Overview of Fungal Skin Infections | Tinea Infections
Summary
TLDRThis educational video delves into tinea infections, commonly known as fungal skin infections. It covers various types of tinea, including athlete's foot (tinea pedis), ringworm (tinea corporis), scalp infection (tinea capitis), jock itch (tinea cruris), and nail infection (tinea unguium). The video explains the clinical presentations, diagnosis through KOH preparation, and treatment options. It highlights special cases like tinea capitis and tinea unguium, which may require oral antifungal treatments or specific topicals like efinaconazole, diverging from typical topical antifungal therapies.
Takeaways
- 🌿 Tinea infections are caused by fungi known as dermatophytes, primarily from the Trichophyton or Epidermophyton genus.
- 🔬 The pathophysiology of tinea involves the fungi metabolizing keratin in the skin, nails, and hair, leading to lesions and other symptoms.
- 📍 Tinea infections are named based on the body location affected, such as tinea corporis for the trunk, tinea pedis for the feet, and so on.
- 🦶 Tinea pedis, or athlete's foot, is the most common tinea infection, presenting as interdigital, hyperkeratotic, or vesiculobullous.
- 🐍 Tinea corporis, also known as ringworm, presents as circular/oval, pruritic, and scaling patches or plaques on the body.
- 🧢 Tinea capitis affects the scalp and can cause hair loss, itching, and scaling, often transmitted through direct contact.
- 🩲 Tinea cruris, or jock itch, is a fungal infection of the groin area, more common in men, and can be associated with sweating, diabetes, obesity, and immunodeficiency.
- 💅 Tinea unguium, or onychomycosis, affects the nails, causing them to become brittle, yellowish, and opaque with debris underneath.
- 🔬 Diagnosis of tinea infections typically involves a KOH preparation of skin scrapings to visualize segmented hyphae, or it may be based on clinical presentation.
- 💊 Treatment usually involves topical antifungals with a '-azole' suffix, but special cases like tinea capitis and tinea unguium may require oral antifungals or specific topical treatments like efinaconazole.
Q & A
What are tinea infections?
-Tinea infections, also known as fungal skin infections, are caused by fungi known as dermatophytes, specifically from the genus Trichophyton or Epidermophyton.
How do dermatophytes cause tinea infections?
-Dermatophytes cause tinea infections by metabolizing the protein keratin found in our skin, nails, and hair, leading to lesions, scarring, brittleness of nails, and dryness.
What are the different types of tinea infections based on body location?
-Tinea infections are named based on the body location they affect: tinea corporis (trunk), tinea pedis (feet), tinea capitis (head), tinea cruris (groin), and tinea unguium (nails).
What is the most common clinical presentation of tinea pedis?
-The most common clinical presentation of tinea pedis, or athlete's foot, is interdigital tinea pedis, which is itchy and scaly.
How is tinea corporis different from other tinea infections?
-Tinea corporis, also known as ringworm, affects the trunk and is characterized by circular/oval, itchy, and scaling patches or plaques that spread centrifugally.
What is tinea capitis and how is it transmitted?
-Tinea capitis is a fungal infection of the head, often leading to hair loss, itching, and scaling. It is transmitted through direct contact.
Why is tinea cruris more common in men than women?
-Tinea cruris, or jock itch, is more common in men due to factors like excessive sweating, which is more prevalent in the groin area of men, especially those who are very active.
What are the clinical characteristics of tinea unguium?
-Tinea unguium, or onychomycosis, presents as a crumbling, brittle nail with a yellowish, opaque appearance and unusual hyperkeratotic debris underneath the nail.
How are tinea infections typically diagnosed?
-Tinea infections are typically diagnosed through a KOH (potassium hydroxide) preparation of skin scrapings, where segmented hyphae are visualized.
What are the treatment options for tinea infections?
-Treatment for tinea infections usually involves topical antifungals with a '-azole' suffix, such as fluconazole or butenafine. However, special cases like tinea capitis and tinea unguium may require oral antifungals or specialized topical treatments like efinaconazole.
Why are oral antifungal treatments sometimes avoided for tinea unguium?
-Oral antifungal treatments for tinea unguium are sometimes avoided due to potential liver toxicity issues, leading to a preference for topical treatments like efinaconazole.
Outlines
🦠 Overview of Tinea Infections
This paragraph introduces fungal skin infections, also known as tinea infections, caused by dermatophytes like trichophyton and epidermophyton. The fungi metabolize keratin in skin, nails, and hair, leading to lesions, scarring, and dryness. Tinea infections are named based on the affected body part: tinea corporis (trunk), tinea pedis (feet), tinea capitis (head), tinea cruris (groin), and tinea unguium (nails).
👣 Tinea Pedis (Athlete’s Foot)
This section explains tinea pedis, or athlete’s foot, the most common dermatophyte infection. It can present in three ways: interdigital (between the toes), hyperkeratotic (on the soles), and vesiculobullous (on the medial foot). All presentations can be itchy and may involve scaling or pain. Visual descriptions highlight scaling and affected areas.
