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Pembimbing: dr.

Chadijah Rifai, SpKK

Callista Fernanda
112015139
Fungal Infections of the Skin
Dermatophytes
Tinea corporis, includes tinea gladiatorum and tinea faciei
Tinea capitis
Tinea cruris
Tinea pedis
Tinea unguium (onychomycosis)
Tinea manuum
Tinea barbae
Tinea incognito (caused by topical steroids)

Candida (yeast) and mold, which may cause onychomycosis or coexist in a dystrophic nail

Pityriasis versicolor (tinea versicolor) caused by Malassezia species

Uncommon fungal skin infections that involve other organs (e.g., blastomycosis,
sporotrichosis)
Infeksi Tinea
Infeksi oleh jamur (dermatofita) pada rambut, kuku,
stratum korneum
Dermatofita: Trichophyton, Microsporum,
Epidermophyton

Anak prepubertal: tinea corporis dan capitis


Dewasa: tinea cruris, pedis, unguium
Tinea Corporis (Kurap)
Tampak kemerahan, annular, bersisik, gatal, central
healing dengan tepi aktif
Lesi single/ multiple uk. 1-5 cm
PP: KOH, kultur, biopsi kulit PAS (Periodic Acid
Schiff)
Tinea Cruris
Pada remaja dan dewasa muda, laki >
Paha atas
PP: lampu wood (coral red fluorescence)
Tinea Pedis/ Atheles Foot
Kulit sela jari kaki, punggung dan telapak kaki
Akut: eritema, maserasi, vesikel yang nyeri
Kronik: bersisik, mengelupas, eritema
Eritema dengan hiperkeratosis: moccasin pattern
Tatalaksana
Topikal cream: terbinafine, butenafine
Oral antifungal: penyakit yang luas, gagal pengobatan
topikal, pasien immunocompromised
Tinea pedis kronik/ rekuren: tidak menggunakan
sepatu yang sempit, mengeringkan jari kaki setelah
mandi
Tinea Capitis
Anak-anak usia 3-9 th
Jenis:
Gray patch
Black dot: Trichophyton tonsurans (gatal, bersisik,
alopesia akibat rambut rusak)
Kerion : komplikasi scar dan kehilangan rambut
permanen
Pada anak disertai limfadenopati servikal dan
suboksipital
Kasus atipikal:
Pemeriksaan KOH untuk mencari spora jamur
Kultur dengan agar Sabouraud
Wood lamp kurang berguna karena T. Tonsurans tidak
berfluorescence
Tatalaksana
Antifungal sistemik: Terbinafine, fluconazole,
griseofulvin (kerion)
Obat topikal tidak dapat menembus batang rambut
Selenium sulfida (Selsun) 1% atau 2,5% / ketoconazole
2% shampoo pada 2 minggu pertama
Selama 2 minggu tidak boleh berbagi sisir, helm, topi,
bantal
Tinea Unguium (Onychomycosis)
Distrofi kuku pada remaja dan dewasa, biasa akibat
trauma
Bentuk:
Subungual distal: kuku tebal, rapuh, berubah warna
Subungual proximal: jarang, pada imunocompromised
PP: KOH, kultur, PAS
Tatalaksana
Pengobatan selama 3-6 bulan
Topikal: subungual proximal
Ciclopirox nail lacquer (Penlac) tingkat kesembuhan
rendah
Terbinafine, fluconazole oral
Differential Diagnosis of Tinea
Infections
Tinea corporis Tinea pedis
Annular psoriasis Contact dermatitis
Atopic dermatitis Foot eczema
Fixed drug eruption Juvenile plantar dermatosis
Lupus erythematosus Psoriasis
(subacute cutaneous)
Pityriasis rosea herald patch
Tinea capitis
Seborrheic dermatitis
Alopecia areata
Atopic dermatitis
Tinea cruris Psoriasis
Candidal intertrigo Seborrheic dermatitis
Erythrasma Trichotillomania
Psoriasis
Seborrheic dermatitis
Tinea Management
Do not use nystatin to treat any tinea infection because dermatophytes are resistant to
nystatin. (However, nystatin is often effective for cutaneous Candida infections.)

Do not use oral ketoconazole to treat any tinea infection because of the U.S. Food and
Drug Administration boxed warnings about hepatic toxicity and the availability of safer
agents.

Do not use griseofulvin to treat onychomycosis because terbinafine (Lamisil) is usually a


better option based on its tolerability, high cure rate, and low cost.

Do not use combination products such as betamethasone/ clotrimazole because they can
aggravate fungal infections.

Do not use topical clotrimazole or miconazole to treat tinea because topical butenafine
(Lotrimin) and terbinafine have better effectiveness and similar cost
Do not, in general, treat tinea capitis or onychomycosis without first
confirming the diagnosis with a potassium hydroxide preparation,
culture, or, for onychomycosis, a periodic acidSchiff stain. However,
kerion should be treated aggressively while awaiting test results, and it
may be reasonable to treat a child with typical lesions of tinea capitis
involving pruritus, scale, alopecia, and posterior auricular
lymphadenopathy without confirmatory testing. If there is no
lymphadenopathy, a confirmatory test is recommended.

Do not treat tinea capitis solely with topical agents, but do combine
oral therapy with sporicidal shampoos, such as selenium sulfide
(Selsun) or ketoconazole.

Do not perform potassium hydroxide preparations or cultures on


asymptomatic household members of children with tinea capitis, but
do consider empiric treatment with a sporicidal shampoo.
Pemeriksaan KOH
Diagnosa infeksi tinea
2 tetes KOH 10-20%
Melarutkan sel skuamosa, meninggalkan elemen
jamur yang utuh
Penutup
Perlunya diagnosa yang tepat untuk mendapatkan
terapi yang sesuai
Prognosis baik bila mendapat terapi yang tepat dan
adekuat serta menjaga kebersihan kulit