Superficial

Fungal
Infections
Learning goals
• Name the most common pathogens responsible for superficial fungal infections.
• Describe the epidemiology and pathology of superficial fungal infections.
• Describe the clinical presentation and diagnosis of superficial fungal infections.
• Explain the therapeutic management plan for superficial fungal infections.
• Explain the importance of drug-resistance dermatophytes and how to mitigate its effects.
Table of contents

Objectives Results analysis

01 You can describe the topic of 03 You can describe the topic of
the section here the section here

Methodology Conclusions
02 You can describe the topic of 04 You can describe the topic of
the section here the section here
 01
Overview
Introduction to
Superficial Fungal
Infections
▪ Definition: Superficial fungal infections,
also known as dermatomycoses, are
common skin infections.
▪ Global Impact: Affect around 1 billion
people worldwide.
▪ Non-life-threatening: Affect skin, hair,
and nails.
Fungi and Infection Overview

Fungi that cause Favorable Common

infections: conditions: Thrive locations:
Dermatophytes, in warm, humid Prevalent in
non-dermatophyte environments (25- temperate and
molds, and yeasts. 28°C). tropical countries.
Risk Factors

Higher risk groups:

People with low socio-economic status.
Crowded living conditions.
Close animal contact.
Poor hygiene.
Increased transmission: Warm and humid environments
contribute to higher transmission rates.
Common Types of Superficial Fungal Infections

1 2 3
Dermatophytes: Yeasts: Cause Non-dermatophyte
Cause tinea or candidiasis and molds: Rarely
ringworm (e.g., pityriasis versicolor. cause skin
Tinea capitis, Tinea infections but can
corporis). infect nails.
Epidemiology of Superficial Fungal Infections

•Global prevalence: 20-25% of the global population affected.

•Most affected groups:
•Children (1-5 years) and the elderly.
•People in sub-Saharan Africa.
•Males are more frequently affected.
•Impact of climate change: Rising temperatures increase the spread of fungal
pathogens.
 02
Tinea capitis,
Tinea corporis,
and Tinea cruris
Tinea Capitis
(Scalp Infection)
▪ Demographics: Mostly affects
children aged 6 months to 12 years.
▪ Caused by: Microsporum and
Trichophyton species.
▪ Symptoms: Scaly patches, broken
hair, black dots on the scalp.
▪ Spread: Via contact with infected
individuals or animals.
Tinea Capitis Clinical Presentation

▪ Caused by: Zoophilic and geophilic

fungi.
▪ Symptoms: Red, raised, and itchy
patches; can lead to scarring and
permanent hair loss.
▪ Complication: Kerion (painful
pustular lesion).
▪ Spread: From animals (e.g., cats
and dogs) or soil.
Tinea Corporis
(Body Infection)
• Demographics: Affects people of all ages
globally.
• Caused by: Trichophyton and Microsporum
species.
• Symptoms: Annular erythematous plaques
with raised, scaly borders and central
clearing.
• Risk factors: Direct contact with infected
individuals or animals.
Tinea Corporis Clinical Presentation

● Annular plaques: Raised,

erythematous borders with central
clearing.
● Inflammatory tinea: May show
pustules or scaling.
● Variants: Tinea incognito (steroid-
altered presentation), Tinea
imbricata (concentric scales).
Tinea Cruris (Groin Infection)
▪ Demographics: More common in
males, often occurs in soldiers and
athletes.
▪ Symptoms: Erythematous, scaly
plaques extending from the groin to
the upper thighs.
▪ Caused by: Anthropophilic fungi
spread via human-to-human
contact.
▪ Risk factors: Crowded
environments, poor hygiene.
Tinea Cruris Clinical Presentation

Location Symptoms Spread Associated with

Groin, inner thighs Red, scaly patches; Via human-to- Tinea pedis or
darker human contact. corporis.
pigmentation
may appear.
Tinea
versicolor
Tinea versicolor is a common fungal
infection of the skin. Causes small,
discolored patches that may be lighter
or darker than the surrounding skin.
Commonly affects the trunk and
shoulders.
Characteristics of
Tinea Versicolor
• The overgrowth of fungus interferes
with normal pigment production.
• Most frequent in teens and young
adults.
• Sun exposure can make tinea versicolor
more visible.
• Also known as pityriasis versicolor.
Symptoms of
Tinea Versicolor
Patches of skin discoloration (back, chest,
neck, upper arms).
Mild itching and scaling.
Diagnosis of Superficial Fungal Infections
Clinical
examination Microscopy:
Identification of typical Examination of skin
symptoms like scaling scrapings using
and redness. potassium hydroxide
(KOH) preparation.

