SUPERFICIAL &

CUTANEOUS
MYCOSES
 → fungal infections
MYCOSES acquired by man
through inhalation
or inoculation by
trauma into the skin
MYCOSES AND MYCOTIC INFECTIONS

→ only about 100 species of yeasts and

molds cause disease in humans and animals

→ Dermatophytes and Candida species are

commonly transmitted between humans
 RISK FACTORS

→ Immunocompromised due to long-term antibiotic treatment

Use of immunosuppressive drugs: Cancer chemotherapy

drugs, Corticosteroids
Drugs that prevent organ rejection

Disorders: AIDS, Burns, if extensive ; Diabetes ; Hodgkin

lymphoma or other lymphomas; Kidney failure ; Lung
disorders, such as emphysema ; Leukemia
CLASSIFICATION OF MYCOSES

Superficial Mycoses
Cutaneous Mycoses
Subcutaneous Mycoses
Systemic Mycoses
Opportunistic Mycoses
 SUPERFICIAL MYCOSES

Noninvasive skin, hair, or nails

No cellular response from host

No pathological changes

Host unaware
 Disease Causative Incidence
Organisms
Pityriasis versicolor Malassezia Common
furfur
Seborrhoeic dermatitis (a lipophilic
including Dandruff yeast)
Follicular pityriasis

Tinea nigra Exophiala Rare

werneckii
White Piedra Trichosporon Common
beigelii
Black Piedra Piedraia hortae Rare
 Pityriasis versicolor

→ a chronic mild superficial infection of the stratum corneum

→ Causative Agent: Malassezia furfur complex

( M globosa, M restricta)
lipophilic
→ young adults yeast,
isolated from
normal skin
→Distribution: Worldwide, more common in TROPICAL
and scalp
climates
 Pityriasis versicolor
Lesions:

discrete, serpentine

hyper or hypopigmented maculae on skin

Chest, upper back, arms, abdomen

Scaly, chalky , inflammation, and irritation are minimal

enlarge or coalesce
 Pityriasis versicolor
Diagnosis:
→ Direct microscopic examination (10-20% KOH,stained with
calcofluor white)
Pityriasis versicolor
Diagnosis:

Wood’s lamp
 Culture is unnecessary
SDA overlaid with peanut oil, olive oil
Dixon’s agar (glycerol-mono-oleate)
 Pityriasis versicolor
Treatment:

Selenium sulfide (1%) applied daily

Oral or topical azoles
Mild fungicides
Miconazoles
 Opportunistic fungemia

→ catheter acquired infection common in neonates & adults

undergoing lipid replacement therapy

→small embolic lesions in the lungs and other organs

Diagnosis: Blood drawn back from catheter, culture tip of

catheter

Treatment: replace fluid and intravenous catheter

 Pityriasis folliculitis

→ follicular papules and

pustules

→ Back, chest, upper

arms, neck, more seldom
the face

→ Itchy

→ after sun exposure

 Pityriasis folliculitis
Diagnosis and Treatment

→ Scrapings or biopsy : yeasts at the mouths of infected

follicles

→ Topical imidazole
If lesions are extensive, ketoconazole, itraconazole
Prophylactic treatment 1x or 2x week to prevent
relapse
 Seborrheic Dermatitis

→ Host factors

→ Parkinson’s disease, AIDS

→ erythema and greasy

scaling

→Scalp, face, eyebrows,

ears, upper trunk

topical imidazole, ketoconazole, relapse is common

 Malassezia Dermatitis

Causative Agent: Malassezia pachydermatis

Phytosporum canis
Common
Microclimate alterations
yeast in
canine
host defenses are downskin
and external
ear canal
little zoonotic potential

Ketoconazole, miconazole
 Malassezia Dermatitis
Lesions:
Pruritus

Greasiness

Lichenification

Strong body odor

Otitis externa

Staphylococcal pyoderma
Peanut-shaped
yeast

M pachydermatis from a dog ear

TINEA is Latin
for “growing
worm”.
 Tinea Nigra
(Tinea Nigra Palmaris)

