Mycology Lecture Final

8/4/2019 Mycology Lecture Final

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FUNGAL

INFECTIONSOF THE SKIN

DERMATOMYCOSES


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MYCOSES MEANSFUNGUS

DERMATO MEANS

SKIN


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Superficial

Dermatomycoses

(tinea)


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Deep

Dermatomycoses


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Superficial mycoses

invade skin surface

i.e epidermis andepidermal appendages

especially hairs and nail


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Classification

Regional:

T.CAPITIS:

-FAVUS

-RING WORM


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RINGWORM:INFLAMMATORY

-PUSTULAR FOLLICULITIS-KERION CELZI


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NON-INFLAMMATOR

1-GRAY PATCH.

2-BLACK DOT R.W.


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T.CORPORIS:

-T.CIRCINATA.

-T.CRURIS.

-T.VERSICOLOUR


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-T.MANUS.

-T.PEDIS.

-ONYCHOMYCOSES

(T.UNGIUM).


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Tinea Capitis


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Fungus infection of

the scalp

Ring Worm

Favus


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Ring WormGray Patch


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Is the commonest

variety of mycotic

scalp affections.


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incubation period

is 1- 4 weeks.


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Usually affects

children at

school age


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spreads in epidemics

especially in family

and school children


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usually causedby

MicrosporonAuduini


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Grey Patch


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Symptoms

Apart from hair

affection, the patient

complains ofhair fall


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Unaccompanied

by any local

symptoms


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Hairs are shortly

cut. Covering

scales are small,

dry, slate colored


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Slightly adherent to

the surface of the

scalp but easily

detached on scraping


28/258Grey Patch


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This patch is

followed by the

appearance of

other patches,


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we get multiple

patches dispersed on

the scalp of the same

clinical picture


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T.Capitis

MultipleScaly

type


32/258Multiple Patches


33/258Multiple Scaly Type


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Mode of infection

DirectBy contact withinfected person.

I di t


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Indirect

By contact with

material soiled with

the organisms e.g.head caps, bed sheets


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DiagnosisScales and hairs are

xamined for detectio

offungal elements


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by KOH or

Lactophenolpreparation


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Culture can be used

in difficult cases.


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SamplingFor

Fungal

Detection


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KOH preparation

showing spores in the

hair shaft


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Differential Diagnosis

From other scaly

lesions on thescalp

P i i


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Psoriasis.

L.E.

Lichen planopilarisFavus.

Lichen accuminatus

(PRP)


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PrognosisSelf-limited at

puberty


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Microscopic Examination

of Hair in Ring Worm


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1-In gray patch

variety it shows

microsporon hair

l l


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Fungal elements

surround the hair

in an irregular

mosaic form.


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bl k d


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2-In black dot

variety the hair matrix

is filled with mycotic

elements forming a

sac form


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3- In kerion Celzi:

hair is surrounded

by regularly arranged

elements like acolumn


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4-In Favus:

Fungal elements are

arranged parallelto

long axis of the hair


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Black dot R.W


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This variety is

characterized by

the development of

l l l i


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scaly macular lesion

on the scalp of

children with well

defined border.


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Black

Dot

R.W


59/258Black Dot Type


60/258Black Dot R W O l f th


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On removal of these

cales the underlyin

epidermis is slightly

inflamed

O l


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On close

examination we find

the hair follicle ostia

are blocked with

black dotsblack dots hi h th


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which are the

remains of the

broken hair at the

surface of the scalp


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usually caused

by Trichophyton

Violaceumand

T. Tonsurans.


65/258Black Dot R W


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67/258Black Dot R W


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Inflammatory

types of R.W


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Usually affect

children but may

affect adults

b id l


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besides scalp

affection the

beard areamay

be affected.

The extent of


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The extent of

inflammation varies

according to the

invading fungus.


