Paediatrics: Fungal skin infections

Fungal skin infections

Dermatophyte infection

Tinea corporis (ringworm)

Annular scaly lesion. Central clearing and sharp edge on trunk, face, or limbs.

Investigation 

Skin scrapings for microscopy and culture.

Treatment 

Topical antifungals, e.g. an imidazole cream, terbinafine cream.

Tinea capitus (scalp ringworm)

Red, scaling scalp lesions with hair loss and short hair stumps. May pres-ent as tender erythematous patch with pustules (kerion). Investigation as for Tinea corporis. Skin lesions appear fluorescent green under Wood’s light.

Investigation 

Skin scrapings and hair pull for microscopy and culture.

Treatment 

Topical antifungal shampoo for one week and 6–8wks oral gri-seofulvin 20mg/kg/day (plus oral steroids if kerion exists).

Tinea pedis (athlete’s foot)

Itchy, irritable skin between the toes +/– sole of foot.

Treatment 

Topical antifungal.

Tinea unguium (onychomycosis)

Nail infection causes discoloured, friable, and deformed nails.

Investigation 

Microscopy and culture of nail clippings.

Treatment 

Oral antifungal for 3mths (e.g. terbinafine).

Candida albicans infection

Predisposing factors

·  Moist body folds.

·  Treatment with broad-spectrum antibiotics.

·  Immunosuppression.

·  Diabetes mellitus.

Variants 

Variants include the following:

·  Cutaneous candidiasis (e.g. napkin rash; see b Plate 12). Macular erythema, slight scaling, small outlying ‘satellite’ lesions, in body folds.

·  Chronic paronychia.

·  Chronic mucocutaneous granulomatous candidiasis (s to congenital immunodeficiency disorder).

Investigations 

Skin scrapings for microscopy and culture.

Treatment 

Oral or topical anti-candidal drugs, e.g. nystatin, fluconazole.

Pityriasis versicolor (Tinea versicolor)

Malassezia infection in post-pubertal children. Asymptomatic hypo/hyper-pigmented macules and scaling on trunk/upper limbs.

Treatment 

Topical imidazole foaming lotion for 3 consecutive nights.