Causative Agent: Hortaea (Exophiala) werneckii

saprophyte in asymptomatic
Chronic,
soil, compost,
humus
young women, warm coastal regions, and
tropical
wood

Distribution: Central and South America, Australia, Southeast

Asia, Africa
 Tinea Nigra
Lesions:

dark (brown to black) on palm,

well demarcated macular lesions
No inflammatory reaction
 Tinea Nigra
Diagnosis:
Direct microscopic examination (KOH)

brown to septate
olivaceous hyphae

Melanized cell 2-celled yeast

wall
 mucoid

yeast-like

shiny black

Culture on SDA
 Tinea Nigra
Treatment :
Whitfield’s ointment (benzoic acid compound)

2% salicylic acid, 3% sulfur

azole antifungal drugs

tincture of iodine

Miconazole nitrate, imidazoles, triazoles

 PIEDRA

→ from the Spanish word stone

→ fungus infection of the hair shaft
→ firm, irregular nodules
→ multiple infections of the same strand
 BLACK PIEDRA

Causative Agent : Piedraia hortae

Ascomycetous
soil is source of infection
fungi

humans and primates

Distribution: Africa, Asia, Central, South America

can be confused with trichorrhexis nodosa and trichonodosis

 BLACK PIEDRA
Lesions:

Scalp hair

beard and moustache

axilla and groin hairs

discrete, hard, gritty , brown to black nodules

 BLACK PIEDRA
Diagnosis & Treatment:
Direct microscopic examination (KOH)

Round to oval asci, curved to fusiform ascospores

Dark septate hyphae
 Culture on SDA-CC
Very slow, dark brown to black
Heaped center with flat periphery
Short aerial mycelium
 BLACK PIEDRA
Diagnosis & Treatment:

Usually shaving or cutting hair short

Terbinafine
 WHITE PIEDRA

Causative Agent : Trichosporon beigelli, T cutaneum

Distribution : South America,Asia

N. America & Europe (sporadic)

soil, stagnant water, decaying fruit, spoiled food, sputum and

body surfaces, horses

Face, axilla, genitals : common

Scalp, eyebrows, eyelashes : less common
 WHITE PIEDRA
Lesions:

yellowish to white, soft, beige or greenish,

irregular transparent sheath
 WHITE PIEDRA
Diagnosis
Direct microscopic examination
(10% KOH or 25% NAOH plus 5% glycerin)

Hyaline septate
hyphae

Oval/rectangular
arthroconidia

Blastoconidia
Culture on SDA with chloramphenicol, without cycloheximide

rapid
Cream-colored

Soft, membranous

Wrinkled radial
furrows

Irregular folding
 WHITE PIEDRA
Treatment:

Usually shaving or cutting hair short

1:200 bichloride mercury, benzoic acid & salicylic acid, 3%

sulfur ointment, 2% Formalin, combinations
 CUTANEOUS MYCOSES

keratinized tissue
restricted to non viable skin

unable to grow at 37° C

unable to grow in presence of serum

Host specific : keratinases, elastases,

enzymes
 DERMATOPHYTES

Dermatophytoses: infection of skin, hair and nails

nonviable skin: only hyphae and arthroconidia

sexual state belong to a single genus Arthroderma

 Presence of Presence of
macroconidia; microconidia, Special Site of
Genera Texture
its its name infection
characteristics characteristics

; large, spindle
shaped,multicellul rough “sheath of skin, hair,
Microsporum ar form on ends of walled  spores” rare in nails
hyphae

 pencil shaped
macroconidia smooth “ghost
Trichophyton with blunt ends walled  hair”
are rare

 only one- to
five-celled,club
shaped macro are
formed in skin and
smooth “ghost of
Epidermophyton greenish-yellow walled x skin” nails, never
colony which hair
mutates readily to
form a sterile
white growth
 ECOLOGICAL GROUPS

