SUPERFICIAL MYCOSES TX ❖ Salicylic Acid
❖ No cellular response and no tissue migration ❖ Azoles (3-4 weeks)
❖ Transmission is from garments, or person-to-person
❖ Easy to diagnose and treat
PIEDRA
Pityriasis versicolor/Tinea Versicolor
❖ “an-an” BLACK PIEDRA WHITE PIEDRA
❖ Uneven pigmentation of the skin (chest, arms, upper back and abdomen)
❖ Nodular infection of the hair ❖ Infection of the hair with larger,
shaft yellowish nodules in the hair
CAUSATIVE Malassezia spp. ❖ Hard black nodules around the ❖ Pubic hair, beard, axillary
AGENT ❖ Malassezia furfur (Pityrosporum orbiculare) scalp ❖ Causative agent:
❖ Malassezia globosa ❖ Causative agent: Piedraia Trichosporon beigelii
❖ Malassezia restica hortae ➢ Trichosporon inkin
❖ Spindle shaped ascospores ➢ Trichosporon asahii
MOT direct or indirect transfer of infected keratinous material from are formed with specialized ➢ Trichosporon
one person to another structures called asci. mucoides
DIAGNOSIS ❖ Skin scraping of infected skin
➢ 10-20% KOH DIAGNOSIS ❖ Hair plucking
➢ Calcofluor White Stain ➢ LPCB
❖ Culture ❖ Culture-SDA
➢ SDA+Cycloheximide+Olive Oil
➢ Dixon’s Aga TX ❖ Topical Azoles
❖ Removal of hair
TX ❖ Topical Administration of Drugs
➢ Selenium sulfide
➢ Azoles (Topical/Oral)
■ Ketoconazole/Itraconazole
■ Imidazole
Tinea nigra / Tinea palmaris
❖ “Tinea” means ringworm
❖ Superficial chronic and asymptomatic infection of the stratum corneum
❖ Lesions appear as dark brown or black discoloration in the palms and soles
❖ Common in tropical regions
CAUSATIVE Hortaea werneckii (Exophiala werneckii)
AGENT
MOT direct contact with the fungus
DIAGNOSIS ❖ Skin Scraping
➢ 10-20% KOH-branched septate hyphae
and budding yeast cells with melanized
cell wall
❖ Culture-SDA
CUTANEOUS MYCOSES ❖ Most difficult to treat
❖ Causative agents:
❖ Infections that extend deeper into the epidermis, as well as infecting the hair ➢ Trichophyton rubrum
and nails ➢ Trichophyton mentagrophytes var. Interdigitale
❖ “Ringworms” ➢ Epidermophyton floccosum
❖ Dermatophytes – “keratin lover” ❖ Treatment:
❖ Diseases associated are called “Dermatophytosis” ➢ Itraconazole
➢ Terbinafine
Dermatophytes- Tinea ➢ Surgical removal of nail
Tineas are classified according to the anatomic site or structure affected:
1. Tinea capitis of the scalp, eyebrows, and eyelashes; Tinea capitis
2. Tinea barbae of the beard; ❖ “ringworm of the scalp hair”
3. Tinea corporis of the smooth or glabrous skin; ❖ Can also infect the beard
4. Tinea cruris of the groin; ❖ Characterized by round bald patches in hair
5. Tinea pedis of the foot; ❖ Spreads outward and the inside of the circle clears out
6. Tinea unguium of the nails (also known as onychomycosis) ❖ Causative agents:
7. Tinea manus of the hands ➢ Microsporum canis
➢ Microsporum gypseum
Dermatophytes according to Genera ➢ Trichophyton mentagrophytes var. mentagrophytes
❖ Can infect skin and appendages ❖ Treatment:
❖ Only 3 genera classified to cause cutaneous mycoses ➢ Griseofulvin (4-6 wks)
➢ Miconazole
➢ Itraconazole
➢ Ketoconazole
➢ Terbinafine
Tinea barbae
❖ “Barber’s itch”
❖ Ringworm of the beard and mustache area, characterized by inflamed
Dermatophytes - Classification depending on habitat: pustules and crusting around the hair
❖ Causative agent:
➢ Trichophyton verrucosum
Anthropophilic Human beings are the main - T. rubrum ➢ Trichophyton mentagrophytes var. equinum
species or only hosts, may be - M. audouinii ❖ Treatment:
transmitted directly or - Epidermophyton ➢ Griseofulvin
indirectly from person to floccosum ➢ Terbinafine
person
Tinea corporis
Zoophilic species parasitize the hair and skin of - T. verrucosum in cattle ❖ Ringworm of the skin arms and legs especially glabrous parts •
animals but can be - M. canis in dogs and Characterized by scaly rash with a raised border ring
transmitted to humans cats. ❖ Causative agents:
➢ Trichophyton mentagrophytes var. Mentagrophytes
Geophilic species live in the soil and are - M. gypseum ➢ Trichophyton rubrum
occasional pathogens of both - T. ajelloi. ➢ Microsporum canis
animals and humans, less ➢ Microsporum audouinii
pathogenic for human beings ➢ Microsporum gypseum
❖ Treatment:
➢ Itraconazole (2-4 wks)
Tinea unguium
➢ Terbinafine
❖ “Onychomycosis” ➢ Miconazole nitrate
❖ Yellow, brittle, thickened and crumbly nail ➢ Tolnaftate
➢ Clotrimazole ❖ Skin and nail scrapings, nail clippings, hair pluckings
