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Skin and soft tissues infections

Skin and soft tissues infections. Classification of mycoses. Superficial and cutaneous Subcutaneous Deep (systemic) . Superficial mycoses . Caused by fungi living as saprophytes Hair, dead skin and lipids secretions They don’t provoke any immune response No pain or itching.

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Skin and soft tissues infections

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  1. Skin and soft tissues infections

  2. Classification of mycoses • Superficial and cutaneous • Subcutaneous • Deep (systemic)

  3. Superficial mycoses • Caused by fungi living as saprophytes • Hair, dead skin and lipids secretions • They don’t provoke any immune response • No pain or itching

  4. Pityriasisversicolor • Common, mild and chronic infection of stratum corneum • World-wide • More common in tropics and sub-tropics • In temperate regions more common during summer

  5. PityriasisversicolorCaused by Malasseziayeast, which is lipophilic dimorphic fungus

  6. KOH Parker ink staining

  7. Tineanigra Typical brown to black, non-scaling macules on the palmar aspect of the hands.  Note: there is no inflammatory reaction

  8. Cutaneous mycoses • Infections in the living parts of the body: • Skin • Hair and nail • Mucocutaneous membranes • Genitalia • Tow types can be recognized • Dematophytes infections • Non-dermatophytes infections

  9. Dematophytes infections(dematophytosis) • Ringworm (hair and skin) • Favus (hair) • Onychomycosis (nail)

  10. Dermatophytosis(=Tinea = Ringworm) Infections of the skin, hair and nails due to a group of related filamentous keratinophilic fungi called dermatophytes

  11. Dermatophytes • Microsporum Hair, skin • Epidermophyton Skin, nail • Trichophyton Hair, skin, nail • Digest keratin by their keratinases • Resistant to cycloheximide

  12. Epidemiology and natural habitat • Some have a world-wide distribution • Some are restricted to particular regions • About 10 species are common causes of human infection • Classified into three groups depending on their usual habitat

  13. Anthropophilic • Human is usual host • T. rubrum (foot & nail infections) • E. floccosum (foot & nail infections) • T. tonsurans (scalp infections) • M. audouinii (scalp infections)

  14. Geophilic • Normal habitat is soil • Can cause infections in both humans and animals • Microsporumgypseum

  15. Zoophilic • Often associated with a particular animal • Microsporumcanis: cats and dogs • Trichophytonverrucosum: horse and cattle

  16. Dermatophytosis • Skin: • Circular dry lesions • Slightly raised red scaly margins • Surrounded by red itchy skin • Fungus remain restricted to stratum corneum • Metabolites provoke inflammation • Hair: • Typical lesions → scarring + alopecia • Nail: • Thickened, deformed, fragile, discolored • Sub-ungual debris accumulation

  17. Dermatophytosis clinical classification Infection is named according to the anatomic location involved

  18. Clinical manifestation (1) • Ringworm • Tineapedis (athlete's foot) • Tineamanuum (hands) • Tineacorporis (trunk, neck and back) • Tineacruris (hairy skin around the genitilia) • Tineabarbae (hairy skin in the face) • Tineacapitis (scalp and eyebrows)

  19. Clinical manifestation (2) • Favus (scalp) • Onychomycosis (nail)

  20. Athlete's foot (Tineapedis )

  21. Tineapedis

  22. Tineamanuum

  23. Tineamanuum

  24. Tineamanuum

  25. Tinea corporis Tinea corporis caused by M. canisfollowing contact with infectious cat

  26. Tineacruris Tinea of the groin showing typical erythematous lesions on the inner thighs Tinea of the buttocks

  27. Tinea barbae

  28. Tinea capitis caused by M. canisfollowing contact with infectious cat Tinea capitis showing extensive hair losscaused by M. canis

  29. Favus and Onychomycosis • Favus • Special form of tineacapitis • Onychomycosis • Fungal infection of nail • The term "tineaunguium" is used specifically to describe dermatophyticonychomycosis

  30. Tinea capitis showing alopecia Favus

  31. Tinea of the nails caused by T. rubrum

  32. Laboratory diagnosis • 50 % of suspicious materials may be negative • Hyphae and/or arthrospores is diagnostic • Culture is more reliable: • Determined species • Source of infection • Can be positive even if direct examination is negative

  33. Hyphal elements seen in skin scraping preparation

  34. Management • Dependant on the clinical setting • Topical or oral antifungal

  35. Oral management options

  36. Non-dermatophytescutaneous infections • Onychmycosis • Intertrigo • Mucocutaneouscandidiasis • Thrush • Vulvo-vaginitis

  37. Intertrigo caused by Candida albicans

  38. Red macerated rash under pendulous breasts is a common presentation of cutaneous candidiasis

  39. Candida diaper dermatitis This condition should not be considered a primary Candida infection as it preceded by an irritant dermatitis

  40. Subcutaneous Mycoses • Skin, subcutaneous tissues, fascia and bone • Localized • Trauma • More in tropics • Mycetoma, chromomycosis and sporotrichosis

  41. Mycetoma

  42. Mycetoma

  43. Sporotrichosis A 60-year-old woman developed multiple subcutaneous nodules and abscesses on her right hand and forearm 7 days after finger thorn prick

  44. Sporotrichosis

  45. Classical Chromoblastomycosis: Fonsecaea pedrosoi De Hoog,Centraalbureau voor Schimmelcultures

  46. Nodulose chromoblastomycosis (Senegal): Fonsecaea pedrosoi De Hoog,Centraalbureau voor Schimmelcultures

  47. Management • Difficult • Surgical excision • Itraconazole and other antifungal

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