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Fungal Infections of Skin                            
Balanitis (Genital Infection)
Candidal Infections
H
erpesZozter
Warts
Fungal Infections of Skin

Fungal infection is also called dad i.e. ring worm infection.

The fungal infection of body may be of following types:
Tinea capitis
Tinea barbae
Tinea corporis
Tinea cruris
Tinea pedis
Tinea manuum (palmaris)
Tinea unguium (onychomycosis)
Tinea faciei
Tinea incognito (steroid-modified tinea)

 

 TINEA CAPITIS: I.E. FUNGUS INVOLVING HEAD & SCALP

Clinical Features:
Non-inflammatory type of tinea capitis:
 Inflammatory type of tinea capitis:
 “Black dot” tinea capitis :
 Favus :

THERAPY

Oral antibiotics & various oral antifungal including newer antifungals are very effective.
Oral corticosteroids

Tinea Barbae

CLINICAL MANIFESTATIONS
Inflammatory type :
The superficial or sycosiform type :
Circinate or spreading type :
 
Atypical forms

Laboratory investigations  for fungus infection;

 1. KOH examination of scales.
 
2. Examination of the blister roof.
 
3.Cultures on Sabouraud’s media with cycloheximide and chloramphenicol.
 
4. Gram’s stain and bacterial culture.
 
5. Wood’s lamp examination.
 
6. Biopsy.

                                                                      CANDIDIASIS  

This is also kind of fungus which commonly involves various body parts.  The various fungi involved are as follows: 

C. parapsilosis
C. tropicalis
C. stellatoides
C. guilliermondi
C. (Torulopsis) glabrate
C. krusei
C. zeylanoides
C. viswanathi
C. lusitaniae

 

CAUSES OF RESISTANT OR RECUURENT CANDIDIASIS

Mechanical factors:

Trauma (burns, abrasions, etc.), local occlusion, moisture and/or maceration (dentures, occlusive garments, obesity)

Nutritional factors:

Avitaminosis, iron deficiency (chronic mucocutaneous candidiasis), generalized malnutrition

Physiologic alteration:

extremes of age, pregnancy, menses

Systemic illnesses:

Down’s syndrome, acrodermatitis enteropathica, diabetes mellitus and certain other endocrinopathies (Cushing’s syndrome, hypoadrenalism, hypothyroidism, hypoparathyroidism), uremiaMalignancy (especially hematologic, thymoma)

Intrinsic immunodeficiency states:

Digeorge’s syndrome, Nezelof’s syndrome, severe combined immunodeficiency syndrome, myeloperoxidase  deficiency, chediak—Higashi syndrome, hyperimmunoglobulinemia E syndrome, chronic granulomatous disease

CLINICAL FEATURES

Candidiasis can be broadly classified into:

1 Cutaneous Candidiasis
Diaper dermatitis
Canidal paronychia
Candidal miliaria
Generalised cutaneous candidiasis
Congenital and neonatal candidiasis
Disseminated candidiasis with cutaneous manifestations 

2 Mucosal Candidiasis
Acute pseudomembranous candidiasis or thrush
Acute atrophic candidiasis
Chronic atrophic candidiasis
Candidal cheilosis or perleche
Chronic hyperplastic candidiasis or candidal leukoplakia
Vulvovaginal candidiasis
Balanitis or balanoposthitis

3 Chronic mucocutaneous  candidiasis

4 Tinea Versicolor (Pityriasis versicolor)

 

DIAGNOSIS OF CAUSE of fungal infection/ candidiasis problem 

First step in proper treatment of fungal infection/ candidiasis is accurate diagnosis of cause of this problem. So we first try to find out cause. We take detailed history, thorough nutritional counselling, physical examination, and examination of hormonal system. After that depending on likelihood of particular, cause relevant tests are done. At our centre we have the facility for all the diagnostic tests needed for the diagnosis of the cause of fungal infection/ candidiasis problems,. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.  

DETAILED HISTORY

Onset: Sudden/gradual, Primary or Secondary,  Response to previous therapy, Stress (physical or mental), H/O precipitation by some drugs, HT,  trauma, Hypothyroidism / Hyperthyroidism . 

