Fungal infections of the skin

Fungal infections of the skin

Superficial mycosis
infection confined to the outer most layer of skin and /or hair
• Pityriasis versicolor
• Keratomycosis
• Tinea nigra
• Black piedra
• White piedra
Cutaneous mycosis (Dermatophytosis)
Infection of the keratinized layer of skin, hair or nail
• Trichophyton
• Epidermophyton
• Microsporum organisms
Subcutaneous mycosis
Involve deeper skin layers, including muscle and
connective tissues
 Dermatophytosis

Pathogenesis Cubical
Rounded

Infection is caused by:

• Arthrospores of fungus OR
• Keratinous material containing fungal elements
Infection needs
• Direct contact with infected material
• Indirect contact by use of infected items of the
patient
• Slight skin trauma
• Excessive moisture predisposes to dermatophytosis
 Dermatophytosis (Tinea)
Common Clinical Types
1. Tinea Corporis
• Infection of skin of trunk, back, dorsum of hand
etc
2. Tinea Capitis
• Infection of skin of scalp & hair : three forms
a) Endothrix
o Abundant fungal growth inside hair shaft
b) Ectothrix
o Spores infect the surface of hair
c) Favic
o Some mycelia are inside the hair shaft with
an air space
3. Tinea Barbae
• Infection of beard & moustache area

4. Tinea Manum
• Infection of hand (palm & interdigital space)

5. Tinea Unguim
• Infection of the nail of hand

6. Tinea pedis (Athlete’s Foot)

• Infection of feet or toes (soles, nails & interdigital space)

7. Tinea Cruris
• Infection of perineal area
 Dermatophytosis (Tinea)
Epidemiology
According to source of infection

1. Anthropolic
• From human to human
e.g. E. floccosum
2. Zoophilic
• From animal to human
e.g. M. canis
3. Geophilic
• Spores from soil
e.g. M. gypseum
 Dermatophytosis (Tinea)
Clinical presentation

• Most people are asymptomatic

• Itching or a rash
• A ringworm skin rash
o Occurs at site of infection
o Has scaly area with redness at outer margin
o Appears as irregular rings
• On scalp : patches of hair loss
• Nails : thickened & brittle
Dermatophytosis (Tinea)
Clinical presentation

Ringworm lesions (rashes)

Tinea of the groin (tinea cruris) showing typical circular,
erythematous lesions with raised advancing margins.
Dermatophytosis (Tinea)
Clinical presentation

Tinea Capitis
Dermatophytosis (Tinea)
Clinical presentation
Dermatophytosis (Tinea)
Clinical presentation

Athlete’s foot
 Dermatophytosis (Tinea)
Diagnosis
1. Clinical Presentation
2. Examination under Wood’s light
• Mycotic area of skin or hair produces fluorescent
colors
3. Direct Microscopy
• Skin & Nail : septated hyphae
• Hair : endothrix, ectothrix, favic
4. Culture
• On SDA with chloramphenicol & cycloheximide
• Dermatophyte Testing Medium (DTM)
o Turns from yellow to red
o Colony morphology
 Dermatophytosis (Tinea)
Diagnosis
Microscopic morphology from colonies

1. Epidermophyton e.g. E. floccosum

Rocket-shape spores with smooth surface

2. Trichophyton e.g.
T. rubrum
T. mentagrophytes
Cylindrical spores wirh smooth surface

3. Microsporum e.g.
M. canis, M. gypseum
Multicellular spindle-shape
Epidermophyton floccosum
 Dermatophytosis (Tinea)
Treatment & Prevention
Topical Agents
• Clotrimazole
• Miconazole
Systemic Agents (Oral)
• Itraconazole
• Terbinafine
• Griseofulvin : has side effects
Prevention of Tinea pedis
• Keeping dryness of skin & nails
• Drying interdigital spaces with a piece of dry gauze
after washing
• Powders, open shoes & changing of socks
 Superficial Mycosis

Pityriasis versicolor (Tinea versicolor)

Causative Agent
• Malassezia furfur (Pityrosporum)
• World-wide 5-50% population affected

Pathogenesis & Clinical features

• Chronic infection of the upper most horny layer of
epidermis
• Can affect any site of the skin
• Causes depigmentation of skin
 Superficial mycosis
Pityriasis versicolor (Tinea versicolor)

Lab Diagnosis
• KOH Preparation
• Diagnostic element is Clusters of yeasts with short
hyphal fragments called “spagetti & meat balls”
appearance

Treatment
• 1% Selenium sulphide shampoo 7 times in 14 days
• Miconazole
• Clotrimazole
 KERATOMYCOSIS
(=Mycotic keratitis)

• Posttraumatic / postsurgical corneal inf.

• Etio: Saprophytic fungi (Aspergillus, Fusarium,

Alternaria, Candida), Histoplasma capsulatum

• Clinical findings: Corneal ulcer

 KERATOMYCOSIS

• Micr.: Hyphae in corneal scrapings

• Treatm.: Surgery (keratoplasty)

Topical pimaricin
Nystatin
Amphotericin B
 TINEA NIGRA

• Superficial chronic infection of Stratum corneum

• Etio: Hortae (Exophiala) werneckii (pigmented)

• Frequent in tropical areas

• Clinical findings: Brownish maculae on palms, fingers,

face
 TINEA NIGRA

• Micr.:Septate hyphae and yeast cells (brown in color)

• Culture: Black colonies

• Treatment.: Topical salicylic acid, tincture of iodine

 BLACK PIEDRA

• Fungal infection of the scalp hair

• Etio: Piedraia hortae

• Frequent in tropical areas

• Clinical findings:
Discrete, hard, dark brown to black nodules on
the hair
 BLACK PIEDRA

• Micr. Septate pigmented hyphae, and asci;

unicellular and fusiform ascospores with polar
filament(s)

• Culture: Brown to black colonies

• Treatment.: Topical salicylic acid, azol cremes

 WHITE PIEDRA
• Fungal infection of facial, axillary or genital hair
• Etio: Trichosporon (yeast)
• Frequent in tropical and temperate zones
• WHITE PIEDRA
– Clinical findings: Soft, white to yellowish nodules
loosely attached to the hair
– Micr.: Intertwined septate hyphae, blasto- and
arthroconidia
– Culture: Soft, creamy colonies
– Treatment.: Shaving, azoles