| Introduction |
 Cutaneous fungal infections of the hand are rare and usually mild
- usually resolve spontaneously
- more common to have fungal infection in macerated skin areas (skin folds)
- May have serious infection in immunocompromised host
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| Classification |
- Infections divided into three categories
- cutaneous
- includes nail bed infections (onychomycosis)
- subcutaneous
- includes sporothrix schenckii from rose thorn prick
- deep
- orthopaedic manifestation
- tenosynovial
- septic arthritis
- osteomyelitis
- organisms include
- endemic
- coccidiomycosis
- histoplasmosis
- blastomycosis
- opportunistic include
- candidiasis
- mucormycosis
- cryptococcocis
- asperfillosisi
- requires surgical debridement
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| Onychomycosis (cutaneous) |
- Introduction
- defined as fungal infection in vicinity of nail bed (cutaneous)
- most common organisms are
- trichophyton rubrum
- a destructive nail plate infection
- candida
- chronic infection of nail fold
- Treatment
- topic antifungal treatment & nail bed removal
- indicated as a first line of treatment
- systemic griseofulvin or ketoconazole
- indicated in recalcitrant cases
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| Sporothrix schenckii (subcutaneous) |
- Introduction
- Sporothrix schenckii a common soil organism
- a subcutaneous infection
- rose thorn in classic mechanism of subcutaneous transmission
- Presentation
- exam will show local ulceration (papule) at site of penetration
- with time additional lesions form in region on lymphatic vessels
- may show proximal lymph node involvement
- Evaluation
- S schenckii isolated at room temperature on Sabouraud dextrose agar
- Treatment
- oral itraconazole for 3 to 6 months
- has replaced potassium iodide due to side effects which included
- thyroid dysfunction
- rash
- GI symptoms
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| Coccidiomycosis (deep) |
- Introduction
- found in southwest arid regions (e.g., new mexico)
- often a deep infection
- Presentation
- manifestations include
- subclinical pulmonary involvement
- orthopaedic manifestations
- synovitis
- arthritis
- periarticular osteomyelitis
- Treatment
- amphotericin B & surgical debridement
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| Histoplasmosis (deep) |
- Introduction
- histoplasma capsulatum infection
- found in Mississippi River Valleys and Ohio
- Presentation
- usually subclinical
- often found incidentally on CXR
- may present with tenosynovial infection
- Evaluation
- diagnosed by skin testing
- Treatment
- amphotericin B & surgical debridement / tenosynovectomy
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