Wood Lamp Fungal Culture

Identification of the exact
Some fungi fluoresce under UV light.
fungal species.
Treatment of Superficial Fungal
Infections
▪ Topical antifungals: Clotrimazole, miconazole,
terbinafine.
▪ Oral antifungals: Terbinafine, itraconazole for more
severe cases.
▪ Hygiene: Keep the skin clean and dry, avoid sharing
personal items.
▪ Screening: Family members and close contacts
should be screened and treated if necessary.
 03
Tinea manuum and
Tinea pedis
Tinea Manuum (Hand Infection)

● Demographics: Most commonly affects one

palm.
● Caused by: Trichophyton rubrum.
● Symptoms: Dry, scaly patches, often confined
to palm creases.
● Associated with: Tinea pedis and
onychomycosis.
Tinea Pedis (Foot Infection)

▪ Demographics: More common in

males and those wearing occlusive
footwear.
▪ Caused by: Trichophyton species.
▪ Risk factors: Sweating, communal
washing areas.
▪ Associated with: Onychomycosis
(nail infection).
Tinea Pedis Clinical Subtypes

Interdigital
Moist scaling, particularly
between the 4th and

Moccasin Vesiculobullous
5th toes.

Dry, powdery scales across Pustules and vesicles on

the sole and sides of the plantar surface.
the foot.
Diagnostic Techniques for Tinea
● KOH Prep
○ Microscopy with potassium hydroxide to observe
septated hyphae

● Wood's Lamp
○ Ultraviolet light examination to detect
fluorescing fungi (e.g., Microsporum species).
Treatment of
Tinea Capitis
▪ Oral Therapy:
▪ Griseofulvin: 6-8 weeks for
Microsporum infections.
▪ Terbinafine: 4 weeks for
Trichophyton infections.
▪ Topical Therapy: Ketoconazole
shampoo to reduce spores.
Treatment of Localized Tineas

▪ Topical Antifungals: Imidazoles

(e.g., ketoconazole), allylamines
(e.g., terbinafine).
▪ Duration: 3 weeks of daily
application for uncomplicated tinea.
▪ Oral Therapy: For extensive
lesions or failed topical treatment,
options include griseofulvin,
terbinafine, or itraconazole.
Onychomycosis (Nail Infection)

▪ Demographics: More common in

adults, particularly the elderly.
▪ Caused by: Trichophyton rubrum
and non-dermatophyte molds.
▪ Symptoms: Thickened, discolored,
and brittle nails.
Types of Onychomycosis
▪ Distal Lateral Subungual
Onychomycosis:
▪ Begins at the tip and sides of the nail.
▪ Nail becomes discolored, thick, and
brittle.

▪ Proximal Subungual Onychomycosis:

▪ Starts at the base of the nail,
moving towards the tip.
▪ Consider immunodeficiency if
observed.
Clinical Presentation of Onychomycosis

▪ Discoloration (yellow, brown, or

white spots on the nail).
▪ Thickening of the nail plate.
▪ Brittle, crumbly, or ragged edges.
▪ Separation of the nail from the nail
bed (onycholysis).
Risk Factors for Onychomycosis

Age Footwear
More common in older Tight, non-breathable
adults. shoes can trap
moisture.

Underlying
conditions Tinea Pedis
Diabetes, Athlete's foot can spread
immunosuppression, to the nails.
peripheral vascular
disease
Diagnosis of Onychomycosis

▪ Clinical Diagnosis: Based on the

appearance of the nail.
▪ KOH Prep: Scraping of the affected
nail to examine for hyphae under a
microscope.
▪ Fungal Culture: Identifies the
specific causative fungus.
▪ Molecular Diagnosis: PCR testing
for faster and more accurate
diagnosis.
Treatment for Onychomycosis
Systemic Treatment
▪ Oral Terbinafine:
Topical Treatment ▪ 6 weeks for fingernails.
▪ Topical Antifungals: ▪ 3 months for toenails.
▪ Amorolfine (nail ▪ Oral Itraconazole:
lacquer). ▪ Pulse therapy: 400 mg/day
▪ Ciclopirox (nail lacquer). for 1 week, repeated
▪ Limitations: Only effective for monthly for 2 months
mild or early-stage infections (fingernails) or 3-4 months
involving a small part of the (toenails).
nail. ▪ Griseofulvin:
▪ 1 g/day for 4-12 months in
severe cases.
Prevention of
Onychomycosis
• Footwear: Avoid tight, non-
breathable shoes.
• Hygiene: Keep feet clean and dry,
and avoid sharing nail clippers.
• Management of Tinea Pedis: Treat
athlete’s foot to prevent spread to
nails.
• Avoid Nail Trauma: Protect nails
from injury.
 Pityriasis
04 Versicolor;
Mucocutaneous
Candidiasis
Pityriasis Versicolor Overview