GEOPHILIC : soil ; decompose keratinaceous debris

ZOOPHILIC: parasitic on animals

ANTHROPHILIC: man is exclusive host

CLINICAL MANIFESTATIONS

Tinea or ringworm – raised circular lesions

Tinea pedis : foot

Tinea capitis: head
Tinea corporis: body
Tinea unguium: nails
Tinea cruris: crotch
 Tinea pedis
(Athlete’s foot)

Etiologic Agents: Trichophyton mentagrophytes,

Trichophyton rubrum, Epidermophyton floccosum,
Trichophyton interdigitale
chronic infection of the toe webs

matting or carpets with desquamated infectious

scales
Moccasin
Tinea pedis
typeby
byTErubrum
floccosum
(left)(left)
; severe
; vesicular
maceration
type by
T interdigitale
(right) (right)
 Tinea unguium (Onychomycosis)

Etiologic Agents: T rubrum, T interdigitale

invasion of the nail plate

one or more nails of the hands or feet

Onychomycosis : nondermatophytic fungal nail

infection (yeasts)
T rubrum
 Tinea corporis

Etiologic Agents: E floccosum, T rubrum, T tonsurans,

M canis and M gypseum (geophilic infections)

glabrous or non hairy areas of the skin

grow within dead keratinized tissue

M canis ; after exposure to infectious kittens
 Tinea cruris

Etiologic Agents: E floccosum, T rubrum,

T interdigitale
proximal medial thighs, perineum and buttocks

Jock Itch - more common in males

military personnel, sharing of towels and

clothing
Erythematous lesions on the thighs
Granular strain Downy strain
 Tinea capitis

scalp and hair

begin at scalp with hyphal invasion

2 types: Ectothrix and Endothrix

 Ectothrix Infection

Etiologic agents: M. canis, M. gypseum, T. equinum

and T. verrucosum

around hair shaft

chain of spores imparting greenish to silvery

fluorescence
 Endothrix Infection

Etiologic agents: T tonsurans, T. violaceum

within hair shaft

black dot, weakened and break

All are anthrophilic

 Kerion

Kerion: severe combined inflammatory and

hypersensitivity reaction
 Favus

Favus: acute inflammatory infection of

hair follicle leading to scrutula or crusts
T. schoenleinii
 Tinea barbae

Etiologic agents: T mentagrophytes

bearded region

zoophilic dermatophyte : pyogenic infection

 Tinea manuum

Interdigital areas and palmar surfaces

Occurs almost exclusively in adults

Itchiness is moderate and minimal

Slow progress : months to years

1st pattern : ringworm pattern at dorsum of hand
 2nd pattern : chronic scaling at palmar surface
Dry, hyperkeratotic, thickened, fine, silvery white scales
 Tinea imbricata
“Tokelau”

Etiologic agents: Trichophyton concentricum

Distribution: Southwest Polynesia, Melanesia,

Southeast Asia, India, and Central America

Concentric rings;
Chronic non-itchy rash
 Tricophytid Reaction

hypersensitivity to metabolic products of fungus

producing dermatophyids
LABORATORY DIAGNOSIS

Skin scrapings → KOH mount

Nail scrapings and clippings

 HAIR

Ectothrix Flouresce Cuticle

under Wood’s destroyed
Lamp
(Bright
greenish
yellow)
Endothrix Do not Cuticle
flouresce intact
Ectothrix Microsporum canis
M. gypseum
T. equinum
T.verrucosum

Endothrix ALL ANTRHOPHILIC!

