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SUPERFICIAL MYCOSESSUPERFICIAL MYCOSES
Sevtap Arikan, MDSevtap Arikan, MD
SUPERFICIAL MYCOSESSUPERFICIAL MYCOSES
DermatophytosisDermatophytosisPityriasis versicolor Pityriasis versicolor KeratomycosisKeratomycosisTinea nigraTinea nigraBlack piedraBlack piedraWhite piedraWhite piedra
DERMATOPHYTOSISDERMATOPHYTOSIS(=Tinea = Ringworm)(=Tinea = Ringworm)
Infection of the skin, hair or nails Infection of the skin, hair or nails caused by a group of keratinophilic caused by a group of keratinophilic fungi, called dermatophytesfungi, called dermatophytes
¨ MicrosporumMicrosporum Hair, skinHair, skin¨ EpidermophytonEpidermophyton Skin, nailSkin, nail¨ TrichophytonTrichophyton Hair, skin, nailHair, skin, nail
DERMATOPHYTESDERMATOPHYTES
Digest keratin by their Digest keratin by their keratinaseskeratinases
Resistant to cycloheximideResistant to cycloheximide Classified into three groups Classified into three groups
depending on their usual depending on their usual habitathabitat
DERMATOPHYTESDERMATOPHYTES
ANTROPOPHILICANTROPOPHILIC Trichophyton rubrum...Trichophyton rubrum...GEOPHILICGEOPHILIC
Microsporum gypseum...Microsporum gypseum...ZOOPHILICZOOPHILIC
Microsporum canisMicrosporum canis: cats and dogs: cats and dogsMicrosporum nanumMicrosporum nanum: swine : swine Trichophyton verrucosum:Trichophyton verrucosum: horse and horse and swine…swine…
DERMATOPHYTOSISDERMATOPHYTOSISPathogenesis and Pathogenesis and ImmunityImmunity
Contact and traumaContact and trauma MoistureMoisture Crowded living conditionsCrowded living conditions Cellular immunodeficiency Cellular immunodeficiency
(chronic inf.)(chronic inf.) Re-infection is possible (but, Re-infection is possible (but,
larger inoculum is needed, the larger inoculum is needed, the course is shorter )course is shorter )
DERMATOPHYTOSISDERMATOPHYTOSISClinical ClassificationClinical Classification
Infection is named according to Infection is named according to the anatomic location involved:the anatomic location involved:
a. Tinea barbaea. Tinea barbae e. Tinea pedis e. Tinea pedis (Athlete’s foot)(Athlete’s foot)
b. Tinea corporis f. Tinea manuumb. Tinea corporis f. Tinea manuumc. Tinea capitis c. Tinea capitis g. Tinea unguiumg. Tinea unguiumd. Tinea cruris d. Tinea cruris
(Jock itch)(Jock itch)
DERMATOPHYTOSISDERMATOPHYTOSISClinical manifestationsClinical manifestations
Skin:Skin: Circular, dry, Circular, dry, erythematous, scaly, itchy lesions erythematous, scaly, itchy lesions
Hair:Hair: Typical lesions,”kerion”, Typical lesions,”kerion”, scarring, “alopecia”scarring, “alopecia”
Nail:Nail: Thickened, deformed, Thickened, deformed, friable, discolored nails, friable, discolored nails, subungual debris accumulation subungual debris accumulation
FavusFavus (Tinea favosa) (Tinea favosa)
DERMATOPHYTOSISDERMATOPHYTOSISTransmissionTransmission
Close human contactClose human contact Sharing clothes, combs, Sharing clothes, combs,
brushes, towels, bedsheets... brushes, towels, bedsheets... (Indirect)(Indirect)
Animal-to-human contact Animal-to-human contact (Zoophilic)(Zoophilic)
DERMATOPHYTOSISDERMATOPHYTOSISDiagnosisDiagnosis
I. ClinicalI. Clinical
AppearanceAppearance
Wood lamp (UV, 365 nm) Wood lamp (UV, 365 nm)
II. Lab II. Lab
A. Direct microscopic A. Direct microscopic examinationexamination
(10-25% KOH)(10-25% KOH)
Ectothrix/endothrix/favic hairEctothrix/endothrix/favic hair
DERMATOPHYTOSISDERMATOPHYTOSISDiagnosisDiagnosis
B. CultureB. CultureMycobiotic agar Mycobiotic agar Sabouraud dextrose agar Sabouraud dextrose agar
DERMATOPHYTESDERMATOPHYTESIdentificationIdentification
A. Colony characteristicsA. Colony characteristicsB. Microscopic morphologyB. Microscopic morphology
MacroconidiumMacroconidiumMicroconidiumMicroconidiumMicrosporum----Microsporum---- fusiform---------------(+)fusiform---------------(+)EpidermophytonEpidermophyton clavate-----------------(-)clavate-----------------(-)Trichophyton-- -Trichophyton-- -(few)cylindrical/ --- --(+) (few)cylindrical/ --- --(+)
clavate/fusiform clavate/fusiform single, single, in in clustersclusters
DERMATOPHYTESDERMATOPHYTESIdentificationIdentification
C. Physiological testsC. Physiological tests In vitro hair perforation testIn vitro hair perforation test Special amino acid and vitamin Special amino acid and vitamin
requirementsrequirements Urea hydrolysisUrea hydrolysis Growth on BCP-milk solids-glucose Growth on BCP-milk solids-glucose
mediummedium Growth on polished rice grainsGrowth on polished rice grains Temperature tolerance and enhancementTemperature tolerance and enhancement
DERMATOPHYTOSISDERMATOPHYTOSISTreatmentTreatment
Topical Topical Miconazole, clotrimazole, Miconazole, clotrimazole, econazole, terbinafine...econazole, terbinafine...