INVESTIGATIONS i.e. DIAGNOSTIC TESTS

At our centre we have all the facility for complete investigation of cause of fungal infection/ candidiasis & other  problems. So we perform following tests, step by step depending on their need based on history & examination. 

LABORATORY INVESTIGATIONS

The various diagnostic tests needed/performed are as follows: - Blood glucose & other systemic test as test for kidney, liver etc. done.

Direct microscopy
Culture
Trichophytin test
Wood’s lamp examination
KOH mounts
KOH examination

Direct microscopic examination of skin scrapings will reveal budding years with hyphae or pseudohyphae. Isolated yeasts can be cultured on sabouraud’s agar with added antibiotics.

In systemic candidiasis, the diagnosis can usually be made from histopathologic examination and culture of appropriate skin biopsy specimens. In addition, blood culture and serological studies using immuno-diffusion, counter-immunoelectrophoresis and latex agglutination methods may be helpful.

TREATMENT OF FUNGAL INFECTION/ CANDIDIASIS

After diagnosing the cause of fungal infection/ candidiasis we prescribe medicines. The success of various drugs we use in fungal infection/ candidiasis problems depends on accurate diagnosis of cause. If empirical treatment is prescribed as most doctors do, it often does not achieves permanent cure. These fungal infection/ candidiasis tonics & ayurvedic medicines can improve your fungal infection/ candidiasis problem temporarily but they cannot give permanent cure.

We provide specific treatment for Recurrent fungal infection/ candidiasis.

Similarly Permanent cure provided for Resistant fungal infection/ candidiasis.

We also give certain Newer treatments in very Difficult cases.

Our treatment also takes care of Scars left over of previous fungal infection/ candidiasis.

The various treatment provide are:
 antimicrobial agents

TREATMENT

topical agent
ultraviolet therapy or PUVA treatment
Topical Agents
Selenium sulphide
Zinc pyrithione,
 
sodium hyposulphite
 
Keratolytic creams,
Broad spectrum antifungals
 
Retinoic acid
Propylene glycol
Oral Therapy
Griseofulvin
ketoconazole,
 
itraconazole,

Oral Antifungals :
Griseofulvin.
Ketoconazole, itraconazole and fluconazole.
Amphotericin B (polyene antibiotic).
Flucytosine.
Terbinafine

Toppical antifungals :
Azole compounds
 
Imidazoles (miconazole, clotrimazole, ketoconazole and econazole).
Newer imidazoles (bifonazole, oxiconazole, tioconazole and sulconazole triazole (teconazole).
Tolnafate.
Ciclopirox olamine.
Whitfield’s ointment.
Halogenated quinolinols (Clioquinol and iodoquinol).
 
Haloprogin (iodinated trichlorophenol).
 
Polyene antibiotics (nystatin).
Crystal gentian violet.
Castellani’s paint.
Potassium iodide.
 
Undecylenic acid.
 
Natamycin. Selenium sulphide shampoo.
Sodium thiosulphate solution.
Zinc pyrithione.
Allylamines (naftifine and terbinafine.)
Antibiotics
Some times steroid need to be given
Surgical treatment

Response of Treatment: As we have fully dedicated team of highly qualified, experienced, doctors, who are expert in field of fungal infection/ candidiasis treatment, Response to treatment is very good. After finding the cause of fungal infection/ candidiasis by above tests it is cured in most patients in three months. Fungal infection/ candidiasis is cured in many cases after correct diagnosis & treatment.

                                                                BALANITIS

Balanitis  i.e. infection of male genitalia specially glans pennis.
Definition:

Balantis: It is infection of glans pennis
Balanoposthitis: It is infection of the foreskin and surface of the underlying glans pennis. Frequently occurs due to infection or chemical irritation .

Aetiology and pathophysiology 
simple intertrigo like infection
Candidal infection due to fungus
genitaltransmission of various kinds of infection.