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It might be:

Mild

li ht th f th


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slight erythema of the

skin in the affected

patch which is covered

by discharge

H i t k


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Hairs are stuck

together broken, and

you can see short as

well as long hairs


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Pustular folliculitis Severe


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Severe

marked edema,

redness and

tumefaction of theaffected hair

leading to the


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leading to the

formation of a

boggy soft

swelling


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On pressure pus

comes out from

the hair follicle

Each hair is


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Each hair is

surrounded by a

pool of pus and is

easily detached


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Kerion


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Kerion Celzi

Kerion


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Kerion

Celzi


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85/258Kerion This inflammatory


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This inflammatory

swelling is called

Kerion CelziIt usually heals by

scar formation


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It is usually caused

by:

Microsporon Canis


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Favus


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one of the most

common mycotic

scalp affections

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caused by

Trichophyton

Schoenleini


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Age:

all ages, more

common in children

but it does not


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but it does not

show self healing

at puberty

E d h h


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Extends throughout

life leading to

cicatrical alopecia


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Favus

cicatricalalopecia


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Contagiosity

not as high as

in R.W.,

di


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sporadic cases

can be detected

among children


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It can also affect

glabrous skin

and nails


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Favus Of The Scalp


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Favus Of The Scalp


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Post

Favic

Alopeci


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Which is the

initial lesion of

Favus


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Scotulum


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s a crus e


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s a crus e

lesion, yellowish

in color, with a

concavo-convex

f e

it its convexity at


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it its convexity at

the scalp making fo

itself an erosion or

depression in the

epidermis


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This leads to firm

adherence to the

scalp,


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on detachement

sero-sanginous

discharge appears

The scotulum is


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The scotulumis

friable, cupshaped,

with a characteristic

mousy odor

polygonal in outline


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polygonal in outline

measuring about

few mms. to one

cm in diameter

If moistened with


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If moistened with

alcohol the color

becomesdeeper

The hairin the affected


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area in the scalp is

usually of normal lengtbut show changes in

picture and color.


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Favic Hair


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Favic Hair

Hair becomes thin,


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,

dry, friable, grayish

in appearance ,

lusterless and dullgray in color


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the scalp appears

as if dusted with

powder


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Microscopic

Examination

The scotulum is


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The scotulum is

shown to be a pure

culture of the

invading fungus

un er themicroscope


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p

fungal elements are

invading the hair

with no elements

t id


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All are withinthe hair


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Fungal elements are


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Fungal elements are

arranged parallel to

the long axis of the

hair


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Tinea Corporis


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This includes

the following:

T Circinata


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T . Circinata .

T . Cruris .

T . Manus & Pedis

T . Versicolour .


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Tinea Circinata

Occurs anywhere


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Occurs anywhereon the body

surface especially

on exposed parts

in the form of


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in the form of

one or multiple

circinate macular

lesions

lesion is made


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lesion is made

ofwell defined

erythematousscaly patches

spreading


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sp ead g

eccentrically

forming a circinat

appearance


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i.e healing in the

center and activit

at the border.


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Tenia

Circinata


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T.Circinata


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T.Circinata

Multiple

Patches

The activity appears


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The activity appears

in the form of

erythema vesicles

and papules.

center may show


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center may show

hyper-pigmentation

and covered with

branny scales

The patient complains


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p p

of

itching and

disfigurement


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T C


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From

other circinateeruptions:


Superficial:


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Pityriasis Rosea . Psoriasis . Lichen planus . Seborrhoeic dermatitis Erythema multiforme. Impetigo .

Deep:


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pSyphilis.Leprosy.

T.B.

Leishmaniasis.

S id i.


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Tenia Cruris

A circinate macular


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lesion occupying

the inner surfaceof the upper partsof both thighs


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Usually

accompanied

with T. pedis.


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Other flexures

may share in

the affection


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It is usually a

symmetrical

affection


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and posteriorly to


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and posteriorly to

the perineum and

gluteal folds

The lesion is


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brownishred in color

with well defined

border and circinateconfiguration

Surface shows


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minute scaliness

and tendency for

healing withspreading margin

T.cruris


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T i C i


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i t t i


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Intertrigo

Erythrasma

Psoriasis


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Tinea

Versicolour

a very common


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y

superficial fungus

infection of the

skin

affecting both


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affecting bothsexes and

commonly seen

at puberty


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It is caused byMicrosporoon

FurFur

Mild asymptomatic


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dysfiguring macular

eruption affecting

the vest area


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short jacketwith longsleeves


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Sites Of

T.V.C

Macules are oval,rounded


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or patchy, brownish or

coffe et lait in colourvarying from light to

deep brown

The lesions are well


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defined and covered

by fine branny

adherent scales.


