases from tinea manuum or tinea pedis • Risk factors for initial infection or reinfection include wearing tight-fitting or wet clothing or undergarments • Tinea cruris is 3 times more common in men than in women

23. Clinically • Patients complain of pruritus and rash in the groin. A history of previous episodes of a similar problem usually is elicited • Large patches of erythema with central clearing are centered on the inguinal creases

25. Lesions extend to the thighs , lower abdomen , pubic area & buttocks • The penis & scrotum typically are spared

26. Scales demarcate sharply the edge

27. In acute infections, the rash may be moist and exudative • Chronic infections typically are dry with a papular annular or arciform border and barely perceptible scale at the margin

28. Chronic infections modified by the application of topical corticosteroids are more erythematous, less scaly, and may have follicular pustules

29. In response to the infection, the active border has an increased epidermal cell proliferation with resultant scaling • This creates a partial defense by way of shedding the infected skin and leaving new, healthy skin central to the advancing lesion

30. Tinea pedis Etymology: L. foot

31. Etiology • The first report of tinea pedis was in 1908 by Whitfield, who, with Sabouraud, believed that tinea pedis is caused by the same organisms that produce tinea capitis and that it is a very rare infection ! • T rubrum being the most common cause worldwide

32. Tinea pedis is thought to be the world's most common dermatophytosis. Rippon states that 70% of the population will be infected with tinea pedis at some time • Childhood tinea pedis is rare

33. Risk factors • A hot, humid, tropical environment • Prolonged use of occlusive footwear • Certain activities, such as swimming and communal bathing, may also increase the risk of infection • A defect may be present in the immune system, such as in cell-mediated immunity, that predisposes some individuals to tinea pedis, but this is not certain

34. Clinical types 1- Interdigital type 2- Chronic hyperkeratotic type(moccasin) 3-Inflammatory/vesicular type

35. 1-Interdigital type: • The most characteristic type, with erythema, maceration, fissuring, and scaling, most often between the fourth and fifth toes & often is accompanied by pruritus • The dorsal surface of the foot is usually clear, but some extension onto the plantar surface of the foot may occur

36. 2-Chronic hyperkeratotic type(moccasin) • Chronic plantar erythema with slight scaling to diffuse hyperkeratosis that can be asymptomatic or pruritic • Both feet are usually affected

37. Typically, the dorsal surface of the foot is clear, but, in severe cases, the condition may extend onto the sides of the foot

38. 3-Inflammatory/vesicular type: • Painful, pruritic vesicles or bullae • Most often on the instep or anterior plantar surface • After they rupture, scaling with erythema persists • Cellulitis,lymphangitis and adenopathy can complicate this type

39. Dermatophytid reactions are associated with vesicular tinea pedis They mimic dyshidrosis (pompholyx) They develop on the palmar surface of one or both hands and/or the sides of the fingers as papules, vesicles, and, occasionally, bullae or pustules may occur, often in a symmetrical fashion

40. This is an allergy or hypersensitivity response to the infection on the foot, and it contains no fungal elements. The specific explanation of this phenomenon is still unclear • Distinguishing between a dermatophytid reaction and dyshidrosis can be difficult. Therefore, a close inspection of the feet is necessary in patients with vesicular hand dermatoses • The dermatophytid reaction resolves when the tinea pedis infection is treated, and treatment of the hands with topical steroids can hasten resolution

41. Tinea Manuum Etymology: L. hand

42. It is less common than tinea pedis • Erythema and hyperkeratosis of the palms and fingers affecting the skin diffusely is the commonest variety, and is unilateral in about half the cases • The accentuation of the flexural creases is a characteristic feature

43. Other clinical variants include crescentic, exfoliating scales, circumscribed, vesicular patches, discrete, red papular and follicular scaly patches, and erythematous, scaly sheets on the dorsal surface of the hand. The latter forms are more likely to be zoophilic • When the palms are infected, the feet are also commonly infected. A typical pattern of involvement is either one hand and both feet or both hands and one foot

45. Tinea Barbae

46. Etiology • The mechanism that causes tinea barbae is similar to that of tinea capitis. In both diseases, hair and hair follicles are invaded by fungi, producing an inflammatory response • Currently, tinea barbae is infrequent around the world • Tinea barbae was observed more frequently in the past when infection frequently was transmitted by barbers who used unsanitary razors, so it was termed barber's itch

47. 1- Inflammatory deep type (kerion) • It is the most common clinical presentation • caused primarily by zoophilic dermatophytes • Most patients show solitary plaques or nodules; however, multiple plaques are relatively common • Usually localized on the chin, cheeks, or neck, involvement of the upper lip is rare

48. The characteristic lesion is an inflammatory reddish nodule with pustules and draining sinuses on the surface. Hairs are loose or broken, and depilation is easy and painless

49. Over time, the surface of the indurated nodule is covered by exudate and crust • This variety of tinea barbae usually is associated with generalized symptoms, such as regional lymphadenopathy, malaise, and fever

50. 2-Noninflammatory superficial type • Caused by anthropophilic dermatophytes • This variety is less common and resembles bacterial folliculitis • Typically, erythematous patches show an active border composed of papules, vesicles, and/or crusts. Hairs are broken next to the skin