CUTANEOUS

MYCOSES

Mycoses - Fungal Infections

Superficial Mycoses
Surface Mycoses Dead layers of skin & its

appendages
Pityriasis versicolor, Tinea nigra, Piedra
Cutaneous Mycoses Full thickness of skin
Dermatophytosis
Muco-cutaneous Candidiasis
Subcutaneous Mycoses
Systemic Mycoses
Opportunistic Mycoses

DERMATOPHYTOSES
DERMATOPHYTES
Filamentous fungi infecting superficial

keratinised tissues - Skin, Hair and Nail

Dermatomycosis v/s Dermatophytosis
Dermatophytoses = Tinea,Ringworm
GENUS

SKIN

NAIL

HAIR

TRICHOPHYTON

EPIDERMOPHYTO
N

MICROSPORUM

Dermatophytes - morphology
In Tissues Hypahe

& Arthrospores
In Culture
Thin, septate,

branching hyphae
Microconidia Small
asexual spores
Macroconidia Large
asexual spores

Dermatophytes morphology.
GENUS

TRICHOPHYTO
N

COLONY

Powdery/
Abundan Relatively
velvety / waxy t
less
Elongated,
Pigmentation
blunt ends

Cottony /
MICROSPORUM velvety/
powdery
White / brown
Powdery,
EPIDERMOPHY
TON

MICROCON MACROCONIDIA
IDIA

Greenish
yellow

Scanty

Numerous
Spindle
shaped

Absent

Many
Pear-shaped
in clusters

Dematophyte species
Trichophyton
T. rubrum
T. violaceum
T. mentagrophytes
T. verrucosum
Microsporum
M. gypseum
M. canis
M. nanum
Epidermophyton floccosum

Trichophyton
mentagrophytes

Microsporum canis

Epidermophyton
floccosum

Microsporum gypseum

Trichophyton rubrum

PATHOGENESIS
SOURCE
Patient - Anthropophilic
Animal - Zoophilic
Soil Geophilic
Grow only in keratinised tissues
Do not penetrate living tissues
Fungal products Local inflammation
Hypersensitivity Distant lesions

CLINICAL
PRESENTATIONS

Ringworm Scaly erythematous lesion with

central clearing

CLINICAL
PRESENTATIONS
Tinea capitis

Tinea corporis

CLINICAL PRESENTATIONS
Tinea barbae
(Barbers itch)

Tinea cruris
(Jock itch)

CLINICAL
Moccasin type of
PRESENTATIONS
Tinea pedis
(Athletes foot)

Tinea pedis

Tinea unguium

Tinea imbricata

Kerion
Favus

Dermatophyte Hair Infection

Ectothrix

Endothrix

ID Reaction (Dermatophytid)
Dermatophyte

infection
Hypersensitivity ID
reaction at a distant
site
ID lesions sterile
Disappear after

treating the primary

lesion

LAB DIAGNOSIS
SPECIMENS: in

sterile paper packets

Skin scrapings
Nail clippings
Plucked Hair
WOODs Lamp

MICROSCOPY
KOH 10% - Digest

keratin
Calcofluor white
Fluorescent technique
CULTURE
On Sabouraud

Dextrose Agar
Microscopic study of
growth

TREATMENT
Limited infection Topical antifungals
Extensive /widespread lesions Oral

antifungals
AZOLES Itraconazole, Clotrimazole,

Ketoconazole, Fluconazole
Griseofulvin Oral drug of choice
Terbinafine

MUCOCUTANEOUS
CANDIDIASIS

CANDIDA
Candida albicans
Non-albicans

Candida spp
Yeast-like fungus
Pseudohyphae
Infection of skin &
mucosa; rarely of
internal organs

Pathogenesis
Candidiasis/ Candidosis/ Moniliasis
Normal inhabitant of skin and mucosa
Diabetes mellitus MC risk factor
Other risk factors AIDS, Steroids,

Immunosuppression
Cutaneous Candidiasis
Mucosal Candidiasis
Systemic Candidiasis - rare

CUTANEOUS
INTERTRIGINOUS
Skin macerated by

perspiration
Groin, perineum,
axillae,
inframammary fold
PARONYCHIA
Frequent immersion

of hands in water

Mucosal candidiasis
Oral Thrush
Bottlefed, elderly,

etc

Vaginal candidiasis
Balanoposthitis
Intestinal candidiasis
Bronchopulmonary

Lab Diagnosis
SPECIMENS:
Scrapings, swabs, sputum, blood, etc
Microscopy budding yeast cells,

pseudohyphae
Culture
Germ tube test
Cornmeal agar Chlamydospore
Sugar assimilation & Fermentation tests
Antifungal susceptibility test

CULTURE
Sabouraud Dextrose

Agar Creamy white,

yeasty odour

Germ tube test in

plasma

Chlamydospores on Cornmeal agar

Reynold Braude phenomenon

TREATMENT
Removal of predisposing factor
TOPICAL
Nystatin
Azoles
SYSTEMIC
Amphotericin B
5 Fluorocytocine
Azole

Thank you