dermatophytosis

1. Presented By : HASNAT TARIQ
(GULAB DEVI INSTITUTE OF PHARMACY, LAHORE,)

2. Introduction
“A fungal infection, also called mycosis, is a skin disease caused by a fungus”
• FUNGUS
Fungus is a colorless plant that lacks chlorophyll, Yeast like / mold like fungi causes
human infections.
• FUNGAL INFECTIONS
Fungal infections range from superficial skin infections to life threatening systemic
infections. Systemic fungal infections are serious that occur when fungi gain
entrance into the interior of the body.

3. Types of Fungal Infections
• Fungal infections also known as mycotic infections has two types:
1.SUPERFICIAL MYCOTIC INFECTIONS
• Superficial mycotic infections occur on the surface of, or just below, the skin or nails.
• Superficial infections include tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea
corporis (ringworm), onychomycosis /tinea unguium (nail fungus), Yeast infections,
caused by Candida albicans.
2.DEEP MYCOTIC INFECTIONS
• Deep mycotic infections develop inside the body, such as in the lungs. Treatment for
deep mycotic infections is often difficult and prolonged.

4. Dermatophytosis

5. Dermatophytosis
• Dermatophytosis is a fungal infection of the skin, hair, or nails caused by
dermatophytes.
• These fungi can infect the outer layers of the skin and thrive on keratin, a protein
found in the skin, hair, and nails.
• Dermatophytosis is typically transmitted through direct contact with an
infected person or animal or by contact with contaminated surfaces such
as floors, towels, or personal items.
Types of Dermatophytosis:

7. a) Tinea Pedis (Athlete’s Foot)
• Also known as Athlete Foots
• Infection of the foot by fungi (dermatophytes)
• The most common dermatophyte infection
• More common in males than females

8. a) Tinea Pedis (Athlete’s Foot)
Causative organisms:
• Trichophyton Rubrum
(Most Common almost 70% of cases)
• Trichophyton interdigitale
• Epidermophyton floccosum
Symptoms:
• Feet Itching
• Peeling
• Redness
• Mild burning and sores.

9. a) Tinea Pedis (Athlete’s Foot)
Risk Factors:
• Warm and humid environments
• Genetic predisposition
• Shared facilities (Like Pools, showers)
• Excessive sweating
• Chronic water/fluid exposure
• Chronic use of enclosed footwear
• Systemic Diseases (Diabetes & Certain Cancers)

10. A)Tinea Pedis (Clinical Presentations)

11. A)Tinea Pedis (Clinical Presentations)

12. B)Tinea Cruris (Jock Itch)
• Super-facial skin infection in groin area by
dermatophytes
• Occurring almost exclusively in young men
than women . Affects the genitals, inner
thighs and buttocks.
Causative organisms:
• Trichophyton Rubrum
(Most Common )
• Trichophyton interdigitale
• Epidermophyton floccosum

13. B)Tinea Cruris (Clinical Presentations)
There is a brownish-red itchy rash, with a well-defined demarcated border, in
the groin.

14. B)Tinea Cruris
Transmission:
• Often spread from another fungal infection (Auto-Infection ;Ex Tinea Pedis).
• Can be transmitted from other human , animals , soil.
Risk Factors:
• Excessive sweating
• Male gender
• Obesity & Diabetes
• Immunosuppression
• Contacts-Sport athlete
• Tight-Fitted Clothes
• Genetic Predisposition
(Decreased beta-Defensins)

15. C)Tinea Corporis (Ringworm)
• Tinea corporis is commonly referred to as ringworm due to the characteristic
ring-shaped rash that often develops on the skin affected by the fungal infection.
Despite its name, ringworm is not caused by a worm but by various types of
fungi, such as dermatophytes.
• Superfacial Fungal infection of the major skin surfaces involves neck , trunk ,
arms and legs
Causative organisms:
• Trichophyton Rubrum
(Most Common )
• Other Trichophyton species
• Microsporum species
(M.canis from cats and dogs)

