Fungal Skin Infections (Dermatophyte Infections, Candidiasis, and Tinea Versicolor)

Fungal Skin Infections (Dermatophyte Infections, Candidiasis, and Tinea Versicolor) is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Superficial fungal infections of the skin, hair, and nails are characterized by erythema, scaling, pruritus, and change in coloration.

Epidemiology

  • Dermatophyte infections:
    • Tinea capitis:
      • Most common fungal infection in pediatric population
      • Occurs mainly in prepubescent children (between ages 3 and 7 years)
      • Asymptomatic carriers are common and contribute to spread.
    • Tinea corporis usually seen in younger children or in young adolescents with close physical contact to others (i.e., wrestlers).
    • Onychomycosis: Overall prevalence is 0–2.6% in children, often occurs with concomitant tinea pedis, or in 1st-degree relatives with infection.
  • Candidiasis: majority of infants colonized with Candida albicans
  • Tinea versicolor: seen in adolescents and young adults

General Prevention

  • Measures should be taken to avoid transmission between hosts, including no sharing of combs, brushes, hats, etc.
  • Hair utensils and hats should be washed in hot, soapy water at onset of therapy.
  • Pets should be watched and treated early for any suspicious lesions.
  • In patients in whom appropriate therapy has not led to improvement in symptoms, siblings and close contacts should be examined and fungal cultures performed.
  • Isolation of hospitalized patient is unnecessary.

Pathophysiology

  • Fungal elements (arthroconidia) adhere to stratum corneum or hair shaft. Proteases work to degrade keratin, which allows for invasion of dermatophytes.
  • Predisposing factors may include moisture, macerated skin, and immunocompromised.
  • Host immune response is usually able to contain infection.
  • Inflammatory response is variable; highly inflammatory forms may lead to pustular lesions and kerion (large inflammatory mass) formation.

Etiology

  • Varies by geographic region
  • Dermatophyte infections:
    • Tinea capitis: >90% caused by Trichophyton tonsurans in North America—spread from human to human (anthropophilic); increasing incidence of Microsporum canis infection spread from animals such as cats and dogs to humans (zoophilic)
    • Tinea corporis: preadolescent children: M. canis, Microsporum audouinii; older children: Trichophyton rubrum, Trichophyton mentagrophytes, T. tonsurans
    • Onychomycosis: T. rubrum, T. mentagrophytes
  • Candidiasis: usually C. albicans
  • Tinea versicolor: Malassezia furfur

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Basics

Description

Superficial fungal infections of the skin, hair, and nails are characterized by erythema, scaling, pruritus, and change in coloration.

Epidemiology

  • Dermatophyte infections:
    • Tinea capitis:
      • Most common fungal infection in pediatric population
      • Occurs mainly in prepubescent children (between ages 3 and 7 years)
      • Asymptomatic carriers are common and contribute to spread.
    • Tinea corporis usually seen in younger children or in young adolescents with close physical contact to others (i.e., wrestlers).
    • Onychomycosis: Overall prevalence is 0–2.6% in children, often occurs with concomitant tinea pedis, or in 1st-degree relatives with infection.
  • Candidiasis: majority of infants colonized with Candida albicans
  • Tinea versicolor: seen in adolescents and young adults

General Prevention

  • Measures should be taken to avoid transmission between hosts, including no sharing of combs, brushes, hats, etc.
  • Hair utensils and hats should be washed in hot, soapy water at onset of therapy.
  • Pets should be watched and treated early for any suspicious lesions.
  • In patients in whom appropriate therapy has not led to improvement in symptoms, siblings and close contacts should be examined and fungal cultures performed.
  • Isolation of hospitalized patient is unnecessary.

Pathophysiology

  • Fungal elements (arthroconidia) adhere to stratum corneum or hair shaft. Proteases work to degrade keratin, which allows for invasion of dermatophytes.
  • Predisposing factors may include moisture, macerated skin, and immunocompromised.
  • Host immune response is usually able to contain infection.
  • Inflammatory response is variable; highly inflammatory forms may lead to pustular lesions and kerion (large inflammatory mass) formation.

Etiology

  • Varies by geographic region
  • Dermatophyte infections:
    • Tinea capitis: >90% caused by Trichophyton tonsurans in North America—spread from human to human (anthropophilic); increasing incidence of Microsporum canis infection spread from animals such as cats and dogs to humans (zoophilic)
    • Tinea corporis: preadolescent children: M. canis, Microsporum audouinii; older children: Trichophyton rubrum, Trichophyton mentagrophytes, T. tonsurans
    • Onychomycosis: T. rubrum, T. mentagrophytes
  • Candidiasis: usually C. albicans
  • Tinea versicolor: Malassezia furfur

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