  DIAGNOSIS OF CAUSE OF BALANITIS PROBLEM  

First step in proper treatment of balanitis is accurate diagnosis of cause of this problem. So we first try to find out cause. We take detailed history, thorough nutritional counseling, physical examination, and examination of hormonal system. After that depending on likelihood of particular, cause relevant tests are done. At our centre we have the facility for all the diagnostic tests needed for the diagnosis of the cause of balanitis problems,. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.  

     INVESTIGATIONS i.e. DIAGNOSTIC TESTS

At our centre we have all the facility for complete investigation of cause of balanitis & other  problems. So we perform following tests, step by step depending on their need based on history & examination. 
The various diagnostic tests needed/performed are as follows:
Investigations:blood sugar, culture, urine tests,& other test.  
Blood glucose & other systemic test as test for kidney, liver etc. done. 

    TREATMENT OF BALANITIS

 

After diagnosing the cause of balanitis we prescribe medicines. The success of various drugs we use in balanitis problems depends on accurate diagnosis of cause. If empirical treatment is prescribed as most doctors do, it often does not achieves permanent cure.

 

We provide specific treatment for Recurrent balanitis.

Similarly Permanent cure provided for Resistant balanitis.

We also give certain Newer treatments in very Difficult cases.
oral therapy
Antifungals as miconazole, fluconazole & others
antibiotics to cure infection

 

Response of Treatment: As we have fully dedicated team of highly qualified, experienced, doctors, who are expert in field of balanitis treatment response of treatment is very good. After finding the cause of balanitis by above tests it is cured in most patients in three months treatment.

Balanitis is cured in many cases after correct diagnosis & treatment.

                                                                        HERPES ZOSTER

This is a varicella zoster virus infection involving different parts of body.
It may present as:
Disseminated herpes zoster
Herpes zoster with aberrant vesicles
Zoster sine herpete
Ramasay Hunt syndrome, 

Complications of Herpes Zoster  
It may leave depressed hypopigmented or hyperpigmented scars
Post-herpetic neuralgia
Post-herpetic anaesthesia
Disseminated zoster
Recurrent zoster
Involvement of motor neurones
Ocular complications
Other complications
Various granulomatous lesions

LABORATORY tests in Herpese Zoster 
Tzanck smears
Electron microscopic examination
Identification of varicella zoster virus antigens
 
Isolation of varicella zoster virus
Complement fixation (CE) test:
Indirect immunofluorescence antibody
varicella zoster virus neutralization test
Other sensitive and specific tests

TREATMENT
Topical preparations
Systemic drugs
Acyclovir
Vidarabine
Zoster immune globulin
Ribavirin
BVDU
Amantadine
Fancyclovir
Valcyclovir

Treatment of Post-herpetic Neuralgia: Many times pain in that particular area persists even after the disappearance of lesion
NSAIDS
AMITRIPTYLINE
Carbamazepine
Gabapentine
Membrane stabilizing drugs
Antioxidants
methycobalamine
capsaicin

                                                         WARTS

The warts can be of following types:
Common Warts
Plantar Warts
Plane warts
Condyloma Acuminata
Filiform and Digitate Warts
Myrmecia or ant hill Warts
Mosaic plantar warts 
Keratosis punctata-likelesions

LABORATORY DIAGNOSIS

Detection of HPV Particles in Clinical Lesions Electron microscopy
Polymerase chain reaction
DNA hybridization techniques
Immunological methods (ELISA)

TREATMENT
Topical applications
Cytotoxics such as podophyllin, 5-FU and can-tharidin 
Surgical and Physical Methods
Cryotherapy
Curettage 
Electrodesiccation 
Blunt dissection
Excision
Carbon dioxide laser
Photodynamic inactivation3
Imiquinod Cream 5%
Therapeutic Immunomodulation


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We provide treatment for :  Recurrent Infection Specialist Dermatologist Delhi Treatment Cure Skin Permanent Scar Pigmented Spot Allopathic Alopathic Ayurvedic Local New Noida Best Qualified Indian East West North South Central Gurgaon Faridabad Ghaziabad hormone therapy  is one of the very remarkable advancement in the last 5 years.

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