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Superficial:cutaneous mycoses


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Superficial:cutaneous mycoses

  1. 1. Thursday, January 19, 2012
  2. 2. SUPERFICIAL MYCOSESThursday, January 19, 2012
  3. 3. WHAT ARE SUPERFICIAL MYCOSES? Superficial mycoses are cosmetic fungal infections of the skin or shaft No living tissue is invaded No cellular response from the host No pathological changes elicited These infections are often so innocuous that patients are often unaware of their condition.Thursday, January 19, 2012
  4. 4. TINEA VERSICOLOR (Pityriasis versicolor) Malassezia furfur: commonly known as “an-an” Direct microscopic examination of alkali stain (KOH or PAS) treated with skin scrapings: “spaghetti and meatballs” CONFIRMATION: cultures are not routinely done ORGANISMS: lipophilic = requires fatty acid-supplemented http://missinglink.ucsf.eduThursday, January 19, 2012
  5. 5. TINEA VERSICOLOR (Pityriasis versicolor) Lesions occur most frequently on the upper torso, arms, and abdomen as discrete hyper – or hypopigmented macular lesions. They scale very easily, giving the affected area a dry, or chalky appearance. Sometimes, lesions appeared to be elevated and folliculitis may occur http:// if hair follicles were involved., January 19, 2012
  6. 6. TREATMENT 1% selenium sulfide applied every other day for 15 minutes and then washed offThursday, January 19, 2012
  7. 7. TINEA NIGRA (Exophiala werneckii) usually asymptomatic and consist of well demarcated macular lesions (discolored spots on the skin that are not raised above the surface) that enlarge by peripheral extension brown to black lesions = often seen at the sole of the foot or at the palmar surface of the hand (other body areas may also be affected)Thursday, January 19, 2012
  8. 8. TINEA NIGRA (Exophiala werneckii) Diagnosis: darkly pigmented yeast like cells and hyphal fragments in microscopic examination of KOH tested scrapings taken from affected area confirmatory test is made by cultureThursday, January 19, 2012
  9. 9. TREATMENT undecyclenic acid keratolytic agent Whitfield’s ointment (daily) Tincture of iodine, 2% salicylic acid or 3% sulfurThursday, January 19, 2012
  10. 10. WHITE PIEDRA (Trichosporon beigelii) soft, white to light brown nodules form on axillary, pubic, beard and scalp hair relapse commonThursday, January 19, 2012
  11. 11. WHITE PIEDRA (Trichosporon beigelii) hyaline septate hyphae that fragment into oval or rectangular arthroconida blastospores can also occur at one or more points on the arthrosporesThursday, January 19, 2012
  12. 12. TREATMENT & DIAGNOSIS DIAGNOSIS direct microscopic exam of hairs culture: asexual phase of the fungus TREATMENT shaving or cutting the infected hair Topical fungicides: bichloride of mercury (1:200) Benzoic and salicylic acid combinations 3% sulfur ointmentsThursday, January 19, 2012
  13. 13. BLACK PIEDRA (Piedraia hortae) hard black nodules formed around the scalp hair (carbonaceous; can house an asci) thick-walled closely septate hyphe, with chlamydoconidia growth is dimorphic – hyphae arthroconidia, and blastoconidia.Thursday, January 19, 2012
  14. 14. DIAGNOSIS & TREATMENT DIAGNOSIS: direct microscopic examination of affected hair culture: Saborauds dextrose agar TREATMENT therapy: shaving and cutting the infected hair topical fungicides, bichloride of mercury Benzoic acid/salicylic acid combinationsThursday, January 19, 2012
  15. 15. BLACK VERSUS WHITE CHARACTERISTIC BLACK PIEDRA WHITE PIEDRA Etiology Piedraia hortae Trichosporon beigelii Over and around the On the surface of the hair shaft , hard, Nodules hair shaft, softer, easy to difficult to detach from separate from hair the hair Tightly packed Arthrospores and Direct Examinations dichotomous branched blastopores can be seen hyphae Presence of asci Positive NegativeThursday, January 19, 2012
  16. 16. CUTANEOUS MYCOSESThursday, January 19, 2012
