![Page 1: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/1.jpg)
Superficial and Superficial and Cutaneous Cutaneous MycosesMycoses
Eva L.Dizon,MDEva L.Dizon,MD
![Page 2: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/2.jpg)
Superficial MycosesSuperficial Mycoses
• Limited to the outermost layer of the skin
• 4 Infections– 1.Pityriasis versicolor– 2.Tinea nigra– 3. Black piedra – 4. White piedra
![Page 3: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/3.jpg)
SuperficialSuperficial
• Do not elicit immune response• No discomfort • Cosmetic problems• Limited to stratum corneum
![Page 4: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/4.jpg)
Pityriasis VersicolorPityriasis Versicolor• Malassezia furfur (Pityrosporum
orbiculare)• Lipophilic yeast like organism• Rich in sebaceous glands• Media is supplemented with fatty
acids• Exist in budding yeast,occasionally
hyphal
![Page 5: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/5.jpg)
Pityrisis versicolor (An-an)Pityrisis versicolor (An-an)
![Page 6: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/6.jpg)
PityriasisPityriasis
• Lesions are found in torso, arms and abdomen
• Scale very easily chalky appearance
• Rarely, papular or grow like folliculitis
![Page 7: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/7.jpg)
PityriasisPityriasis
• Clinical Diagnosis: KOH- Spaghetti and meatballs
• Treatment: Azoles
![Page 8: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/8.jpg)
Tinea NigraTinea Nigra• Exophiala werneckii• Produce melanin black or brown
color• Grows as yeast Older hyphae with
mycelia and conidia
![Page 9: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/9.jpg)
Tinea nigraTinea nigra• Lesion- gray
to black macular palms
• Diagnosis- Skin scrapings with alkali stain
• Cultures- Sabourauds’s media pigmented yeast and hyphae
![Page 10: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/10.jpg)
Black PiedraBlack Piedra• Piedraia hortae- exist in teleomorphic
state• Cultures – asexual state
- older cultures teleomorphic (asci ,which contain spindle shaped ascospores)
![Page 11: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/11.jpg)
Black piedraBlack piedra
• Clinical feature: presence of hard nodules found along the infected hair shaft
• Nodules contain asci
![Page 12: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/12.jpg)
White PiedraWhite Piedra
• Trichosporon beigelii• Grows in media without
cyclohexamide• Cultures are pasty and white
developed deep radiating furrows and become yellow and creamy
![Page 13: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/13.jpg)
White PiedraWhite Piedra
• Microscopic examination septate hypae that develops into arthroconidia
• Hair- soft ,pasty,cream colored growth
![Page 14: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/14.jpg)
TreatmentTreatment• Skin
removal of the organism by: 1.Selenium sulfide 2.Thiosulfate 3.Salicylic acid 4.Hyposulfite inhibition of ergosterol by: 1.miconazole
![Page 15: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/15.jpg)
Cutaneous mycosesCutaneous mycoses
• Skin• Hair• Nails• Evoke cellular immune response• Dermatophytes• Clinical
manifestationsringworm or tinea
![Page 16: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/16.jpg)
Cutaneous mycosesCutaneous mycoses
• Etiology Microsporum
Trichophyton
Epidermophyton
![Page 17: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/17.jpg)
Cutaneous mycosesCutaneous mycoses
• Classifications: Anatomic location
Tinea pedis Tinea capitis Tinea corporis
Tinea cruris Ecologic location
Geophilic Zoophilic
Anthrophilic
![Page 18: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/18.jpg)
Cutaneous mycosesCutaneous mycoses
• Keratophilic – use keratin as subject to live ( parasites)
• Keratinases- invade only keratinized layers
![Page 19: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/19.jpg)
• 2 basic types of dermatophytic infection:
1. The acute or inflammatory type of infection, which is associated with CMI to the fungus, generally heals spontaneously or responds nicely to treatment.2. The chronic or non-inflammatory types of infection, which is associated with a failure to express CMI to the fungus at the site of infection, is relapsing and responds poorly to treatment.
![Page 20: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/20.jpg)
Cutaneous mycosesCutaneous mycoses
![Page 21: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/21.jpg)
Tinea corporisTinea corporis
![Page 22: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/22.jpg)
Cutaneous mycosesCutaneous mycoses• THE IDENTIFICATION REACTION(ID)• Patients infected with a dermatophyte may show
a lesion, often on the hands, from which no fungi can be recovered or demonstrated.
• It is believed that these lesions, which often occur on the dominant hand (i.e. right-handed or left-handed), are secondary to immunological sensitization to a primary (and often unnoticed) infection located somewhere else (e.g. feet).
• These secondary lesions will not respond to topical treatment but will resolve if the primary infection is successfully treated.
![Page 23: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/23.jpg)
Cutaneous mycosesCutaneous mycoses• Laboratory diagnosis: scrapings
from clinical specimens• Hair – endothrix (spores inside the hair
shaft) -ectothrix -exception: T.schoenleinii Disease-favus-waxy mass of hyphal elements (scutulum) microscopic –degenerated hyphal elements
![Page 24: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/24.jpg)
Cutaneous mycosesCutaneous mycoses
• Cultures• Selective media – containing
cycloheximide and chlorampenicolincubate at 25 C.
• Identification based on the conidia
![Page 25: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/25.jpg)
Ringworm cultureRingworm culture
![Page 26: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/26.jpg)
MicrosporumMicrosporum
![Page 27: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/27.jpg)
General characteristics of Macroconidia and General characteristics of Macroconidia and Microconidia of DermatophytesMicroconidia of Dermatophytes
Genus Macroconidia Microconidia
Microsporum Numerous, thick walled,rough
Rare
Epidermophyton Numerous, smooth walled
Absent
Trichophyton Rare,thin walled, smooth
Abundant
![Page 28: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/28.jpg)
MicrosporumMicrosporum
![Page 29: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/29.jpg)
TrichophytonTrichophyton
![Page 30: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/30.jpg)
MicrosporumMicrosporum
![Page 31: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/31.jpg)
Epidermophyton floccusom
![Page 32: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/32.jpg)
![Page 33: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/33.jpg)
DiagnosisDiagnosis• Diagnosis is based upon:
1. Anatomical site infected 2. Type of lesion 3. Examination with a Woods lamp (366
A°) 4. Examination of KOH-treated skin
scales from the infected area 5. Culture of the organism (not too
important)
![Page 34: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/34.jpg)
Differential diagnosisDifferential diagnosis• In a differential diagnosis you must consider:
1. Leprosy 2. Secondary syphilis 3. Pityriasis rosea
4. Psoriasis 5. Nummular eczema 6. Lichen planus 7. Alopecia areata 8. Trichotillomania 9. Dyshidrosis 10. Contact dermatitis.
![Page 35: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/35.jpg)
TreatmentTreatment• Skin – azoles,inhibits cytochrome 450
dependent enzyme systems at the demethylation step from lanosterol to ergosterol
• Hair- Griseofulvin, oral , affects microtubular system
![Page 36: Superficial and Cutaneous Mycoses Eva L.Dizon,MD](https://reader035.vdocuments.us/reader035/viewer/2022062408/56649ed95503460f94be7d11/html5/thumbnails/36.jpg)
Thank you very much!!!