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T V C


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T.V.C. On The Chest


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T.V.C. onthe Back


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Colour changes in


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ifferent sitesin th

same patient and

among differentindividuals


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Colour change is

ascribed to the

following factors:


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Site of the lesion


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whether on an

exposed site or a

hidden site.

yg ene o e


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atient as frequen

baths removes the

scaly layer on the

l i

that prevents


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the reach of UV

to the skin

underneath.


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Tenia Manus

& Pedis


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Superficial fungus

infection of bothhands and feet.

It may take one


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of the following

clinical pictures

1-Erythematous scaly


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or circinate type.

2-Eczematous or

vesiculobullous type

Both types occur on


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Both types occur on

the dorsal aspect of

the hands and feet


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Erythematous Scaly Type


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3-Hyperkeratotictype:


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on the palmar

and

plantar aspects


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Hyperkeratotic Type


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H k i T di

4-Commonest


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type is the

interdigital type


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Clinical picture of

the standard type:

Affects the


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interdigital

spaces between

toes and fingers

The skin becomes


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whitish, sodden,

macerated and the

depth of the cleftis fissured


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d l

On removal of


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the macerated

keratinous

material

the underlying skin


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is erythematous,

moist , and may be

eroded

It is very common


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among athelets

and called

atheletic foot


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Onychomycosis

fungus infection


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of the nails

caused by many

species of fungi

The affected nail


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is dry, brittle,

lusterless and the

surface is pittedand grooved.

Nails may be


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y

separated

rom the nail bed


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Onychomycosis


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Moniliasis

nails retain its


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luster, thick

accompanied

by paronychia


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Fungal


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Monilial

Chronic eczema


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Lichen planus

Psoriasis.Syphilis.

Lichen accuminatus.


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Treatment

ofMycoses


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General

Treatment

Griseofulvine


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An oral antibiotic

fungicidal agent

derived frompenicillin species.

It is given in a


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tablet form each

tablet contains250

mgm of ordinarygriseofulvine

The same therapeutic


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effect is obtained by

125 mgm offineparticle F.P.

Griseofulvin


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It may be given


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in a single

weekly dose

calculated by


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T .V . C.Erythrasma.

Moniliasis.

Contraindications


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Pregnancy,

liver, kidney or

heart disease.

Side effects :


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- Nausea

-Vomiting

- Headache

Duration of Treatment:


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T.corporis 3-4 weeks

T.capitis 5-7 weeks

T.Pedis 7-9 weeks


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onychomycosis

Nails 3-4

monthsToes 5-6 months

Other systemic

f


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antifungals are

now in common

use.

They should be

d h


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used with caution

as some of them

have serious sideeffects as:

l


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Ketoconazolewhich is apotent

hepatotoxic drug

Terbenafine

d


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and

Itraconazoleare used safelyin indicated cases

But they are

d


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expensive and

limited to

worthy cases.

or nea ers o or

Fl l l


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Fluconazole capsules150 mgm onceweekly for 4 weeks

may be given inresistent cases

l


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LocalTreatment

local fungicidals

T I di T l f


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Tr.Iodine,Tolnaftate

Clotrimazole,

Undecylinic acidderivatives

Whitfield ointment

S li li id 3


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Salicylic acid 3

Benzoic acid 6

lanovaseline 100

we use modified form

f Whitfi ld i t t


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ofWhitfield ointmentbecause the original

formula is very irritant

but very effective.

In cases of

i d


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eczematisedfungal infections,

we use

Preparations containing

f i id l t


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fungicidal agent

plus

hydrocortisone oranother steroid

or the preparation

ll d


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called

Castellanipaint which must beprepared fresh


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Documents

Mycology Lecture Final