❖ Hyphae with arthroconidia
Tinea pedis ❖ Hair-endothrix, ectothrix
❖ “athlete’s foot”, “alipunga”
❖ Most prevalent of all dermatophycosis Culture
❖ Chronic infection of the toewebs ❖ Always with inhibitors (Cycloheximide, Gentamicin, Chloramphenicol)
❖ Itching between toes and the development of small vesicles, when ruptured
there is a discharge of a thin fluid Wood’s Lamp
❖ Pealing and cracking of the skin accompanied by pain and pruritus ❖ Positive (+) when skin fluorescence green
❖ Causative agents:
➢ Trichophyton mentagrophytes var, interdigitale Hair perforation Test
➢ Trichophyton rubrum ❖ to distinguish between Trichophyton mentagrophytes and its variants
➢ Epidermophyton floccosum
❖ Treatment:
➢ Itraconazole (2-4 wks)
➢ Terbinafine
➢ Miconazole nitrate
➢ Tolnaftate, Clotrimazole
IDENTIFICATION
Tinea cruris
Trichophyton rubrum
❖ “Jock Itch”, “had-had”
❖ Fungal infection of the groin area ❖ Colonial Morphology: Surface: white irregular/fluffy Reverse: dark red brown
❖ Dry itch lesions that starts in the scrotum and spreads to the groin • Sharing ❖ Microscopically: tear-shaped microconidia
of underwear, clothes, towels
❖ Causative agents: Trichophyton mentagrophytes var. Interdigitale
➢ Trichophyton rubrum ❖ Colonial Morphology:
➢ Epidermophyton floccosum ➢ Surface: white and wooly
➢ Trichophyton mentagrophyte var. interdigitale ➢ Reverse: yellow to brown
❖ Treatment: ❖ Microscopically: Spherical grape like cluster
➢ Fluconazole
➢ Imidazole Trichophyton mentagrophytes var. mentagrophytes
➢ Terbinafine ❖ Colonial Morphology:
➢ Surface: cream and granular
Tinea manus ➢ Reverse: clear to brown
❖ “Tinea manuum” ❖ Microscopically: Spherical and abundant microconidia with presence of
❖ Ringworm of the hands or fingers multi-celled macroconidia
❖ Dry scaly lesion that may involve one or both hands, or two or more fingers •
Itchiness, burning, cracking and scaling Trichophyton schoenleinii
❖ Causative agents: ❖ Colonial Morphology:
➢ Trichophyton rubrum ➢ Surface: yellow to brown, waxy and folded
➢ Epidermophyton floccosum ➢ Reverse: colorless to yellow
➢ Trichophyton mentagrophyte var. interdigitale ❖ Microscopically: Antler-like hyphae
❖ Treatment
➢ Terbinafine Microsporum audouinii
➢ Itraconazole ❖ Colonial Morphology:
➢ Surface: gray to cream, flat velvety with radial feather-like markings
LABORATORY DIAGNOSIS OF TINEA ➢ Reverse: deep yellow
❖ Microscopically: Pectinate and racquet hyphae Rare macroconidia
Direct Microscopy: 10-20% KOH method Calcofluor White Stain ❖ Rice Medium: causes brown discoloration of the rice
❖ Indicate which part of the skin
❖ Mold type of fungi
Microsporum canis
❖ Colonial Morphology:
➢ Surface: white to yellow flat velvety with radial feather like markings
➢ Reverse: deep yellow
❖ Microscopically: Thick walled with superficial projection of macroconidia
❖ Rice Medium: good growth yellow pigmentation and sporulation
Microsporum gypseum
❖ Colonial Morphology:
➢ Surface: creamy and powdery
➢ Reverse: yellow to tan
❖ Microscopically: Thick walled with superficial projection of macroconidia
Epidermophyton floccosum
❖ Colonial Morphology:
➢ Surface: greenish brown, sweatlike folded colonies
➢ Reverse: yellow to brown
❖ Microscopically: Club-shaped macroconidia. Microconidia are not formed
SUBCUTANEOUS MYCOSES i. 10% KOH Wet Mount
ii. Calcofluor White Stain
❖ Infects the muscles and subcutaneous tissues b. Tissue Biopsy
❖ Transmitted through traumatic implantation in the skin i. H&E
ii. Periodic Acid Schiff
1. Sporothricosis iii. Grocott’s Methenamine Silver
2. Chromoblastomycosis 2. Culture-SDA
3. Mycetoma
4. Subcutaneous Entomophthoromycosis Mycetoma
5. Phaeohyphomycosis
❖ 3 types: Eumycetomas, Actinomycetomas, Botryomycosis
6. Rhinosporidosis
❖ Granulomatous tumor of subcutaneous tissue
❖ Purplish discoloration and tumor-like deformities that drain pus with granules
Sporotrichosis
❖ Most common on foot, brain, abscess, eyes and sinuses
❖ “Rose-gardener’s disease” ❖ Most common in bare-footed populations living in tropical or subtropical
❖ Infection is chronic - characterized by nodular and ulcerative lesions that regions
develop along lymphatics that drain the primary site of inoculation ❖ Eumycotic
❖ Causative Agent: Sporothrix schenckii ➢ White Grain Mycetoma: Scedosporium apiospermum, Acremonium
❖ MOT is associated with traumatic inoculation of soil, vegetable or organic spp.