Trichophyton tonsurans
Trichophyton villaceum
 Culture

Non-selective: Saboraud’s Dextrose Agar (SDA)

Selective: SDA-CC (Mycosel or Mycobiotic agar)

Dermatophyte test medium

Incubation: room temperature, at least 2 weeks

 Culture

SDA – CC for 1-3 weeks

 Identification

Gross color & texture

Microscopic characteristics

Confirm/compare with:
Written descriptions
Drawings
Photographs
 TREATMENT

Removal of infected and dead epithelial

structures

Apply topical antifungal chemical or antibiotic

keep dry, avoid shared bathing facilities and

infected pets
 Infection Oral Topical Duration
Tinea capitis griseofulvin Shampoos and
terbinafine miconazole
Weeks

cream ,
ketoconazole,
itraconazole

Tinea corporis, itraconazole Miconazole

terbinafine Nitrate
2-4 weeks
Tinea pedis Tolnaftate
clotrimazole
Tinea unguium itroconazole ---- (surgical Relapses
terbinafine removal) are
common
 Microsporum gypseum

Geophilic

single inflammatory skin/scalp lesion

Distribution: worldwide
 REVERSE

Flat, spreading suede-like to granular

Cinnamon growth

Yellow brown pigment on reverse of colony

 Symmetrical, ellipsoidal

Thin-walled verrucose macroconidia

Distal end round, proximal end blunt

Trichophyton mentagrophytes

Zoophilic :
mice, cats,horses,sheep,rabbits
Inflammatory skin/scalp lesions

Ectothrix infection

Distribution: worldwide
 REVERSE

Flat, white to cream color, powdery to granular surface

Red brown submerged peripheral fringe

Reverse pigment is yellowish brown to pinkish

 Spherical microconidia

Dense clusters, “en grappe”

Spiral hyphae
Smooth, thin-walled, clavate, multiseptate macroconidia
 Trichophyton rubrum

Anthropophilic

Chronic infection of skin & nails, rarely scalp

Ectothrix and Endothrix hair infection

Distribution: worldwide
 REVERSE

White, suede-like to downy

Deep wine red pigment on reverse side

Moderate to scanty slender clavate to pyriform
microconidia
 Macroconidia are absent,
Closterospore-like projections in some strains
Trichophyton tonsurans

Variation in texture and color

Suede-like to powdery
Flat with raised center or folded
With radial grooves

Pale buff to yellow

Varying sizes and shapes of microconidia

Long clavate to pyriform

Very occasional clavate macroconidia
Partial requirement for thiamine
Trichophyton concentricum

Anthrophophilic

Tinea imbricata

Distribution:
Pacific Islands of Oceania
Southeast Asia
Central and South America
Raised and folded, glabrous and suede-like
White to cream color
Deeply folded into the agar

No microconidia and macroconidia

 Trichophyton schoenleinii

Waxy and glabrous

Deeply folded honeycomb-like thallus with subsurface

growth
 Antler “nail head” hyphae
Favic chandeliers

No microconidia and macroconidia

Epidermophyton floccosum

Anthrophophilic

No hair invasion in vivo

Distribution: worldwide
 Greenish brown or “khaki” colored
Suede-like surface, raised and folded center, flat periphery

White pleomorphic tufts of mycelium

Yellowish brown reverse pigment

Smooth thin-walled macroconidia in clusters growing
directly from hyphae

No microconidia
Numerous chlamydoconidia in older cultures
 Microsporum canis

Zoophilic:
Cats & Dogs

Invades skin & hair, rarely nails

Distribution: worldwide
 White cottony growth

Golden yellow reverse pigment

Spindle shaped, thick walled, verrucose macroconidia
with a terminal knob
 Trichophyton verrucosum

Zoophilic:
Cattle
Infect humans : direct contact, infected fomites
Highly inflammatory: scalp, beard,exposed areas

Ectothrix infection: flouresce only in cattles

Distribution: worldwide
Glabrous, heaped, folded white colony

No reverse pigments
Thiamine-enriched media: clavate – pyriform microconidia
Characteristic rat tail or string bean shape
END.