1. Fungal Infections of the skin Superficial and cutaneous infections

2. Skin fungal infections
Clinical Skin fungal infections are generally divided into
Superficial
Tinea versicolor, Piedra (Trichosporosis), and Tinea nigra
Cutaneous
Dermatophytosis, Candidiasis of skin, mucosa, nails and others
Subcutaneous
Mycetoma, Sporotrichosis, Chromoblastomycosis, and others

3. Superficial Mycoses
Defined as infections in which a pathogen is restricted to the Stratum corneum, with little or no tissue reaction
These affect the uppermost dead layers of skin or hair shaft
They are painless and usually do not provoke the immune system
They include
1- Tinea versicolor
2- Tinea nigra
3- Piedra

4. Tinea Versicolor
Tinea versicolor is a long-term (chronic) fungal infection of the skin
The fungus interferes with the normal pigmentation of the skin
resulting in small, discolored patches
The most common sites
The back, underarms, upper arms, chest, and neck
Tinea versicolor occurs most frequently in teens and young adults
Sun exposure may make tinea versicolor more apparent
Tinea versicolor often recurs, especially in warm, humid weather

5. Clinical presentation:
Tinea versicolor is a type of infection of the keratinized epithelial cells in the stratum corneum.
Hypo- or hyperpignented macules on chest or back.
The infection causes patches of discolored skin that may be:
Colored white, pink, tan or dark brown
Slow-growing, scaly and mildly itchy
More noticeable after sun exposure

6. Causes
The fungus that causes Tinea versicolor can be found on healthy skin (normal flora of skin).
It only starts causing problems when the fungus overgrows
A number of factors may trigger this growth, including:
Hot, humid weather
Excessive sweating
Oily skin
Hormonal changes
Weakened immune system

7. Malassezia furfur, and Malassezia globosa
It is a Yeast
Lipophilic
Normal flora of skin
Diagnosis
Skin scraping
Potassium hydroxide (20% KOH)
Positive for short hyphae and yeast cells
Spaghetti and meatballs
Culture
Malassezia furfur
Oil should be added to the media

8. Pityriasis versicolor commonly causes hypopigmentation in people with dark skin tones

9. Superficial Mycoses Tinea nigra:
Superficial fungal infection
Causes dark brown to black painless
patches (macule) on the palms of the hands and the
soles of the feet.
This infection is caused by the fungus formerly classified as Exophiala werneckii
More recently classified as Hortaea werneckii

10. Diagnosis Skin scrapings Culture on SDA & Mycobiotic
In 10% or 20% KOH will show brown septate hyphae
The KOH lyses the nonfungal debris
Culture on SDA & Mycobiotic
growth of dematiaceous fungus
produce melanin in their cell walls
Agar plate with the dominant fungi in the salterns, the black yeast Hortaea werneckii
Micrograph of the fungus Hortaea werneckii

11. Superficial Mycoses - Piedra
Asymptomatic infection of the hair shaft, causing nodules on the hair shaft
On scalp hair, and other body hair.
Black piedra (Exothrix infection)
Piedraia hortae
Dark pigmented nodules
Hard and firmly attached to hair shaft
White piedra( Endothrix infection)
Trichosporon beigelii
Lightly pigmented, white to brown nodules
Soft, loosely attached

12. N

13. Laboratory diagnosis 1. Clinical Material 2. Direct Microscopy
Epilated hairs with white soft nodules present on the shaft
2. Direct Microscopy
Hairs should be examined using 10% KOH
3. Culture
Sabouraud's dextrose agar (SDA)
White piedra
Hair with black Piedra

14. Treatment of Superficial infections
2% salicylic acid
3% sulfur ointments
Whitfield's ointment
Ketoconazole
Piedra
Cutting or shaving the hair
Or apply 2% salicylic acid
Or 3% sulfur ointment
Nizoral shampoo (contains Ketoconazole)
Antifungal agents
Topical

15. Dermatophytosis
Fungal infections of the Keratinized tissues of the body (mainly: Stratum corneum, Skin epidermis, and dermis could be involved).
Scalp, glabrous skin, and nails caused by a closely related group of fungi known as dermatophytes
They are primary pathogens

16. Tinea (Ringworm): Classified according to site of inf:
Contagious
Direct contact between infected humans or animals (goats, sheep, camel, cows, horses)
Transfer form one area of the body to another
Familial cross infection occurs
Tinea (Ringworm): Classified according to site of inf:
T. capitis scalp
T. corporis glabrous (body) skin
T. pedis foot (Athlete’s foot)
T. cruris groin

17. Dermatophytes Etiology
A group of related fungi called dermatophytes (filamentous fungi; septate hyphae and conidia):
Microsporum
infections on skin and hair
Epidermophyton
infections on skin and nails
Trichophyton
infections on skin, hair, and nails
Keratin - utilizing on hosts - humans

18. Tinea Capitis
Ringworm of the scalp (Tinea capitis) is a fungal infection of the scalp hair and epidermis.
Highly contagious infection
most common in toddlers and school-age children
Treatment for ringworm of the scalp includes
medications taken by mouth
medicated shampoo
Some cases of ringworm of the scalp result in severe inflammation at the site of infection
that may cause scarring or permanent hair loss

19. Clinical presentation:
Papules are solid raised skin lesions with defined borders (less than 1 cm).
One or more round patches (Erythematous papules) of scaly skin where the hair has broken off or just above the scalp.
Patches that slowly expand or enlarged in circular appearance
Scaly, gray or reddened (inflamed) area.
Brittle or fragile hair that easily pulls out
Tender or painful areas on the scalp.

