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SUPERFICIAL MYCOSES

SUPERFICIAL MYCOSES. Sevtap Arikan, MD. SUPERFICIAL MYCOSES. Dermatophytosis Pityriasis versicolor Keratomycosis Tinea nigra Black piedra White piedra. DERMATOPHYTOSIS (=Tinea = Ringworm).

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SUPERFICIAL MYCOSES

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  1. SUPERFICIAL MYCOSES Sevtap Arikan, MD

  2. SUPERFICIAL MYCOSES • Dermatophytosis • Pityriasis versicolor • Keratomycosis • Tinea nigra • Black piedra • White piedra

  3. DERMATOPHYTOSIS(=Tinea = Ringworm) • Infection of the skin, hair or nails caused by a group of keratinophilic fungi, called dermatophytes • MicrosporumHair, skin • EpidermophytonSkin, nail • TrichophytonHair, skin, nail

  4. DERMATOPHYTES • Digest keratin by their keratinases • Resistant to cycloheximide • Classified into three groups depending on their usual habitat

  5. DERMATOPHYTES • ANTROPOPHILIC Trichophyton rubrum... • GEOPHILIC Microsporum gypseum... • ZOOPHILIC Microsporum canis: cats and dogs Microsporum nanum: swine Trichophyton verrucosum: horse and swine…

  6. DERMATOPHYTOSISPathogenesis and Immunity • Contact and trauma • Moisture • Crowded living conditions • Cellular immunodeficiency (chronic inf.) • Re-infection is possible (but, larger inoculum is needed, the course is shorter )

  7. DERMATOPHYTOSISClinical Classification • Infection is named according to the anatomic location involved: a. Tinea barbae e. Tinea pedis (Athlete’s foot) b. Tinea corporis f. Tinea manuum c. Tinea capitis g. Tinea unguium d. Tinea cruris (Jock itch)

  8. DERMATOPHYTOSISClinical manifestations • Skin: Circular, dry, erythematous, scaly, itchy lesions • Hair: Typical lesions,”kerion”, scarring, “alopecia” • Nail: Thickened, deformed, friable, discolored nails, subungual debris accumulation • Favus (Tinea favosa)

  9. DERMATOPHYTOSISTransmission • Close human contact • Sharing clothes, combs, brushes, towels, bedsheets... (Indirect) • Animal-to-human contact (Zoophilic)

  10. DERMATOPHYTOSISDiagnosis I. Clinical Appearance Wood lamp (UV, 365 nm) II. Lab A. Direct microscopic examination (10-25% KOH) Ectothrix/endothrix/favic hair

  11. DERMATOPHYTOSISDiagnosis B. Culture Mycobiotic agar Sabouraud dextrose agar

  12. DERMATOPHYTESIdentification A. Colony characteristics B. Microscopic morphology MacroconidiumMicroconidium Microsporum----fusiform---------------(+) Epidermophyton clavate-----------------(-) Trichophyton-- -(few)cylindrical/ --- --(+) clavate/fusiform single, in clusters

  13. DERMATOPHYTESIdentification C. Physiological tests • In vitro hair perforation test • Special amino acid and vitamin requirements • Urea hydrolysis • Growth on BCP-milk solids-glucose medium • Growth on polished rice grains • Temperature tolerance and enhancement

  14. DERMATOPHYTOSISTreatment • Topical Miconazole, clotrimazole, econazole, terbinafine... • Oral Griseofulvin Ketaconazole Itraconazole Terbinafine

  15. PITYRIASIS VERSICOLOR • Superficial chronic infection of Stratum corneum • Etio:Malassezia furfur (Pityrosporum orbiculare) (Lipophilic yeast) • Clinical findings: Hyperpigmented or depigmented maculae on chest, back, arms, abdomen

  16. PITYRIASIS VERSICOLOR • Systemic infection (parenteral lipid solution) • Micr.: Short hyphae, yeast cells • Culture: Yeast (suppl.: olive oil) • Treatm.: Topical selenium sulfide Oral ketaconazole Oral itraconazole

  17. KERATOMYCOSIS(=Mycotic keratitis) • Posttraumatic / postsurgical corneal inf. • Etio: Saprophytic fungi (Aspergillus, Fusarium, Alternaria, Candida), Histoplasma capsulatum • Clinical findings: Corneal ulcer

  18. KERATOMYCOSIS • Micr.: Hyphae in corneal scrapings • Treatm.: Surgery (keratoplasty) Topical pimaricin Nystatin Amphotericin B

  19. 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

  20. TINEA NIGRA • Micr.:Septate hyphae and yeast cells (brown in color) • Culture: Black colonies • Treatm.: Topical salicylic acid, tincture of iodine

  21. 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

  22. BLACK PIEDRA • Micr. Septate pigmented hyphae, and asci; unicellular and fusiform ascospores with polar filament(s) • Culture: Brown to black colonies • Treatm.: Topical salicylic acid, azol cremes

  23. WHITE PIEDRA • Fungal infection of facial, axillary or genital hair • Etio:Trichosporon (yeast) • Frequent in tropical and temperate zones

  24. 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 • Treatm.: Shaving, azoles

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