16. C)Tinea Corporis (Ringworm)
Transmission
• Direct skin contact
Often transmitted by animals (pets or livestock) and can also be picked up from the
soil.
Risk Factors:
• High humidity and warm/hot environment
• Tight fitting clothes
• Children & Farmers
• Immunosuppressed patient
• Genetic predisposition (Decreased Beta defensins)
• Systemic disease (Diabetes & lymphoma)

17. C)Tinea Corporis (Clinical presentations)
• There are itchy pink or red scaly patches with a well-defined inflamed border.
• Lesions are often paler at the center, becoming progressively inflamed towards the
outer edge.
• Lesions often occur singly but can be multiple and sometimes overlap to form a large
continuous patch.

18. • Use Topical Antifungals for at least 2-4 weeks, even if it appears
healed.
• Reduce moisture to the infected area.
• If infection is on the foot, do not walk barefoot {to avoid spreading it);
• Apply medicine 1-2 inches beyond the rash.
C)Tinea Corporis (Counselling)

19. D)Tinea Unguium (Onychomycosis)
• Infection of the nail by Fungi
(Dermatophytes)
• Fungi digest keratin of the nail
leading to brittle/ damaged
nails
Causative organisms:
• Trichophyton Rubrum
(Most Common about 90% of
infections )
• Microsporum
• Epidermophyton

20. D)Tinea Unguium (Onychomycosis)
Clinical Presentations
• Crumbling of nail- brittle
• Yellowish, opaque
• Subungual hyperkeratotic debris
Diagnosis:
• KOH mount (Preparation of nail clippings)
• PAS (Periodic Acid-Schiff) stain of nail clippings

21. Diagnosis of Dermatophytosis
• Diagnosis:
1. Clinical Diagnosis
2. KOH wet mount
(Sample collection Preparation of KOH mount Mixing & Covering
Microscopic examination Visualize Segmented Hyphae)

22. ORAL ANTIFUNGALS
• The main used for dermatophytosis are terbinafine, itraconazole and
fluconazole.
• Terbinafine is the treatment of choice for tinea infections at 250 mg/day for
2–6 weeks, depending upon the infection.
• These agents act by inhibition of the fungal enzyme squalene epoxidase, an
enzyme involved in the synthesis of ergosterol, an essential component of
the fungal cytoplasmic membrane
• Fingernails infections may be for ≥6 weeks at 250 mg/day .
• Toenail infections may be for 12 weeks at 250 mg/day
• Itraconazole is the second preferred agent at 200 mg BD for 1 week and
longer with repeated courses for finger and toenail involvement
Treatment of Dermatophytosis

23. Griseofulvin is an alternative treatment for tinea capitis. The usual adult
dosage is 500 mg or 1 g OD for severe infections. The duration of treatment
will depend upon the infection;
6 weeks  tinea corporis.
6 months  fingernails
12 months toenail infections
TOPICAL ANTIFUNGALS
• The most commonly used topical agents are the imidazoles, of which a
wide variety is available, including clotrimazole, econazole, miconazole and
tioconazole. There is little to choose between these agents, all of which are
usually applied 2 or 3 times daily, continuing for up to 2 weeks after the
lesions have healed.
• Other topical agents include Polyenes terbinafine and tolnaftate
Treatment of Dermatophytosis

24. Topical Antifungal Brands

25. Oral Antifungals Brands

26. Topical Antifungals (Frequency and duration)
Tinea Pedis Tinea Corporis Tinea Cruris
Terbinafine (OD or BD for 1-2
weeks)
Terbinafine (OD for week) Terbinafine (OD for week)
Ciclopirox (BD for 4 weeks) Ciclopirox (BD for 4 weeks)
Butenafine
(OD or BD for 1-4 weeks)
Butenafine
(OD or BD for 1-4 weeks)
Butenafine
(OD or BD for 1-4 weeks)
Clotrimazole ( BD for 4 weeks) Clotrimazole ( BD for 4 weeks) Clotrimazole( BD for 2 weeks)
Miconazole ( BD for 4 weeks) Miconazole ( BD for 4 weeks) Miconazole ( BD for 2 weeks)
Ketoconazole (OD for 6 weeks) Ketoconazole (OD for 2 weeks) Ketoconazole (OD for 2 weeks)
Duration and Frequency of different Topical Antifungals