▪ Definition: Pityriasis Versicolor is a

fungal infection caused by
Malassezia species.
▪ Common Areas Affected: Chest,
back, and upper limbs.
▪ Non-contagious: Benign
condition.
▪ Risk Factors: Hot, humid climates,
genetic predisposition, and
hormonal factors.
Pityriasis Versicolor Clinical Features

▪ Symptoms: Irregular macules and

patches that can be hypo- or
hyperpigmented.
▪ Scaling: Fine scale that appears
more pronounced when scratched.
▪ Location: Thorax, neck, and upper
limbs, but not on palms or soles.
▪ Common in: Children and young
adults.
 Diagnosis of Pityriasis Versicolor

01 02 03

Clinical
KOH Prep Wood's Lamp Diagnosis
Shows large budding cells and Yellow-green fluorescence Often diagnosed based on
short hyphae (spaghetti and under UV light. visual examination of
meatballs appearance). the lesions.
Treatment of Pityriasis Versicolor

▪ Topical Therapy: Ketoconazole 2%

gel/shampoo, miconazole or
clotrimazole cream.
▪ Duration: Applied daily for 3 weeks.
▪ Second-Line Therapy: Oral
fluconazole (300 mg weekly for 2-4
weeks) or itraconazole (100 mg
daily for 7 days) for more severe
cases.
Mucocutaneous Candidiasis Overview

▪ Definition: Candidiasis is caused by

Candida species, primarily C.
albicans.
▪ Affected Areas: Skin, mucous
membranes (mouth, genitals), and
nails.
▪ Risk Factors: Diabetes,
immunosuppression, humid
environments, topical steroids.
Clinical Presentation of Mucocutaneous Candidiasis

▪ Intertrigo: Candidiasis in skin folds

like the groin, armpits, and breast
folds, characterized by red, scaly
plaques with satellite pustules.
▪ Oral Candidiasis: White patches
(thrush) on the tongue and inner
cheeks that can be scraped off.
▪ Nail Candidiasis: Erythema and
swelling around the nail
(paronychia).
Diagnosis of Mucocutaneous Candidiasis
● Microscopy: Swabs or scrapings from infected
areas examined under the microscope.

● Fungal Culture: Sample cultured to identify

Candida species.
Treatment of Mucocutaneous Candidiasis

▪ Topical Antifungals: Clotrimazole,

miconazole, or nystatin creams
applied twice daily for 3 weeks.
▪ Oral Candidiasis: Amphotericin B
or miconazole oral gel.
▪ Recurrent Infections: Oral
fluconazole for 7-14 days or longer
in severe cases.
Research resources
● Badiane AS, Ramarozatovo LS, Doumbo SN, et
al. Diagnostic capacity for cutaneous fungal
diseases in the African continent. International
Journal of Dermatology. 2023;62(9):1131-
1141.
● Chanyachailert P, Leeyaphan C, Bunyaratavej S.
Cutaneous Fungal Infections Caused by
Dermatophytes and Non-Dermatophytes: An
Updated Comprehensive Review of
Epidemiology, Clinical Presentations, and
Diagnostic Testing. J Fungi (Basel).
2023;9(6):669.
● DermNetNZ.org
Thanks!
Question
1. Which of the following is NOT a common pathogen
responsible for superficial fungal infections?
a. Trichophyton
b. Microsporum
c. Candida
d. Staphylococcus
2. What percentage of the global population is affected by
superficial fungal infections?
a. 5-10%
b. 20-25%
c. 40-45%
d. 60-65%
Question
3. Which age group is most commonly affected by Tinea capitis?
a. Infants under 6 months
b. Children aged 6 months to 12 years
c. Teenagers aged 13-19 years
d. Adults over 20 years
4. What is the characteristic appearance of Tinea corporis?
a. Scaly patches with broken hair
b. Annular erythematous plaques with raised, scaly borders and
central clearing
c. Thickened, discolored, and brittle nails
d. White patches on the tongue and inner cheeks
Question
5. Which diagnostic technique uses ultraviolet light to detect
fluorescing fungi?
a. KOH preparation
b. Fungal culture
c. Wood's lamp examination
d. PCR testing
6. What is the first-line treatment for localized tinea infections?
a. Oral griseofulvin
b. Topical antifungals
c. Oral terbinafine
d. Systemic corticosteroids