1. FUNGAL DISEASES of THE SKIN DR. ZIAD ELNASSER

2. FUNGI More than 200,000 species. More than 200,000 species. Eucaryotes. Eucaryotes. Chronic diseases. Chronic diseases.

3. STRUCTURE No peptidoglycan, glycerol, LPS, or teichoic acids. No peptidoglycan, glycerol, LPS, or teichoic acids. Cell wall is formed of Polysaccharides, Mannan, Glucan, and Chitin. Cell wall is formed of Polysaccharides, Mannan, Glucan, and Chitin. Determinants of serologic specificity. Determinants of serologic specificity. Chitin is similar to crab shells or cellulose of plansts. Chitin is similar to crab shells or cellulose of plansts.

4. METABOLISM Heterotrophic, decaying organic matter. Heterotrophic, decaying organic matter. Strict aerobes, some are anaerobes. Strict aerobes, some are anaerobes. Asexual vs Sexual reproduction, Conidia vs Spores. Asexual vs Sexual reproduction, Conidia vs Spores.

5. GROWTH AND MORPHOLOGY Size 2 - 4 µ up to visible structures. Size 2 - 4 µ up to visible structures. Two courses YEAST and or MOLD. Two courses YEAST and or MOLD. Yeasts buds produce blastoconidia. Yeasts buds produce blastoconidia. Colonies. Colonies. Molds form Hyphae then Mycelium, Septa. Molds form Hyphae then Mycelium, Septa. Aerial, or Rhizoids. Aerial, or Rhizoids. Pseudohyphae. Pseudohyphae.

11. GROWTH AND MORPHOLOGY Conidia on a condiophore. Conidia on a condiophore. Macroconidia, Microconidia. Macroconidia, Microconidia. Chlamydoconidia. Chlamydoconidia. Arthroconidia Arthroconidia Ascospores Ascospores Dimorphic fungi. Dimorphic fungi.

16. CLASSIFICATION Depends on spores, septation. Depends on spores, septation. Zygomycetes. Zygomycetes. Ascomycetes. Ascomycetes. Basidiomycetes. Basidiomycetes. Deuteromycetes (Fungi imperfecta). Deuteromycetes (Fungi imperfecta).

17. CLASSIFICATION Superficial Mycosis. Superficial Mycosis. Subcutaneous Mycosis. Subcutaneous Mycosis. Opportunistic Fungi. Opportunistic Fungi. Systemic Mycosis. Systemic Mycosis.

18. SUPERFICIAL MYCOSIS Dermatophytes. Dermatophytes. Tinea versicolor. Tinea versicolor. Tinea nigra. Tinea nigra. Piedra. Piedra.

19. DERMATOPHYTES Ring worm, Tinea, Atheletes foot, Jock itch. Ring worm, Tinea, Atheletes foot, Jock itch. Epidermophyton, Microsporum, Trichophyton. Epidermophyton, Microsporum, Trichophyton. Macroconidia morphology. Macroconidia morphology. Grows on SAB, 25 C, septate hyphae. Grows on SAB, 25 C, septate hyphae.

23. EPIDEMIOLOGY Adapted to skin of humans and or animals. Adapted to skin of humans and or animals. Soil. Soil. Low infectivity, close contact. Low infectivity, close contact. Families, barber shops, locker rooms. Families, barber shops, locker rooms. Simple hands washing. Simple hands washing.

24. PATHOGENESIS Minor trauma, stratum corneum not deeper. Minor trauma, stratum corneum not deeper. Anatomic location, skin growth and desquamation, inflamatory response. Anatomic location, skin growth and desquamation, inflamatory response. Role of Corticosteroids. Role of Corticosteroids. Ring worms or Tineas. Ring worms or Tineas. Skin, nails, hair (exothrix, endothrix). Skin, nails, hair (exothrix, endothrix).

26. IMMUNITY Inflamatory stage to complete healing. Inflamatory stage to complete healing. Antibodies play no role. Antibodies play no role. CMI and DH play a mojor role. CMI and DH play a mojor role. Enhanced desquamation. Enhanced desquamation. Conditions affecting T cell function. Conditions affecting T cell function. Some grow with no inflammation? Some grow with no inflammation?