🔵 Tinea Corporis (Ringworm)
Tinea corporis, also known as ringworm, affects the trunk (excluding hands, feet, groin, and face). It manifests as pruritic (itchy) circular or oval, scaling patches or plaques that spread centrifugally (from the center outward). Lesions are well-demarcated and can enlarge over time.
🧢 Tinea Capitis (Scalp Infection)
Tinea capitis is a fungal infection of the scalp that leads to patchy hair loss and scaling. It is transmitted through direct contact, meaning it can spread between individuals. A memory aid is provided: 'cap' for the head.
🤾♂️ Tinea Cruris (Jock Itch)
Tinea cruris, or jock itch, affects the groin area and is more common in men. It begins on the inner thighs and spreads centrifugally. This condition is erythematous (red), well-demarcated, and often associated with excessive sweating, diabetes, obesity, or immunodeficiency.
💅 Tinea Unguium (Nail Infection)
Tinea unguium, also known as onychomycosis, is a fungal infection of the nails, leading to brittle, crumbling, yellowish, opaque nails with hyperkeratotic debris underneath. An entire lecture on this topic is available for more detailed information.
🔬 Diagnosing and Treating Tinea Infections
Tinea infections are diagnosed through clinical presentation or by KOH skin scraping preparation to visualize segmented hyphae. Treatment typically involves topical antifungals ending in '-azole' (e.g., fluconazole or butenafine). Two special cases (tinea capitis and tinea unguium) may require oral antifungals or efinaconazole due to their severity.
📚 Additional Dermatology Resources
The speaker concludes by encouraging viewers to explore more dermatology-related topics through a dedicated playlist. This serves as an invitation for further learning on various skin conditions.
Mindmap
Keywords
💡Tinea infections
💡Dermatophytes
💡Keratin
💡Tinea corporis
💡Tinea pedis
💡Tinea capitis
💡Tinea cruris
💡Tinea unguium
💡KOH preparation
💡Topical antifungals
💡Terbinafine
Highlights
Introduction to fungal skin infections, known as tinea infections, caused by dermatophytes from the genus Trichophyton or Epidermophyton.
Tinea infections affect the skin, nails, and hair by metabolizing keratin, leading to lesions, scarring, brittleness of nails, and dryness.
Tinea infections are named based on the location: tinea corporis (trunk), tinea pedis (feet), tinea capitis (head), tinea cruris (groin), and tinea unguium (nails).
Tinea pedis (athlete's foot) is the most common dermatophyte infection, presenting as itchy, scaly, and affecting areas between the toes or soles.
Different forms of tinea pedis include interdigital (between toes), hyperkeratotic (soles), and vesiculobullous (medial foot, painful and pruritic).
Tinea corporis (ringworm) affects the body except for hands, feet, groin, and face, presenting as circular or oval scaling patches or plaques that spread centrifugally.
Tinea capitis affects the scalp, causing hair loss, itching, and scaling, and is spread through direct contact.
Tinea cruris (jock itch) occurs in the groin area, more common in men, and often associated with sweating, diabetes, obesity, and immunodeficiency.
Tinea unguium (onychomycosis) affects nails, causing them to become brittle, yellow, and opaque, with hyperkeratotic debris underneath.
Diagnosis of tinea infections is often done through clinical presentation or a KOH preparation showing segmented hyphae in skin scrapings.
Treatment typically involves topical antifungals, particularly medications ending in '-azole,' such as fluconazole and butenafine.
Two special cases of tinea infections require oral antifungals or extended treatment: tinea capitis (scalp) and tinea unguium (nails).
Terbinafine or griseofulvin is used for treating tinea capitis, while efinaconazole is favored for long-term treatment of tinea unguium.
Oral antifungals for tinea unguium are being avoided due to liver toxicity concerns, leading to a shift towards topical efinaconazole.
A mnemonic for remembering special cases: the head (capitis) and the toes (unguium) are the extreme points where oral or extended treatment is required.
Transcripts
Hey everyone! This lesson is on an overview of fungal skin infections, or otherwise known
as tinea infections. So in this lesson we will be talking about a variety of different tinea
infections, so we're going to go over their clinical presentation, how we diagnose them,
and finally how we treat them. So tinea infections are infections by fungi known as dermatophytes,
and they come from the genus trichophyton or epidermophyton. Here are the images of those
trichophyton and epidermophyton fungi. Now the pathophysiology of tinea infections involves the
fungi metabolizing the protein keratin in our skin, nails and hair - this is how they actually present
and why they actually look the way they do because fungi metabolize keratin it leads to lesions,
scarring, brittleness of the nails, and dryness that type of clinical picture. Now, the tinea infections
are actually named depending on body location. If there is any infection on the trunk, it's
known as tinea corporis. If it's an infection on the feet, it's tinea pedis, if it's an infection on the
head it's tinea capitis. If it's an infection of the groin, it is tinea curries, and if it's an infection
of the nail, it is known as tinea unguium. So we're going to talk about each of these in more detail in the
next couple slides. So the first one we're talking about is tinea pedis, otherwise known as athlete's foot.