  17. 17. CUTANEOUS MYCOSES : DERMATOPHYTES superficial fungal infections of the skin, hair and nails may stimulate immune response no living tissues are involved = generally restricted to the keratinized layers of the integument and its appendages NOTE: a variety of pathological changes may occur in the host because of the presence of infectious agent and its metabolic productThursday, January 19, 2012
  18. 18. CLASSIFICATION OF DERMATOPHYTESThursday, January 19, 2012
  19. 19. REPRESENTATIVE DERMATOPHYTESThursday, January 19, 2012
  20. 20. CLINICAL FEATURES OF DERMATOPHYTE INFECTIONS FUNGI MOST CLINICAL SKIN DISEASE LOCATION OF LESIONS FREQUENTLY APPEARANCE RESPONSIBLE clinical patches with advancing red, Microsporum canis, TINEA CORPORIS Non-hairy smooth skin vesiculated border and Trichophyton (ringworm) central scaling = mentagrophytes pruritic acute: itching, red T. rubrum interdigital spaces on vesicular TINEA PEDIS T. mentagrophytes feet of persons wearing (athlete’s foot) Epidermophyton shoes chronic: itching, floccosum scaling, fissures erythematousnscaling T. rubrum TINEA CRURIS (jock groin lesion in intertriginous T. mentagrophytes itch) areas = pruritic E. floccosumThursday, January 19, 2012
  21. 21. CLINICAL FEATURES OF DERMATOPHYTE INFECTIONS FUNGI MOST FREQUENTLY SKIN DISEASE LOCATION OF LESIONS CLINICAL APPEARANCE RESPONSIBLE scalp hair circular bald patches ENDOTHRIX: fungus with short hair stubs or M. canis TINEA CAPITIS inside hair shaft broken hair within hair T. tonsurans follicles = Mircosporum- EXOTHRIX: fungus on infected hair fluoresce surface of hair edematous, T. rubrum TINEA BARBAE beard hair erythematous lesion T. mentagrophytes nails thickened or crumbling distally, T. rubrum TINEA UNGUIUM nail discolored = usally T. mentagrophytes (onychomycosis) associated with Tinea E. floccosum pedisThursday, January 19, 2012
  22. 22. TINEA CAPITIS (ringworm of the scalp)Thursday, January 19, 2012
  23. 23. TINEA BARBAEThursday, January 19, 2012
  24. 24. TINEA CORPORIS (ringworm)Thursday, January 19, 2012
  25. 25. TINEA CRURIS (jock itch)Thursday, January 19, 2012
  26. 26. TINEA PEDIS (athlete’s foot))Thursday, January 19, 2012
  27. 27. TINEA MANUUMThursday, January 19, 2012
  28. 28. TINEA UNGUIUM (onychomycosis)Thursday, January 19, 2012
  29. 29. Microsporum audoinii Tinea capitis = intercalary chlamydoconidiumThursday, January 19, 2012
  30. 30. Microsporum canis Tinea capitis, corporis and barbae = pyriform shaped conidiaThursday, January 19, 2012
  31. 31. Microsporum cookei saprophytic = may be found in animal hairs (dogs and rodents)Thursday, January 19, 2012
  32. 32. Microsporum ferrugineum Tinea capitis, corporis = bamboo-shaped hyphaeThursday, January 19, 2012
  33. 33. Microsporum gypseum Tinea capitis, corporis, favosa = ellipsoidal; 4-6 cells in macroconidiaThursday, January 19, 2012
  34. 34. Microsporum gallinae white comb lesion in chicken = blunt tip; cylindrofusiform-shapedThursday, January 19, 2012
  35. 35. Microsporum nanum Tinea capitis, corporis = ringworm of pigsThursday, January 19, 2012
  36. 36. Epidermophyton floccosum Tinea cruris, pedis, unguium = rarely invades hairThursday, January 19, 2012
  37. 37. Microsporum equinum Tinea in horses = large chain of sporesThursday, January 19, 2012
  38. 38. Microsporum fulvum Tinea capitis = bullet-shaped septaThursday, January 19, 2012
  39. 39. Trichophyton mentagrophytes all types of tinea = spiral hyphae “en grappe”Thursday, January 19, 2012
  40. 40. Trichophyton rubrum all types of tinea = “en thyrse”Thursday, January 19, 2012
  41. 41. Trichophyton veruccosum Tinea corporis, barbae = ringworm in cattle (culture requires inositol)Thursday, January 19, 2012
  42. 42. Trichophyton tonsurans Tinea capitis, corporis - originates from aboriginesThursday, January 19, 2012
  43. 43. Trichophyton schoenleinii Tinea capitis, favosa, corporisfavus = scutula (permanent hair loss)Thursday, January 19, 2012
  44. 44. Trichophyton violaceum Tinea capitis, favosa, corporis = black dot (deep violet in culture)Thursday, January 19, 2012
  45. 45. Trichophyton concentricum Tinea imbricata = resembles antler tipThursday, January 19, 2012
  46. 46. ECOLOGICAL NICHE OF CUTANEOUS MYCOSESThursday, January 19, 2012
  47. 47. COMPARING HAIR INFECTIONSThursday, January 19, 2012