matter contaminated with the fungus ➢ Black Grain Mycetoma: Curvularia spp., and Madurella spp.
❖ Zoonotic transmission reported in armadillo hunters, and with infected cats ❖ Actinomycotic
❖ Fixed Cutaneous Sporotrichosis ➢ Nocardia and Actinomycetes spp.
➢ Lesions develop at the site of implantation of the fungus ❖ Laboratory Diagnosis
➢ They remain localized and do not spread along lymphatic channels 1. Direct Microscopy
❖ Lymphocutaneous Sporotrichosis a. Tissue Biopsy
➢ Primary lesions develop at the site of implantation of the fungus, i. H&E
secondary lesions appear along lymphatic channels ii. PAS
❖ Laboratory Diagnosis iii. GMS
1. Direct Microscopy Tissue biopsy b. Serosanguinous fluid containing the granules
a. PAS i. 10% KOH
b. GMS ii. Calcofluor White Stain
i. Asteroid bodies 2. Culture-SDA
ii. Cigar-shaped yeasts ❖ Treatment
2. Culture ➢ Surgical debridement or excision
a. SDA ➢ Terbinafine
b. BHI+blood ➢ Voriconazole
❖ Treatment: Oral Potassium Iodide, Itraconazole, Fluconazole ➢ Posaconazol
Chromoblastomycosis Phaeohyphomycosis
❖ “Verrucous dermatitis”, “chromomycosis” ❖ Lesions generally occur on the feet and legs, although the hands and other
❖ Scaly “cauliflower-like” lesion on foot or leg body sites may be involved
❖ Characterized by slow development of progressive granulomatous lesions ❖ Causative agents:
❖ Causative agents ➢ Exophiala jeanselmei
➢ Fonsecaea pedrosoi ➢ Wangeilla dermatitidis
➢ Cladophialophora carrionii ➢ Cladophialophora bantiana
➢ Phialophora verrucosa ❖ Treatment:
❖ Treatment: ➢ Surgical incision
➢ Itraconazole ➢ Itraconazole with or without concomitant flucytosine
➢ Terbinafine ➢ Posaconazole, Voriconazole, and Terbinafine
➢ Posaconazole usually combined with flucytosine ❖ Laboratory Diagnosis:
❖ Laboratory Diagnosis 1. Direct Microscopy
1. Direct Microscopy
a. Skin Scrapings
a. Skin Scrapings, Sputum, Bronchial washings and
aspirates, Exudates
i. 10% KOH
ii. Calcofluor White Stain
b. Tissue Biopsy
i. H&E
ii. PAS
iii. GMS
2. Culture
a. SDA
Subcutaneous Entomophthoromycosis
❖ Known as subcutaneous mucormycosis
❖ Caused by mucormycetes of the order Entomophthorales: Conidiobolus
coronatus and Basidiobolus ranarum (haptosporus)
❖ Cause a chronic subcutaneous form of mucormycosis that occurs
sporadically as a result of traumatic implantation of the fungus
❖ B. ranarum causes subcutaneous infection of the proximal limbs in children
❖ C. coronatus infection is localized to the facial area, predominantly in adults
❖ Both are saprophytes that are present in leaf and plant debris
❖ B. ranarum - been found in the intestinal contents of small reptiles and
amphibians
➢ have disk shaped, rubbery, movable masses that may be quite
large and are localized to the shoulder, pelvis, hips, and thighs
❖ C. coronatus infection is confined to the rhino facial area and often does not
come to medical attention until there is a noticeable swelling of the upper lip
or face
❖ Laboratory Diagnosis
➢ Direct Microscopy Skin Biopsy tissue
■ H&E
■ GMS
❖ Treatment
➢ Itraconazole.
➢ Oral Potassium Iodide
➢ Facial reconstructive surgery may be necessary in the case of C.
coronatus infection; extensive fibrosis remains after eradication of
the fungus
Rhinosporidosis
❖ development of large polyps or wart-like lesions in the nose, conjunctiva and
occasionally in ears, larynx, bronchus, penile urethra, vagina, rectum and
skin
❖ 90% of cases have been reported from India, Sri-Lanka and South America
❖ Causative agent: Rhinosporidium seeberi