This is probably a very common one that many people know about and probably have had. It is the
most common dermatophyte infection and it presents in a few different clinical presentations. The first
one is the most common presentation - it is interdigital tinea pedis. This is the most
common type - it's itchy (pruritic) and it's scaly. So we can see in this image here again it's very scaly looking.
Another presentation is a hyperkeratosis. It's erythematous
but mostly involves the soles of the feet and the other one is a vesiculobullous
eruption, and again this can be pruritic, so itchy, but can also be very painful and it happens on the
medial foot. So interdigital is between the toes. Hyperkeratotic occurs on the soles of the
feet and then the vesiculobullous eruption occurs on the medial foot. So again, if we take a look at this
image here we can see noticeable scaling in this interdigital presentation. Now the next one
we're going to talk about is tinea corporis. Tinea corporis is also known as ringworm, and again this one
affects the trunk. So when we say trunk, it really basically means anywhere on the body except the
hands, the feet, the grown or the face. And this one is also pruritic (itchy) and as you can see in the
image, it is circular/oval in shape and it too is also a scaling patch or plaque. So it's a patch or
plaque. A patch is a flat surface or flat lesion that's greater than one centimeter and a plaque is
a raised lesion greater than one centimeter and it spreads centrifugally - so it really means
that it spreads from the inside, outwards so it can continually get larger and larger from its central
location. So again, we take a look at the image here it's a demarcated, very well demarcated, circle or
oval, and when we take a look at the lesion itself, it's a scaling patch or plaque. The next presentation
we're going to talk about is tinea capitis. Tinea capitis is a fungal infection of the head and an
easy way to remember this is capitis, "cap", so you can think of the cap or the top of your head or
you can put a baseball "cap" on your head. So this is how you can remember tinea
capitis is an infection of the head. And this leads hair loss and it too is also pruritic (itchy)
and scaling and this one is actually more related to a direct contact transmission. So if
one person has tinea capitis, you can actually have a transmission from that person to another
individual so that they can have tinea capitis as well. So again, you see this patchy hair loss with
this characteristic scaling appearance. The next presentation we're talking about is tinea
cruris. Tinea cruris is a fungal infection of the groin area, and this is commonly known as
jock itch. This affects men more than women, and what happens generally in this presentation
is that it begins on the medial thigh (so the inner sides of the thighs), and it's also spread
centrifugally, so it spreads from its center outwards. It's also erythematous and elevated. So
it becomes well demarcated because of this, and it has associated factors involved: one
is excessive sweating - so a lot of times this is why it's a jock itch sometimes in men or someone
that's very active where they can become very sweaty in that area and it can lead to this
jock itch. Other associated factors include diabetes and obesity and also immunodeficiency, so all
these can relate to getting jock itch or recurrent jock itch or recurrent tinea cruris. And the last
presentation to talk about is tinea unguium. This one is basically a fungal infection of the
nail. I have an entire lecture on this topic if you want more information. It's also called
onychomycosis. It is basically a crumbling, brittle nail just because the fungi are actually digesting
away the nail itself. It leads to a yellowish, opaque nail and if you're to take a look
underneath the nail you get some unusual hyperkeratotic debris. So now that we've seen a variety
of clinical presentations of tinea infections, how are they diagnosed? The diagnosis involves
doing a KOH preparation of skin scrapings and what you would see is you would visualize segmented hyphae
- so you'd see an image like this and you would see these segmented hyphae. So
a lot of times we don't do this, it may just be a clinical diagnosis (clinical presentation) of the tinea infection.
So once we've made the diagnosis, how do we treat it? Treatment typically involves topical antifungals
or medications with "-azole" at the end of their name. With the "-azole" suffix, you can think of medications
like fluconazole and another one might be butenafine. So majority of cases of
tinea infections are treated with topical antifungals but there are two special
cases I want you to think about and I'll tell you a way to remember them in a moment. So the two
special cases are tinea capitis (tinea capitis so the top of your head) we're going to typically use
terbinafine or griseofulvin. And the second one is tinea unguium (or the fungal infection of the nail),
and we're going to generally either use an oral antifungal or efinaconazole for a
very long period of time about 48 weeks (so a lot of time). We've been moving away from oral
antifungal just because of some liver toxicity issues, so we're more going toward efinaconazole,
which is also a topical treatment but it's a more special topical treatment for tinea unguium. So these are
the two special cases and I told you I'd tell you a way to remember them that the top of your
head and your fingers so they're basically the extremes right? So the top of your head, the the
highest up you're going, it's basically the extreme of your height, and all the way down to
the bottom of your feet at the tip of your toes is the other special case, and those are the two
types of fungal infections that you're going to have to use something else other than just the typical
topical antifungal. If you also want to learn more about other dermatology conditions please
check out my dermatology playlist. Thanks so much for watching and I hope to see you next time!
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