Dermatophytosis

• Cutaneous mycosis

• Dermatomycosis– Yeast– Saprophytes– Systemic mycosis– Dermatophytes

•Dermatophytosis

Dermatophytosis

• Definition

• Greek

• English

• Persian

• Dermatophytes

Dermatophytosis

• Dermatophyte– Sexual

• Arthroderma

– Asexual• Macroconidia

–Trichophyton–Microsporum–Epidermophyton

Dermatophytosis

• Trichophyton– Cylinder

• Microsporum– Spindle

• Epidermophyton– Club

Dermatophytosis

• Trichophyton– T.rubrum, T.mentagrophytes, T.violaseum,

T.schoenleinii, T.verrucosum

• Microsporum– M.canis, M.gypseum

• Epidermophyton– E.floccosum

Dermatophytosis

• Geophilic – M.gypseum

• Zoophilic– M.canis, T.verrucosum

• Anthropophilic – T.rubrum, T.violaseum, T.schoenleinii

E.floccosum

Dermatophytosis

• Tinea capitis

• Tinea barbae

• Tinea cruris

• Tinea pedis

• Tinea mannum

• Tinea corporis

• Tinea unguium

Tinea capitis

• Definition• Trichophyton & Microsporum• Clinical manifestation• Crust

– Krion– Scatulum

• Age• Genus• Ectothrix, Endothrix, Favus

Ectothrix

• Outside • Krion• Cuticle• Gray patch • Age• Genus• After maturation • M.canis, M.audouinii,

T.verrucosum, T.mentagrophytes

M.canis• Zoophilic• Dog & cat• Yellow • Microconidia Few• Macroconidia

– Thick wall– Knob

M.gypseum

• Geophilic• Favus( may be) • Red • Don't have knob

Endothrix

• Inside • Cuticle• Black dot, bald patch • Age• Genus• After maturation • Anthropophilic

– T.violaceum, T.sudanense, T.tonsuranse

Favus

• Hyphae (Air canal) lustreless

• scatulum

• Age

• Genus

• After maturation

• Cheesy or mouse judder

• T.schoenlinii

T.schoenleinii

• Anthropophilic

• Favic chandelier

Differential diagnosis

• Alopecia

• Trichotillomania

Laboratory diagnosis

• Sampling– Sesser

• Culture– Scc(2)

• Direct – Ectothrix, Endothrix, Favus

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Dermatophytosis

• Tinea capitis

Tinea barbae

• Definition

• Genus

• Age

• Beard & mustache

• Zoophilic

• T.verrucosum, T.mentagrophytes

T.Verrucosum

• Zoophilic

• Cow & cattle

• 37°

• Chlamydioconidia

Tinea barbae

• Clinical manifestation – Circular– Scaling– Vesicle– Ectothrix, Endothrix, Favus

