Infecciones por dermatofitos
Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- lesiones descamativas en el cuero cabelludo
- alopecia en parches
- lesiones cutáneas descamativas eritematosas con zona central clara
- erupción eritematosa descamativa con pústulas foliculares en la barba o el bigote
- parches eritematosos anulares en el rostro
- vesículas y descamación de las manos
- agrietamiento, maceración y descamación en los espacios interdigitales del cuarto y quinto dedo del pie
- piel plantar hiperqueratótica descamativa en forma crónica con eritema de las plantas, los tobillos y los lados de los pies
- foliculitis con nódulos
Other diagnostic factors
- uña engrosada con hiperqueratosis subungueal, onicólisis y decoloración de blanco amarillenta a marrón
- parches pequeños blancos moteados en la superficie de la placa ungueal con resquebrajamiento de la uña
- linfadenopatía
- alopecia de puntos negros
- placa ungueal blanca lechosa
- área de leuconiquia en la placa ungueal proximal
Risk factors
- Exposición a personas, animales o suelo infectados
- exposición a fómites incluyendo sombreros, peines, cepillos de pelo y tapizados
- Uso crónico de corticosteroides tópicos u orales
- VIH
- Diabetes mellitus y otros trastornos metabólicos
- Prendas oclusivas
- Tiempo húmedo y caluroso
- obesidad
- Hiperhidrosis
- Uso frecuente de áreas de baños públicos con los pies descalzos
- Deformidades de los pies
- Traumatismo recurrente en la piel
- deportes de contacto
- Dermatitis atópica
- antecedentes familiares positivos
- enfermedad vascular periférica
Diagnostic investigations
1st investigations to order
- microscopía con hidróxido de potasio (KOH)
Investigations to consider
- dermatoscopia
- cultivo fúngico
- reacción en cadena de la polimerasa (PCR)
- examen con lámpara de Wood (luz ultravioleta)
Emerging tests
- microscopía confocal de reflectancia
Treatment algorithm
tiña de la cabeza
tiña de la barba, tiña de la mano o granuloma de Majocchi
tiña facial, tiña corporal, tiña crural o tiña del pie
tiña ungueal (onicomicosis)
Contributors
Authors
Antonella Tosti, MD
Professor of Clinical Dermatology
Dermatology and Cutaneous Surgery
University of Miami Health System
FL
Disclosures
AT received honorarium and travel reimbursement from Valeant, PharmaDerm, and Polichem, is on the speaker bureau for PharmaDerm, and is a consultant for Erchonia Laser and Almirall.
Acknowledgements
Dr Antonella Tosti would like to gratefully acknowledge Dr Keira L. Barr and Dr Barry L. Hainer, the previous contributors to this topic.
Disclosures
KLB declares that she has no competing interests. BLH is on the speaker bureaus for the vaccine programmes of Merck and Sanofi-Pasteur pharmaceutical companies.
Peer reviewers
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NY
Disclosures
NS declares that she has no competing interests.
Christina M. Gelbard, MD
Department of Dermatology
UT Dermatology
Health Science Center of Houston
Houston
TX
Disclosures
CMG declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Ameen M, Lear JT, Madan V, et al. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014 Nov;171(5):937-58.Full text Abstract
Fuller LC, Barton RC, Mohd Mustapa MF, et al. British Association of Dermatologists’ guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014 Sep;171(3):454-63.Full text Abstract
Foley K, Gupta AK, Versteeg S, et al. Topical and device-based treatments for fungal infections of the toenails. Cochrane Database Syst Rev. 2020 Jan 16;(1):CD012093.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dermatitis atópica
- Dermatitis dishidrótica
- Liquen simple crónico
More DifferentialsGuidelines
- Tinea capitis
- Antifungal agents for common outpatient paediatric infections
More GuidelinesPatient information
Infecciones por hongos en las uñas
Pie de atleta
More Patient information
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