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Chapter 21. Dermatophytosis

Distribution

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Fig. 21-1

Scaly lesions of tinea capitis.


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Fig. 21-2

Alopecia with scales.


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Fig. 21-3

Alopecia with large erythematous plaque and widespread macules and papules (id reaction).


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Fig. 21-4

Papules and plaques in figurate arrangement.


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Fig. 21-5

Plaque with annular border showing scales.


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Fig. 21-6

Papules and plaques with ill-defined borders on the forehead, nose, and cheeks.


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Fig. 21-7

Erythematous scaly papules and nummular plaques.


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Fig. 21-8

Erythematous scaly circinate plaques.


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Fig. 21-9

Arciform scaly plaques.


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Fig. 21-10

Scaly palms.


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Fig. 21-11

Erythematous scaly plaque with scalloped border.


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Fig. 21-12

Erythematous scaly papules and plaques, some of them with arcuate and polycyclic outlines.


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Fig. 21-13

Patches with many papules near and at the border.


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Fig. 21-14

Annular scaly plaque.


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Fig. 21-15

Infundibular papules and pustules surrounded by erythema, the scaly periphery being scalloped (Majocchi’s granuloma).


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Fig. 21-16

Maceration and scales, some of them in the form of a collarette.


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Fig. 21-17

Thickened yellow nail plate with a ragged distal margin.


Configuration

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Fig. 21-18

Erythematous scaly papules arranged in an annulus.


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Fig. 21-19

Papules and vesicles covered by scales and crusts, all of which combined have created a serpiginous outline.


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Fig. 21-20

Labyrinthine arrangement of scaly papules.


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Fig. 21-21

Scaly plaques in a pattern of concentric rings.


Individual Lesions

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Fig. 21-22

Erythematous plaque topped by pustules.


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Fig. 21-23

Crowded erythematous papules and pustules in nummular shape on the side of the face; nodules on the jawline and chin.


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Fig. 21-24

Large erythematous nummular plaque surmounted by innumerable pustules.


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Fig. 21-25

Papules and pustules on and within a circle.


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Fig. 21-26

Plaque with figurate outline and an elevated border composed of papules, pustules, and crusts.


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Fig. 21-27

Infundibulocentric scaly papules, some of them eroded, with diffuse hyperpigmentation (Majocchi’s granuloma).


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Fig. 21-28

Partially alopecic erythematous tumor with a papillated surface (kerion).


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Fig. 21-29

Patch of alopecia with scales.


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Fig. 21-30

Plaque with draining sinuses and crusts (kerion).


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Fig. 21-31

Closely-set nodules, pustules, and draining sinuses in a boggy mass (kerion).


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Fig. 21-32

Tense vesicles and vesiculopustules, some of them grouped.


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Fig. 21-33

Vesicles, a tense bulla, and scale-crusts.


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Fig. 21-34

Vesicles and pustules.


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Fig. 21-35

Scaly erythematous plaque with sharply defined scalloped borders (moccasin distribution).


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Fig. 21-36

Wedge-shaped onycholysis and subungual hyperkeratosis (distaltype of onychomycosis).


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Fig. 21-37

Chalky white discoloration of the distal nail plate.


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Fig. 21-38

Yellow-white discoloration of the distal two-thirds of the nail plate and subungual hyperkeratosis.


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Fig. 21-39

Severely dystrophic nails and scales in foci on volar skin.


New! Additional Images

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Fig. 21-40

Large somewhat annular plaques with scale-crust at their margin indicate likelihood of immunosuppression. A pink papule at the jaw line is an early lesion. Pigmented papules are Miescher’s nevi.


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Fig. 21-41

All of the lesions shown here, namely, papules, nodules, erosions, and ulcers, are secondary to suppurative infundibulitis induced by a dermatophyte, i.e., “sycosis barbae.”


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Fig. 21-42 A

Papules have become confluent to form ill-defined plaques whose border is scalloped.


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Fig. 21-42 B

Papules have become confluent to form ill-defined plaques whose border is scalloped.


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Fig. 21-43

The annular plaque is covered by scale-crusts. As the lesion advanced outward, a “zone of clearing” was left in the center.


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Fig. 21-44

The remarkable figurate pattern came into being by virtue of the peculiar growth of the fungus responsible for it.


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Fig. 21-45

Nummular scaly plaque. Note that the border of the lesion is slightly scalloped.


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Fig. 21-46

The figurate pattern produced by a fungus is accentuated by scale on the inner aspect of arc-like ridges.


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Fig. 21-47

The bizarre-shaped plaque is made up largely of numerous scaly, crusted papules. Note “zones of clearing” in some loci.


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Fig. 21-48

The arciform plaques have a raised border. Scattered hemorrhagic crusts are secondary to excoriation. Signs of onychomycosis also are apparent.


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Fig. 21-49

This scaly palm, whose flexural folds are accentuated by the disease, is accompanied by signs ofonychomycosis.


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Fig. 21-50

Tinea manum typified by diffuse redness and by accentuation of scaliness in flexural creases. Collarettes of scale are a sure sign of loss of a cap of parakeratosis above a focus of spongiosis.


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Fig. 21-51

The constellation of destruction of the distal part of the nail plate, onycholysis, and subungual keratosis are evidences of onychomycosis.


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Fig. 21-52

Papules and plaques, some with accentuation of skin markings (lichen simplex chronicus), are those of dermatophytosis, the clue being papules in arcuate and serpiginous array and infundibulocentricity (Majocchi’s granuloma).


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Fig. 21-53

The moccasin distribution of a plaque covered by ichthy osiform scale is one of many manifestations of dermatophytosis. The fissure, a crack in the hyperkeratotic surface, extends to the papillary dermis.


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Fig. 21-54

The serrated appearance of the distal end of the nail and the subungual keratosis are evidences of onychomycosis.


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Fig. 21-55 A

This nummular patch of alopecia covered by furfuraceous scale resulted from an infection of stratum corneum and hair shafts by a fungus.


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Fig. 21-55 B

This nummular patch of alopecia covered by furfuraceous scale resulted from an infection of stratum corneum and hair shafts by a fungus.


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Fig. 21-56

Nummular scaly patches of alopecia are an expression of an infection by a fungus.


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Fig. 21-57 A

Annular, arcuate, and polycyclic scaly lesions are typical of one manifestation of fungal infection. A child such as this one with widespread lesions could be immunosuppressed, but need not be.


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Fig. 21-57 B

Annular, arcuate, and polycyclic scaly lesions are typical of one manifestation of fungal infection. A child such as this one with widespread lesions could be immunosuppressed, but need not be.


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Fig. 21-58

Kerion with secondary cellulitis, the former being an exuberant response to dermatophytosis and the latter a complication by gram positive bacteria.


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Fig. 21-59

Majocchi’s granuloma, a suppurative infundibulitis consequent to infection of hair shaft and inner sheath by dermatophytes.