Mycoses can be classification as Superficial, Cutaneous, Subcutaneous or Deep. While the first 3 are discussed here, Deep Mycosis is discussed elsewhere.
Superficial & Cutaneous
Superficial is limited to the stratum corneum and elicit no inflammation, while cutaneous involves the integument and its appendages, including hair and nails. Cutaneous mycosis may involve the stratum corneum or deeper layers and inflammation is present.
1. Black piedra(Piedraia hortae) Rx: Terbinafine.
2. White piedra(Trichosporon beigelii) Trichosporosis, Rx: Itraconazole.
3. Tinea nigra(Phaeoannellomyces werneckii).
4. Pityriasis versicolor (Malassezia furfur) - Topical Rx:
- Topical Selenium (Shampoo)
- Ketoconazole (Fungicide / Fungizole cream & shampoo) for 2 wks.
- Ciclopirox (Batrafan cream)
- Clotrimazole (Candid / Surfaz cream)
- Miconazole (Zole cream)
- Terbinafine (Terbicip cream)
Oral Rx of Pit. versicolor:
- Ketoconazole: 200-mg daily for 10-day or 400-mg single-dose.
- Fluconazole: 150- to 300-mg weekly dose for 2-4 weeks.
- Itraconazole: 200 mg/d for 7 days.
- Pramiconazole and sertaconazole.
- Prophylactic: 1 tablet per month of ketoconazole, fluconazole, and itraconazole has been used successfully to prevent recurrences.
- SINGLE DOSE TRICK: The single-dose regimens, or pulse therapy regimes, can be made more effective by having the patient exercise 1-2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.
5. Tenia (Ringworm): The word Tinea means worm. Trichophyton, means "thread plant". Trichophyton, Microsporum and Epidermphyton. These are Molds. They are not normal flora of skin. Names according to location: Tinea capitis: Ringworm of the scalp, eyebrow and lashes. Tinea corporis: Ringworm of the body. Tinea cruris: Ringworm of the groin, perineum and perianal region. Tinea unguium: Ringworm of the nail. Tinea barbae: Ringworm of the beard. Tinea pedis: Ringworm of the feet. Tinea manuum: Ringworm of the hand. Acording to habitat: Zoophilic or "animal loving. cats, dogs, horses, cows, poultry are most common source of ringworm. E.g. Microsporum canis. remain alive for years in blankets, in clothing, bedding, combs and other grooming tools. Anthropophilic or "man loving. cannot be transferred to animals. Geophilic or "earth loving."
Tenia Rx: Terbinafine 250 mg/d for 1-2wks for skin, 250 mg/d for 3 months for nails. Itraconazole, 200 mg/d for 1-2wks for skin, 200 mg/d for 3 months for nails, or 200 mg b.d. for 1wk each month x 3 mths.
Subcutaneous
Infection of the subcutaneous tissues, usually at the point of traumatic inoculation. An inflammatory response develops in the subcutaneous tissue frequently with extension into the epidermis. Three general types:
- Chromoblastomycosis: Usually of the lower extremities. Histological examination - Cu pennies. No involvement of bone, tendon, or muscle.
- Mycetoma: Mycetoma is a chronic subcutaneous infection caused by actinomycetes or fungi. It is a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, and can extend to the underlying bone. Grains containing aggregates of organisms are discharged through multiple sinuses. Also named Madura foot (Mycetoma pedis). The infection is endemic in Africa, India and the Central and South Americas. Actinomycetoma & Eumycetoma: Mycetoma caused by microaerophilic actinomycetes is termed actinomycetoma. Actinomycetes, are considered as transitional forms between bacteria and fungi. Mycetoma caused by true fungi is called eumycetoma. Actinomyces is a genus of the actinobacteria class of bacteria. They are all Gram-positive. Mycetoma Rx: itraconazole. Voriconazole, treatment duration is 10 months. Voriconazole is the drug of choice for invasive infections caused by agents of eumycetoma. Actinomycetoma Rx: A combination of 2 drugs in 5-week cycles is used, Trimethoprim-sulfamethoxazole (TMP-SMZ), Dapsone, Streptomycin / Amikacin. Welsh Rx: The combination of amikacin with cotrimoxazole is known as the Welsh regimen. Adding rifampin to the Welsh regimen allows for remissions without recurrence.
- Sporotrichosis : Sporothrix schenckii, involves the subcutaneous tissue at the point of traumatic inoculation. The infection usually spreads along cutaneous lymphatic channels of the extremity involved. Can invade joints (in alcoholics), lungs (in COPD), & other deeper structures (in AIDS). Rx: Itraconazole 200mg/d until 2-4 wks after lesions. For pulmonary 200 mg bd for 1 yr.