27. B. Pityriasis Versicolor

28. Pityriasis Versicolor
• Common skin infection with fungi of the species
Malassezia furfur (Pityrosporum ovale)
• Occur worldwide (Most commonly in tropical
climates).
• Adolescents and young adults most affected.
Risk factors
• Summer months
• Hyperhidrosis
• Chronic use of steroids
• Immunosuppression
• Tropical locales
• Cushing’s syndrome

29. Pityriasis Versicolor

30. Pityriasis Versicolor
Clinical presentations
Macular (flat) patches of altered pigmentation occurring mainly on the trunk and upper
legs and arms.
In white-skinned people patches are brownish and look as if suntanned, whereas on
darker-skinned or heavily tanned people patches are pale or white. The affected area
has an overall dappled appearance.
Differential Diagnosis :The condition is most likely to be confused with vitiligo.

31. Pityriasis Versicolor
TREATMENT
 Midazole cream applied daily for 3 weeks
 ketoconazole 2% shampoo (Apply undiluted and wash off after 5 minutes). Repeat daily for 1
week, then weekly for several weeks to prevent reinfection.
 Selenium sulfide shampoo (Selsun Blue) or 2% selenium sulphide lotion or 20% sodium
thiosulphate applied daily for 10–14 days, wash off after 4–5 hours, Use weekly for 8 weeks.
 In severe cases, oral itraconazole (200 mg once daily for 7 days) may be given.

32. C. Vaginal Infections

33. Vaginal fungal infections
• Vaginal fungal infections are common. Approximately 75% of women
will have at least one episode, and half of these women will have
recurrence.
• Fungal vaginal infections are uncommon before a female begins
menstruating.
• Hormones impact the pH of the vagina, making menstruating women
more susceptible. Infections occur most commonly during the week
before menstruation, making treatment decisions around the menses
important. Women can begin treatment during menses or wait until
the bleeding stops.
• Vaginal fungal infections are more common during pregnancy.

34. Vaginal fungal infections
Symptoms
• Primarily itching with possible soreness and pain (burning) during
urination or mating. Some women have a cottage-cheese like
discharge (white, thick, clumpy).
Diagnosis
• Can be confirmed with a vaginal culture to check for fungal growth,
while a pH test can be used to help rule out other conditions.

35. Vaginal fungal infections
Risk factor:
• Women taking high-dose estrogen, hormone replacement therapy or
antibiotics are at elevated risk.
• Antibiotic use can kill the normal flora and lead to fungal overgrowth.
Treatment:
• Mild-moderate, infrequent infection: 1, 3 or 7 day treatment with
vaginal cream, ointment or vaginal suppository/ tab OTC.
• Topical Clotrimazole (Canestan)
• Miconazole cream
• oral Fluconazole (Diflucan) 150 mg PO x OD

36. Vaginal fungal infections
Counselling:
1. Prior to using the product, wash the external genital area with mild soap and
water, and pat dry with a towel.
2. Insert applicator, suppository or vaginal tab at night before bed.
3. Lying down immediately after insertion helps retain the medicine inside the
vagina; a protective pad can be used.
4. Complete entire course of treatment.
5. Lactobacillus or yogurt with active cultures is thought to reduce infection
occurrence)

37. References
• Clinical pharmacy and therapeutics by Kate Whittlesea & Karen
Hodson (6th edition)
• Rxprep NAPLEX 2022 COURSE BOOK
• https://youtu.be/Q6XGUa8BYVQ?si=2Iecj9e8uJBJXSfu
• https://youtu.be/9Nzt8cc66LU?si=c2Mr9wod9EKx8MD3
• https://youtu.be/GpG22UKhMNw?si=ZCvPm2SSDyeb1Q-g
• https://youtu.be/GpG22UKhMNw?si=ZCvPm2SSDyeb1Q-g
• Illustrations from Internet