Superficial fungal infection of the skin

Abstract

Superficial fungal infections of the skin are a common presentation in clinical practice. Any skin surface, the mucous membranes, nail plates, and nail beds can be affected. Tinea pedis is the most common fungal infection and may affect up to 70% of the adult population worldwide. Ubiquitous candidal organisms are found in the oral flora of many healthy persons and result in infection in the presence of certain host factors or immunodeficiency disorders. Onychomycosis has had an increasing incidence worldwide, and it now accounts for almost half of all nail disorders. These and many other infections can have varying presentations as well as features that resemble nonfungal disorders. Therefore, it is important that primary care physicians are familiar with the many cutaneous fungal infections and their differential diagnosis to ensure that appropriate therapy is selected.

Irritant Dermatitis

“…However, it is one author's experience (L. M.) that short bursts of topical steroids are often worth an initial attempt to improve symptoms until avoidance strategies may be implemented. In addition, a few small studies suggest that topical calcineurin Seborrheic dermatitis Greasy or powdery scale in scalp, posterior auricular region, eyebrows, and nasolabial folds Johnson and Nunley (2000) Dermatophytosis Scaly plaques that may be in an annular configuration Increased scale or pustules at leading edge Erythematous scaly plaques in moccasin distribution on feet Two plantar surfaces involved and one palm involved (two foot, one hand presentation) Yellowing and thickening of nails White crumbling nail surface Hyphal elements seen on potassium hydroxide preparation Culture positive for dermatophyte Hyphae seen with PAS stain on biopsy Zuber and Baddam (2001) inhibitors may improve signs and symptoms of ICD (Engel et al, 2008;Mensing et al, 2008). For recalcitrant lesions, phototherapy or systemic immunosuppression with cyclosporine or azathioprine may be helpful (Cohen and Heidary, 2004 …”

Onychomycosis: Current Treatment Options

“…For appropriate patients, systemic therapy for onychomycosis may be chosen. Introduced in 1958 for the treatment of onychomycosis, griseofulvin inhibits fungal cell wall synthesis, DNA production, cellular microtubules, and RNA binding (Gupta & Del Rosso, 1958;Zuber & Baddam, 2001). For the most part, newer agents have become first line therapy in place of griseo-fulvin due to shorter lengths of therapy and higher cure rates with the newer agents (Rodgers & Bassler, 2001).…”

“…Medication side effects of either method include headache, rash, or gastrointestinal problems (Rodgers & Bassler, 2001). In addition, dry skin, weakness, hypertension, dizziness, and decreased libido have been reported (Zuber & Baddam, 2001). Rarely, serious liver toxicities can occur (Rodgers & Bassler).…”

“…This agent inhibits ergostol production by inhibiting the fungal enzyme squalene epoxidase. When terbinafine is prescribed, it is given as 250 mg once a day for six weeks for infected fingernails or twelve weeks for infected toenails (Zuber & Baddam, 2001). In reported studies, terbinafine has been found to have a mycologic cure rate of 71% ± 8 % (Goodfield & Evans, 1992;Hofmann, Brautigam, Weidenger, & Zaun, 1995).…”

“…In head-to-head studies comparing terbinafine to itraconazole, terbinafine has been found to have superior clinical and mycologic outcomes (Brautigam, Noting, Schopf, & Weidinger, 1995;Evans & Sigurgeirsson, 1999). Common side effects with terbinafine include headache, rash, diarrhea, nausea, taste disturbance, and abdominal pain (Rodgers & Bassler, 2001;Zuber & Baddam). As with itraconazole, hepatic toxicity can be a serious complication.…”