1. Thursday, January 19, 2012

2. SUPERFICIAL MYCOSES
Thursday, January 19, 2012

3. WHAT ARE SUPERFICIAL
MYCOSES?
Superficial mycoses are cosmetic fungal infections of the skin
or shaft
No living tissue is invaded
No cellular response from the host
No pathological changes elicited
These infections are often so innocuous that patients are often
unaware of their condition.
Thursday, January 19, 2012

4. TINEA VERSICOLOR
(Pityriasis versicolor)
Malassezia furfur: commonly known
as “an-an”
Direct microscopic examination of
alkali stain (KOH or PAS) treated
with skin scrapings: “spaghetti and
meatballs”
CONFIRMATION: cultures are not
routinely done
ORGANISMS: lipophilic =
requires fatty acid-supplemented http://missinglink.ucsf.edu
Thursday, January 19, 2012

5. TINEA VERSICOLOR
(Pityriasis versicolor)
Lesions occur most frequently on
the upper torso, arms, and
abdomen as discrete hyper – or
hypopigmented macular lesions.
They scale very easily, giving the
affected area a dry, or chalky
appearance.
Sometimes, lesions appeared to be
elevated and folliculitis may occur http://
if hair follicles were involved. dermimages.med.jhmi.edu
Thursday, January 19, 2012

6. TREATMENT
1% selenium sulfide
applied every other
day for 15 minutes
and then washed off
Thursday, January 19, 2012

7. TINEA NIGRA
(Exophiala werneckii)
usually asymptomatic and consist
of well demarcated macular
lesions (discolored spots on the
skin that are not raised above the
surface) that enlarge by peripheral
extension
brown to black lesions = often
seen at the sole of the foot or at the
palmar surface of the hand (other
body areas may also be affected)
Thursday, January 19, 2012

8. TINEA NIGRA
(Exophiala werneckii)
Diagnosis: darkly pigmented
yeast like cells and hyphal
fragments in microscopic
examination of KOH tested
scrapings taken from affected
area
confirmatory test is made
by culture
Thursday, January 19, 2012

9. TREATMENT
undecyclenic acid
keratolytic agent
Whitfield’s ointment
(daily)
Tincture of iodine, 2%
salicylic acid or 3%
sulfur
Thursday, January 19, 2012

10. WHITE PIEDRA
(Trichosporon beigelii)
soft, white to light
brown nodules
form on axillary,
pubic, beard and
scalp hair
relapse common
Thursday, January 19, 2012

11. WHITE PIEDRA
(Trichosporon beigelii)
hyaline septate hyphae that
fragment into oval or
rectangular arthroconida
blastospores can also occur
at one or more points on the
arthrospores
Thursday, January 19, 2012

12. TREATMENT & DIAGNOSIS
DIAGNOSIS
direct microscopic exam of hairs
culture: asexual phase of the fungus
TREATMENT
shaving or cutting the infected hair
Topical fungicides: bichloride of mercury
(1:200)
Benzoic and salicylic acid combinations
3% sulfur ointments
Thursday, January 19, 2012

13. BLACK PIEDRA
(Piedraia hortae)
hard black nodules formed
around the scalp hair
(carbonaceous; can house an
asci)
thick-walled closely septate
hyphe, with chlamydoconidia
growth is dimorphic – hyphae
arthroconidia, and
blastoconidia.
Thursday, January 19, 2012

14. DIAGNOSIS & TREATMENT
DIAGNOSIS:
direct microscopic examination of
affected hair
culture: Saborauds dextrose agar
TREATMENT
therapy: shaving and cutting the infected
hair
topical fungicides, bichloride of mercury
Benzoic acid/salicylic acid combinations
Thursday, January 19, 2012

15. BLACK VERSUS WHITE
CHARACTERISTIC BLACK PIEDRA WHITE PIEDRA
Etiology Piedraia hortae Trichosporon beigelii
Over and around the
On the surface of the
hair shaft , hard,
Nodules hair shaft, softer, easy to
difficult to detach from
separate from hair
the hair
Tightly packed
Arthrospores and
Direct Examinations dichotomous branched
blastopores can be seen
hyphae
Presence of asci Positive Negative
Thursday, January 19, 2012

16. CUTANEOUS MYCOSES
Thursday, January 19, 2012

17. CUTANEOUS MYCOSES :
DERMATOPHYTES
superficial fungal infections of the skin, hair and nails
may stimulate immune response
no living tissues are involved = generally restricted to
the keratinized layers of the integument and its
appendages
NOTE: a variety of pathological changes may occur in
the host because of the presence of infectious agent and
its metabolic product
Thursday, January 19, 2012

