Guttate Psoriasis Pack

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Fungal Infection - continue

TINEA PEDIS (Athlete’s Foot)
This condition is most commonly caused by Trichophyton rubrumm. It affects the webbing between the toes and the soles of the feet. The top of the feet and occasionally the ankles may also be involved.

A streptococcus bacteria can also invade the infected site causing localized infection. In more severe cases, cellulites (inflammation of the subcutaneous tissue) and lymphangitis (redness & inflammation of the lymphatic vessels, seen as red streaks in a streptococcal infection) can also occur.

Tinea pedis is quite common in adults, especially in young males. Highly infectious, it can be spread easily in communal areas such as changing rooms, showers or swimming pools. The condition is aggravated by hot “sweaty” weather and further inflamed by wearing tight-fitting shoes or sports runners.

There are three basic presentations of this condition:-
* Lesions are commonly between the toes and between the sole border with the toes. The fourth and fifth toe spaces are more frequently infected.

* Small vesicles are the first indication. They easily rupture when rubbed and the resulting “oozing” fluid gives off a distinctive “fishy” smell. The skin softens and turns white and after peeling develops a bright red appearance.

* Some cases it presents as dry, rough skin which may be itchy and cracked.

* Subsequent infection by other bacteria is common.

* It is often worse in winter, tending to improve in warmer weather (probably due to the fact open or no shoes are worn and the feet can “breath”).

* Reoccurences are possible.

* Presents with a “shoe” like appearance over the entire foot and sometimes the ankle. The skin is dry and scaly and the sole may appear as a red or even whitish colour.

* Frequently seen in patients who also have Tinea manuum.

* Can be accompanied by infected nails.

* Treatment is more difficult, however, good results can be achieved.

* Vesicles evolve rapidly either on the sole or top part of the foot. On the sole they often “collect” as groups, underneath the thickened skin.

* May also present as large bullae (blisters). The vesicles eventually rupture. Upon drying, peeling occurs leaving a reddened base. This presentation resembles an allergic contact dermatitis.

* Can also be accompanied by infected nails and secondary bacterial infections.

TINEA UNGUIUM (Ringworm of the nails)
Infection of the nail plates of the fingers or toes is commonly caused by Trichophyton metagrophytes or Trichophyton rubrum.

The infection can be primary or secondary. Primary infections often develop following external injury to the nail. Secondary infections result from a “spread” of the infective organism from pre-existing skin infections of the hands/feet.
* As one gets older, the likelihood of nail infections increases.

* The toe nails more likely infected than the fingernails. The nail of the big toe is the most common site of infection.

* The nail becomes progressively opaque, yellow and thickened. Eventually the whole nail plate becomes infected and the nail starts to separate from the bed.

* In severe cases the nail has difficulty in re-growing as it is deformed and weakened and breaks or fragments easily.

TINEA BARBAE (Ringworm of the beard)
This conditions affects mainly men and involves the beard and moustache regions of the face. It is due to the invasion of the hair follicle by dermatophyte Trichomychosis.

It presents as pustular folliculitis with red, inflamed and painful papules, nodules or pustules. The hairs are “loose” and can be easily removed. Commonly found on the upper lip, it can in extreme cases, spread to the cheeks, eyelids, eyebrows and even the forehead. If these areas are involved, the presentation is completely different, usually showing a sharply marginated redness with fine scaling over the affected area.

TINEA FACIALIS (Ringworm of the face)
More common in children, the condition is often misdiagnosed because of its presentation. It usually affects the cheeks, chin, nose and upper lip and is characterized by a well defined red patch. It can be extremely itchy and often results in a scoured, bloody ruptured appearance. It can be accompanied by white/yellowish scaling. It normally starts in one or two small areas that centrally progress outwards. It can also be light (photo) sensitive.

TINEA CORPORIS (Ringworm of the body)
A superficial dermatophyte infection of the “smooth” skin of the body – trunk, neck and limbs - but excluding the feet, hands and groin. The main fungi responsible are Microsporum and Trichophyton.

Lesions start with “grouped” papules of papulovesicles, which gradually increase in number and size. Singular or multiple, sharply defined circular, semicircular or concentric “edges” occur, forming “rings”. These “rings” are usually very red. As the centre heals, the elevated surrounding edge continues to erupt in clusters of papules or papulovesicles. It continues to spread out and a concentric pattern forms.

Fine scaling and mild to severe itching that accompanies the condition, is often worse in the summer. Cooler weather breaks the cycle only to reoccur the following summer.

A condition that almost exclusively affects adult men in the groin and genital area. It is worse in Summer due to sweating. It can still occur in Winter if heavy, multi-layered clothing is worn. It can also be transmitted through sexual contact.

In the initial stages the condition presents as a red scaly patch within a flexural fold, i.e. groin. This spreads gradually from the flexural fold to the thigh and buttocks. The patch is marked by a narrow, raised, well-defined inflamed edge. Small vesicles or pustules may form within the area. As the “centre” heals, hyperpigmentation, which is temporary, develops. The spread of the circular, semicircular or concentric patches is even.

It can spread to the scrotum with severe localized itching.

Although Epidermophyton floccosum is the main cause of this condition, Trichophyton rubrum can also be responsible.

If Trichophyton rubrum is the cause the onset is usually considerably slower. The lesions associated with this type of infection can spread as far as the abdomen and the lower back. This form is extremely painful.

Seconday bacterial infections can also increase the severity of the condition.

Please click here to see Pityriasis.

It is commonly caused by the yeast, Candida albicans and less often by other yeast strains.

Candida albicans is a normal inhabitant of the gut, vaginal tract and the mouth. Certain predisposing factors such as obesity, pregnancy, diabetes, the taking of oral contraception, antibiotics or the application of topical steroids, heat or immune dysfunction, cause the yeast to colonize out of control.

The yeast usually only infects the outer layers of the skin, spreading under the outer layer and causing it to lift and peel. Accompanied generally by intense redness which leaves a bare, glistening surface. It colonizes in the body folds affecting the skin under the breasts, the genitals, nail plate, mouth, face and scalp, and between the toes or fingers.

In people who are immune compromised the condition can become systemic. Invasion of the blood vessels can occur with widespread infection of the gastro-intestinal tract, trunk and extremities. May also present as a secondary infection in conditions such as eczema.


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