20. Tinea capitis

21. Causes
Ringworm of the scalp is caused by one of several varieties of mold-like fungi called dermatophytes
Microsporum canis or Microsporum gypseum
Epidermophyton floccosum.
Trichophyton mentagrophytes.

22. Methods of transmission
Ringworm is contagious and can spread in the following ways:
Human to human
direct skin-to-skin contact with an infected person
Geophilic species
Keratin - utilizing soil saprophytes
Object to human: Anthropophilic species
clothing, towels, bed linens, combs or brushes
Animal to human : Zoophilic species:
dogs and cats, especially kittens
cows, goats, pigs and horses

23. Complications
Kerion
Kerion is the result of the host's response to a fungal ringworm infection of the hair follicles of the scalp with secondary bacterial infection.

24. Tests and diagnosis Tests typically include a visual exam History
Sometimes, you may take a sample of the hair or skin
History
Close contacts, duration.
Morphology of lesion
Broken hairs, black dots, localized
Woods Lamp
Blue green
Culture

25. Tinea Capitis - Treatment
Must treat hair follicle
Topical , but might be not effective
Systemic agents
Griseofulvin for children – is taken by mouth as a liquid or tablet
Side effects
Sensitive skin
Terbinafine
You may prescribe one of these medications for six weeks or more

26. Tinea Corporis - Ringworm (body)
Ringworm of the body is one of several forms of ringworm, a fungal infection that develops on the top layer of the skin
It's characterized by an itchy, red circular rash with healthy-looking skin in the middle
Ringworm gets its name from the characteristic ring that can appear
Ringworm on the arm

27. Clinical presentation:
A circular rash on the skin that's red and inflamed around the edge and healthy looking in the middle
Slightly raised expanding rings of
red patches, scaly skin on the trunk or face
A round, flat patch of itchy skin

28. Causes Microsporum canis or Microsporum gypseum Epidermophyton
floccosum.
Trichophyton
mentagrophytes;
(Micro-and Macro-
conidia;
Lactophenol-cotton blue)

29. Risk factors predisposing for dermatophytosis:
Living in humid or crowded conditions
Have close contact with an infected person or animal
Share clothing, bedding or towels, with fungal infection patient
Sweat excessively
Participate in contact sports, such as wrestling, football or rugby
Wear tight or restricted clothing
Have a weakened immune system
Complications
A fungal infection rarely spreads below the surface of the skin
People with weak immune systems, may find it difficult to get rid of the infection

30. Tests and diagnosis
You will determine if patient have ringworm or another skin disorder
skin scrapings or samples from the infected area and look at them under a microscope
a procedure known as a potassium hydroxide (KOH) test
If a sample shows fungus, treatment may include an antifungal medication
If the test is negative but you still suspects that patient have ringworm, a sample may be sent to the laboratory for testing
this test is known as a culture
you may also order a culture if condition doesn't respond to treatment

31. Candidiasis (Yeast Infection)
Candidiasis is a fungal infection that can affect areas such as the:
Skin
Genitals, Throat
Mouth, Blood.
Overgrowth of a type of yeast called Candida,
usually Candida albicans
Dimorphic fungi that is
normally found
in human body.

32. Oral Candidiasis (Thrush)
A yeast infection of the mouth or throat area is called thrush
Healthy adults do not usually get thrush. It is most often seen in:
Infants
Elderly
Patients getting chemotherapy
People with AIDS or other conditions that weaken the immune system
It can also be seen in
people with diabetes
in those who take antibiotics
asthma inhalers with steroid medication

33. Oral candidiasis in a child

34. Yeast Infection of the Genitals
Vaginal yeast infections are common in women. Common symptoms include:
Extreme itching in the genital area
Soreness and redness in the genital area
White, clumpy vaginal discharge
Painful intercourse
But men can get a yeast infection, too. Symptoms in men include:
Red rash on genitals
Itching or burning on the tip of the genitals
It is important to get treated for a genital yeast infection. You may pass the infection back and forth to a sexual partner

35. Subcutaneous Fungal Infection
A-Sporotrichosis:
Caused by Sporothrix schenkii.
B-Mycetoma (Madura foot):
-Localized skin abscess due to granulomatous
infection of dermis and subcutaneous tissue.
-Caused by:
1-Pathogenic soil fungi: Madurella mycetomatis.
2-Bacteria: Actinomycetoma:
Actinomyces species or Nocardia.

36. Subcutaneous Fungal Infection
Madura Foot
Chromoblastomycosis

37. Sporotrichosis
Mycetoma