18. CLASSIFICATION OF
DERMATOPHYTES
Thursday, January 19, 2012

19. REPRESENTATIVE
DERMATOPHYTES
Thursday, January 19, 2012

20. CLINICAL FEATURES OF
DERMATOPHYTE INFECTIONS
FUNGI MOST
CLINICAL
SKIN DISEASE LOCATION OF LESIONS FREQUENTLY
APPEARANCE
RESPONSIBLE
clinical patches with
advancing red, Microsporum canis,
TINEA CORPORIS
Non-hairy smooth skin vesiculated border and Trichophyton
(ringworm)
central scaling = mentagrophytes
pruritic
acute: itching, red
T. rubrum
interdigital spaces on vesicular
TINEA PEDIS T. mentagrophytes
feet of persons wearing
(athlete’s foot) Epidermophyton
shoes chronic: itching,
floccosum
scaling, fissures
erythematousnscaling T. rubrum
TINEA CRURIS (jock
groin lesion in intertriginous T. mentagrophytes
itch)
areas = pruritic E. floccosum
Thursday, January 19, 2012

21. CLINICAL FEATURES OF
DERMATOPHYTE INFECTIONS
FUNGI MOST FREQUENTLY
SKIN DISEASE LOCATION OF LESIONS CLINICAL APPEARANCE
RESPONSIBLE
scalp hair
circular bald patches
ENDOTHRIX: fungus with short hair stubs or
M. canis
TINEA CAPITIS inside hair shaft broken hair within hair
T. tonsurans
follicles = Mircosporum-
EXOTHRIX: fungus on infected hair fluoresce
surface of hair
edematous, T. rubrum
TINEA BARBAE beard hair
erythematous lesion T. mentagrophytes
nails thickened or
crumbling distally, T. rubrum
TINEA UNGUIUM
nail discolored = usally T. mentagrophytes
(onychomycosis)
associated with Tinea E. floccosum
pedis
Thursday, January 19, 2012

22. TINEA CAPITIS
(ringworm of the scalp)
Thursday, January 19, 2012

23. TINEA BARBAE
Thursday, January 19, 2012

24. TINEA CORPORIS
(ringworm)
Thursday, January 19, 2012

25. TINEA CRURIS
(jock itch)
Thursday, January 19, 2012

26. TINEA PEDIS
(athlete’s foot))
Thursday, January 19, 2012

27. TINEA MANUUM
Thursday, January 19, 2012

28. TINEA UNGUIUM
(onychomycosis)
Thursday, January 19, 2012

29. Microsporum audoinii
Tinea capitis = intercalary
chlamydoconidium
Thursday, January 19, 2012

30. Microsporum canis
Tinea capitis, corporis and barbae =
pyriform shaped conidia
Thursday, January 19, 2012

31. Microsporum cookei
saprophytic = may be found in animal hairs
(dogs and rodents)
Thursday, January 19, 2012

32. Microsporum ferrugineum
Tinea capitis, corporis = bamboo-shaped
hyphae
Thursday, January 19, 2012

33. Microsporum gypseum
Tinea capitis, corporis, favosa = ellipsoidal;
4-6 cells in macroconidia
Thursday, January 19, 2012

34. Microsporum gallinae
white comb lesion in chicken = blunt tip;
cylindrofusiform-shaped
Thursday, January 19, 2012

35. Microsporum nanum
Tinea capitis, corporis = ringworm of pigs
Thursday, January 19, 2012

36. Epidermophyton floccosum
Tinea cruris, pedis, unguium = rarely
invades hair
Thursday, January 19, 2012

37. Microsporum equinum
Tinea in horses = large chain of spores
Thursday, January 19, 2012

38. Microsporum fulvum
Tinea capitis = bullet-shaped septa
Thursday, January 19, 2012

39. Trichophyton mentagrophytes
all types of tinea = spiral hyphae “en
grappe”
Thursday, January 19, 2012

40. Trichophyton rubrum
all types of tinea = “en thyrse”
Thursday, January 19, 2012

41. Trichophyton veruccosum
Tinea corporis, barbae = ringworm in cattle
(culture requires inositol)
Thursday, January 19, 2012

42. Trichophyton tonsurans
Tinea capitis, corporis - originates from
aborigines
Thursday, January 19, 2012

43. Trichophyton schoenleinii
Tinea capitis, favosa, corporisfavus = scutula
(permanent hair loss)
Thursday, January 19, 2012

44. Trichophyton violaceum
Tinea capitis, favosa, corporis = black dot
(deep violet in culture)
Thursday, January 19, 2012

45. Trichophyton concentricum
Tinea imbricata = resembles antler tip
Thursday, January 19, 2012

46. ECOLOGICAL NICHE OF
CUTANEOUS MYCOSES
Thursday, January 19, 2012

47. COMPARING HAIR
INFECTIONS
Thursday, January 19, 2012