OralOralGriseofulvinGriseofulvinKetaconazoleKetaconazoleItraconazoleItraconazoleTerbinafineTerbinafine
PITYRIASIS PITYRIASIS VERSICOLORVERSICOLOR
Superficial chronic infection of Superficial chronic infection of Stratum corneumStratum corneum
Etio:Etio: Malassezia furfur Malassezia furfur (Pityrosporum orbiculare)(Pityrosporum orbiculare) (Lipophilic yeast)(Lipophilic yeast)
Clinical findings:Clinical findings: Hyperpigmented or depigmented Hyperpigmented or depigmented maculae on chest, back, arms, maculae on chest, back, arms, abdomenabdomen
PITYRIASIS PITYRIASIS VERSICOLORVERSICOLOR
Systemic infection (parenteral Systemic infection (parenteral lipid solution)lipid solution)
Micr.:Micr.: Short hyphae, yeast cellsShort hyphae, yeast cells Culture:Culture: Yeast (suppl.: olive Yeast (suppl.: olive
oil)oil) Treatm.:Treatm.: Topical selenium Topical selenium
sulfide sulfideOral ketaconazoleOral ketaconazole
Oral itraconazoleOral itraconazole
KERATOMYCOSISKERATOMYCOSIS(=Mycotic keratitis)(=Mycotic keratitis)
Posttraumatic / postsurgical Posttraumatic / postsurgical corneal inf. corneal inf.
Etio:Etio: Saprophytic fungi Saprophytic fungi ((AspergillusAspergillus, , Fusarium, Fusarium, Alternaria, Candida), Alternaria, Candida), Histoplasma capsulatumHistoplasma capsulatum
Clinical findings:Clinical findings: Corneal ulcer Corneal ulcer
KERATOMYCOSISKERATOMYCOSIS
Micr.: Micr.: Hyphae in corneal Hyphae in corneal scrapingsscrapings
Treatm.: Treatm.: Surgery (keratoplasty)Surgery (keratoplasty)
Topical pimaricinTopical pimaricin
NystatinNystatin
Amphotericin BAmphotericin B
TINEA NIGRATINEA NIGRA
Superficial chronic infection of Superficial chronic infection of Stratum corneumStratum corneum
Etio:Etio: HortaeHortae (Exophiala) (Exophiala) werneckii werneckii (pigmented)(pigmented)
Frequent in tropical areasFrequent in tropical areas Clinical findings: Clinical findings: Brownish Brownish
maculae on palms, fingers, facemaculae on palms, fingers, face
TINEA NIGRATINEA NIGRA
Micr.:Micr.:Septate hyphae and Septate hyphae and yeast cells (brown in color)yeast cells (brown in color)
Culture:Culture: Black colonies Black colonies
Treatm.:Treatm.: Topical salicylic acid, Topical salicylic acid, tincture of iodinetincture of iodine
BLACK PIEDRABLACK PIEDRA
Fungal infection of the scalp hairFungal infection of the scalp hair Etio:Etio: Piedraia hortae Piedraia hortae Frequent in tropical areasFrequent in tropical areas Clinical findings: Clinical findings: Discrete, hard, Discrete, hard,
dark brown to black nodules on dark brown to black nodules on the hairthe hair
BLACK PIEDRABLACK PIEDRA
Micr.Micr. Septate pigmented hyphae, Septate pigmented hyphae, and asci; unicellular and fusiform and asci; unicellular and fusiform ascospores with polar filament(s)ascospores with polar filament(s)
Culture:Culture: Brown to black colonies Brown to black colonies Treatm.:Treatm.: Topical salicylic acid, Topical salicylic acid,
azol cremesazol cremes
WHITE PIEDRAWHITE PIEDRA
Fungal infection of facial, Fungal infection of facial, axillary or genital hairaxillary or genital hair
Etio:Etio: Trichosporon Trichosporon (yeast)(yeast) Frequent in tropical and Frequent in tropical and
temperate zonestemperate zones
WHITE PIEDRAWHITE PIEDRA
Clinical findings: Clinical findings: Soft, white to Soft, white to yellowish nodules loosely yellowish nodules loosely attached to the hairattached to the hair
Micr.: Micr.: Intertwined septate Intertwined septate hyphae, blasto- and hyphae, blasto- and arthroconidiaarthroconidia
Culture:Culture: Soft, creamy colonies Soft, creamy colonies Treatm.:Treatm.: Shaving, azoles Shaving, azoles