Dermatophytosis

• Tinea barbae

Dermatophytosis

• Tinea barbae

Dermatophytosis

• Tinea barbae

Tinea barbae

• Differential diagnosis– Alopecia

• Laboratory diagnosis

Tinea cruris

• Definition

• Sever itch

• With tinea pedis

• Ecology

• Male

• Anthropophilic

• E.floccosum, T.mentagrophytes, T.rubrum

E.floccosum

• Anthropophilic

• Do not have microconidia

• Macroconidia – 2-4 or 3-5 cells

• E.stoackdaleae

Tinea cruris

• Clinical manifestation

• Maculae

• Red

• Vesicle

• Erythematic

• Itch

• Don't involve pubis

Dermatophytosis

• Tinea cruris

Dermatophytosis

• Tinea cruris

Dermatophytosis

• Tinea cruris

Dermatophytosis

• Tinea cruris

Tinea pedis

• Athlet >s foot• Age• Shoes, warm,

moisture• T.M, T.R, E.F

Tinea pedis

• Clinical manifestation

–Chronic intertrigenous

–Chronic papulosquamous hyperkeratotic

–Vesicular or sub acute–Acute ulcerative

Tinea pedis

• Chronic intertrigenous• Common type• White scale• Between 5,4 & 4,3• Itch

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Tinea pedis

• Chronic papulosquamous hyperkeratotic• T.rubrum• Moccasin foot• Scaling

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Tinea pedis

• Vesicular or sub acute

• T.M, T.R

• Id reaction • Dermatophytid

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Dermatophytosis

• Tinea pedis

Tinea pedis

• Acute ulcerative

• Bacteria

• Treatment is difficult

Tinea mannum

• Definition

• Position

• Clinical manifestation

• Agents

T.mentagrophytes• 4 strain • Interdigital is anthropophilic• Erinaci is zoophilic (-)• Hair penetration

– DW 20 ml– 10% yeast extract 5D– Horse hair– 25° to 4 week

T.mentagrophytes

• Hyphae

– Spiral or coil

• Macroconidia

– Club

T.rubrum

• Anthropopilic

• CMA +• Urease -• Hair -• Sorbitol +

Tinea corporis

• Definition• Trichophyton• Microsporum• Body reaction• Contagious• Direct & indirect• Annular• Center & margin• Vesicle

– T.M, T.V

Dermatophytosis

• Tinea corporis

Dermatophytosis

• Tinea corporis

Dermatophytosis

• Tinea corporis

Tinea corporis

• Tinea imbricata– T.concentricum– Anthropophilic– Clinical manifestation – Genetic– Ecology

Tinea imbricata

Tinea imbricata

Laboratory diagnosis

• Tinea cruris, pedis, mannum & corporis• Sampling• Direct• Culture

Tinea unguium

• Definition• Onychomycosis

– Yeast– Saprophytes

• scopulariopsis

Tinea unguium

• Leukonychia mycotica

• invasive

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Tinea unguium

Dermatophytosis

• Onychomycosis

Dermatophytosis

• Onychomycosis

Dermatophytosis

• Treatment– Griseofulvine– Terbinafin

Factors involved

• Regional – Heat – Humidity

• Individual – Local

• Hyperhydrosis• Local steroid

– Systemic• Immunosuppression • Corticosteroid

Antigens

• Complex structure – Cell wall Antigen– Enzymes

Cell wall Antigen

• Chitin

• Glucan

• Mannoprotein

• Galactomannan

Enzymes

• Keratinase• Elastase • Collagenase• Proteinase

– Metalloproteinase– Serine proteinase

Immune system

• Skin

• Unsaturated transferin

• α2 macroglobulin

Skin

• Physical & chemical barrier

• Innate immunity

• Low humidity

• UV

• Flora

skin

• Keratinization & Epidermal Proliferation– Increase turn over– Shedding

• Antifungal agent– Saturated fatty acid

Immune system

• Unsaturated transferin– Free iron

• e chain transport• Krebs cycle

• α2 macroglobulin– Keratinase inhibition

The inflammatory response

• Reverse relationship

• Inflammatory & chronic – Anthropophilic

• Inflammation low• Infection permanent

– Zoophilic & geophilic• Inflammation sever• Infection self limitation

The inflammatory response

• Dermatophyte → complement → chemo tactic

alternative C5a

Neutrophile Activation Oxidative

Nonoxidative

Myeloproxidase

Super oxide Hyd

roge

n pe

roxi

de

Catepsin

Lactoferin

Defensin

Humeral immunity

• Types of Ab– IgG, IgM, IgA & IgE– Nonprotective

Cell mediated immunity

• Deficiency in CMI– Permanent infection– Recurrent infection

Regulation OfImmune Response

• Mannan– Immune inhibitor– Blocking of monocyte receptors– In vitro

• Inhibition of lymphoblast production• Inhibition of lymphocyte proliferation

Immunization

• T.verrucosum

• LFT-130

• Drug therapy