27. CLINICAL MANIFESTAIONS In apparent to chronic. In apparent to chronic. Tinea capitis (Scalp), Itching, hair dots. Tinea capitis (Scalp), Itching, hair dots. Tinea pedis (Foot), Itching, moist, sweaty Tinea pedis (Foot), Itching, moist, sweaty Tinea mannuum (Hands) Tinea mannuum (Hands) Tinea cruris (Groin), obesity. Tinea cruris (Groin), obesity. Tinea barbae (beared) Tinea barbae (beared) Tinea ungium (Nail bed), discoloration. Tinea ungium (Nail bed), discoloration. Tinea corporis (body), itching. Tinea corporis (body), itching.

33. DIAGNOSIS Differentiate from other illnesses. Differentiate from other illnesses. Microscopy, skin scaping. Microscopy, skin scaping. Woods lamp. Woods lamp. Culture? In negative cases only. Culture? In negative cases only.

35. TREATMENT Many are self limiting. Many are self limiting. Tolnaftate. Tolnaftate. Naftifine. Naftifine. Azoles. Azoles. Grisiofulvin or Ketoconazole (systemic) Grisiofulvin or Ketoconazole (systemic) Keratolytic agents. Keratolytic agents. General preventive measures. General preventive measures.

36. Tinea versicolor Pityriasis versicolor(Pityrosporum orbiculare). Pityriasis versicolor(Pityrosporum orbiculare). Discrete hypopigmentation, induration, and scaling. Discrete hypopigmentation, induration, and scaling. Trunk, arms. Trunk, arms. Pigmentaion varies form pink to brown. Pigmentaion varies form pink to brown. Skin scaping shows budding yeast with hyphae. Skin scaping shows budding yeast with hyphae.

38. Tinea nigra Tropical. Tropical. Brown to black macular lesions. Brown to black macular lesions. Little inflamation, no scaling. Little inflamation, no scaling. Cladosporum werneckii. Cladosporum werneckii. Brown to black pigmented septate hyphae. Brown to black pigmented septate hyphae. Yeast form slow hyphal forms. Yeast form slow hyphal forms.

40. Piedra Hair only. Hair only. Black or white nodules. Black or white nodules. White (Trichosporum cutaneum) White (Trichosporum cutaneum) Black (Piedra hortae) Black (Piedra hortae)

43. SUBCUTANEOUS MYCOSIS Sporotrichosis, single agent. Sporotrichosis, single agent. Chromoblastomycosis, multiple. Chromoblastomycosis, multiple. Mycetoma, multiple. Mycetoma, multiple. Trauma, localized under the skin. Trauma, localized under the skin.

44. SPOROTRICHOSIS Sporothrix schenckii. Sporothrix schenckii. Dimorphic. Dimorphic. Cigar shaped yeast. Cigar shaped yeast. Septate hyphae, cluster of conidia on a phore. Septate hyphae, cluster of conidia on a phore. Found in soil, Thorn brick injury. Found in soil, Thorn brick injury.

48. PATHOGENESIS Acute pyogenic and granulomatous reaction Acute pyogenic and granulomatous reaction Painless papule, enlarges then ulcerates. Painless papule, enlarges then ulcerates. Enlarged L.Ns, chronic course. Enlarged L.Ns, chronic course. Systemic involvement rare. Systemic involvement rare.

49. DIAGNOSIS Microscopy is not effective. Microscopy is not effective. Biobsy usually negative, but if positive asteroid body is diagnostic. Biobsy usually negative, but if positive asteroid body is diagnostic. Definitive Dx is by culture. Definitive Dx is by culture.

51. TREATMENT Potassium iodid. Potassium iodid. Amphotericin B. Amphotericin B. Itraconazole. Itraconazole.

52. CHROMOBLASTOMYCOSIS Phialophora and Cladosporium. Phialophora and Cladosporium. Tropical, on foot or leg. Tropical, on foot or leg. Papule then warty like structure. Papule then warty like structure. Painless, no L.Ns involvement. Painless, no L.Ns involvement. Soil, bare footed people. Soil, bare footed people. Brown pigmented hyphae. Brown pigmented hyphae. Surgery, Flucytosine. Surgery, Flucytosine.

54. MYCETOMA Trauma to the foot. Trauma to the foot. Multiple agents. Multiple agents. Petrieldium boydii. Petrieldium boydii. Massive induration with sinusis. Massive induration with sinusis. Tropical environment. Tropical environment. Morphology of the sexual microconidia. Morphology of the sexual microconidia. Nocarida causes the same disease. Nocarida causes the same disease. Difficult to treat Difficult to treat