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Superficial Fungal Infections

»	What is a dermatophyte?
»	How are superficial fungal infections diagnosed?
»	On a KOH examination, hyphal-like structures arranged in a mosaic pattern are noted. Does this indicate the presence of a dermatophyte?
»	What are the three most commonly used culture media for the growth of dermatophytes?
»	Describe some of the presentations of superficial fungal infections caused by dermatophytes.
»	Which dermatophyte causes the most fungal infections of skin?
»	What is the most common cause of tinea capitis in the United States?
»	Name the four clinical patterns of tinea capitis.
»	What are the types of hair invasion in tinea capitis? What dermatophytes are associated with each type?
»	What is a Wood’s light? What organisms are detected by this exam?
»	How is tinea capitis treated?
»	What is meant by a carrier state in tinea capitis?
»	Name the three types of tinea pedis. Which dermatophyte is most commonly associated with each?
»	What nondermatophyte mold can cause mycotic infections that mimic moccasin-type tinea pedis?
»	What is a dermatophytid reaction?
»	Name and describe the four clinical presentations of onychomycosis.
»	Can other diseases mimic onychomycosis?
»	What is tinea versicolor?
»	How does Malassezia induce both hyperpigmentation and hypopigmentation in the skin?
»	How is tinea versicolor diagnosed? Why is it difficult to culture this organism?
»	Does Malassezia cause any other skin disease?
»	What is tinea nigra?
»	What is a Majocchi’s granuloma?
»	What is piedra?
»	Name the organism most commonly isolated from cutaneous candidiasis.
»	How do candidal infections present clinically?
»	What factors predispose to candidiasis?
»	Which diseases are associated with adult-onset chronic mucocutaneous candidiasis?
»	Name the different classes of oral antifungal agents and their mechanisms of action.
»	Which hepatic cytochrome is affected by itraconazole, ketoconazole, and fluconazole?
»	Which drugs should be used with caution when using ketoconazole, itraconazole, or fluconazole? Why?
»	Which drugs are contraindicated when using azole antifungal agents and why?
»	Which oral antifungal agents can lower cyclosporine levels?
»	Which drugs can affect antifungal drug levels?
»	Which antifungal drugs have a limited spectrum of activity in the treatment of superficial fungal infections?

Which drugs should be used with caution when using ketoconazole, itraconazole, or fluconazole? Why?

Warfarin, quinidine, digoxin, calcium channel blockers, bulsufan, HIV protease inhibitors, cyclosporine, angiotensin II inhibitors, tacrolimus, oral hypoglycemic agents, hydantoin anticonvulsants, and alcohol. These drugs should be used with caution, because the primary effect of azole antifungal drugs on hepatic enzyme metabolism is inhibition. This results in an elevation of the serum level of any drug that requires hepatic metabolism by the cytochrome P-450 3A4 enzyme in order to be removed.

Gupta AK, Ryder JE: The use of oral antifungal agents to treat onychomycosis, Dermatol Clin 21:469–479, 2003.