UNIVERSITY OF SANTO TOMAS

FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY

GENERALITIES
 Dermatophytosis – infection of skin, hair, and nails by the dermatophytes (invade the epidermis)
 Dermatomycoses – synonyms of tinea and ringworm – skin/hair infection by non invasive non-dermatophytic fungi

The Dermatophytes
 Filamentous
 Keratin as nutrient source
 Most common
 Mycotic Factors
o Mannans (immunosuppressive)
o Xantomegnin (toxin)
o Hemagglutinins
 Based on Conidia Formation

 Based on Colony Morphology

 Epidemiological Groups
o Geophilic
 Microsporum gypseum
o Zoophilic
 Microscoporum canis
o Anthropophilic
 Trichophyton rubrum
 Infection may be acquired via walking barefoot in publica shower rooms and through exposure to kittens and puppies which
may harbor M. canis.
o May be transmitted by fomites.
 Pathogenicity : Keratinase and Lipases cause injury to the keratinocytes and elicit inflammatory response with marked
production of IgE thereby causing pruritus.
Macroconidia Microconidia
Numerous, large, spindle-shaped
Microsporum Few or absent
Thick-walled, rough, multiseptate
Rare, club-shaped
Trichophyton Numerous (spherical or tear-shaped)
Thin-walled, smooth, 8-10 septa
Epidermophyton Numerous, thick and thick-walled, smooth Not formed

Colony
Microsporum Powdery or velvety aerial mycelium
Trichophyton Powdery, waxy, or velvety
Velvet or powdery,
Epidermophyton With suede-like texture, and yellow green or
khaki green pigmentation

Skin Hair Nail

Microsporum Yes Yes Rare

Trichophyton Yes Yes Yes

Epidermophyton Yes Rare Yes
UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY
Trichophyton mentagrophytes rubrum Verrucosum violaceum tonsurans schoenleinii concentricum interdigitale
Classification Zoophilic Anthropophilic Zoophilic Anthropophilic
Intermediate to
Growth rate Intermediate-growing Slow-growing Slow-growing Slow-growing Slow-growing Slow-growing Moderately rapid
slow-growing
Area/s Feet Skin, nails, rarely Scalp, beard, nails,
Feet Scalp, hair, and nails Skin and nails Scalp Skin Nails, feet
Affected on beard, hair, or scalp and skin
Obverse: Thin and white Obverse: yellow, flat
Obverse: dome shaped Obverse: Velvery,
Obverse: Flat and to ochre-brown, glabrous Obverse: Lavender or and powdery Obverse: white to tan, Surface : Velvety
White and downy-fluffy smooth waxy
Colony granular or powdery heaped up and button- purple, waxy-shiny Reverse: Yellow brown glabrous to Cottony
Reverse: port-wine; Reverse: Yellowish or
Morphology cream tan or buff like heaped/wrinkled to reddish-brown Reverse: Heaped to white/cream/buff
variants may be orange-brown,
Reverse : tan – brown Reverse: Colorless or Reverse: Verrucose *Possess mahogany- folded Reverse : Tan -
brown,yellow-orange irregularly folded
salmon brown undercoat Brown
Distorted twisted hypha
Chains of Occasionally spiral hypha Nailheads, Broad, tangles, highly
chlamydoconidia favic chandelier, branched hyphal Branched hypahe
Tightly coiled and Spiral Chains of
Vegetative Terminal or antler hypha elements
and septate Birds on a fence chlamydoconidia
hypha Tortuous; some Exhibits chlamydoconidia Few to none spiral
Nodular bodies
favic chandelier (antler- Terminal Septated which may hyphae
Occasional
like) Matchstick stalks chlamydoconidia have antler tips
favic chandelier
Single, thin clavate, or
teardrops that are borne Truncate, of varying
Teardrop Clavate or ovoid
sessile shapes
Singly or clustered on En thyrses
Rare May or may not be
Microconidia branched conidiophore Pyriform, sessile (cottony) & en
Small clusters pyriform Numerous Clavate, sessile present
grappe (velvety)
(“birds on a fence”)
En grappe Tear-drop shaed
Balloon forms
En thryses
Rare
Pencil-shaped
Short, blunt, irregular
Clavate to cigar “Rat tail” 2-8 celled irregularly
clubs May or may not be
Macroconidia Few, long, narrow shaped Rare Thin-walled
present
Few, thin, smooth walls cylinders with thin String-bean shaped
Moderately thick, smooth
smooth parallel walls
walls
Ectothrix Endothrix Endothrix Hair Perforation
Ectothrix Does not invade hair
Hair Perforation Test (-) Hair Perforation (-) Hair Perforation Variable Test (-)
Hair Perforation Test (+) Urease (-)
Tests Urease (-) Urease (-) Urease (+) Hair Perforation (-) Urease (+)
Urease (+) Growth 37C (+)
Growth at 37, 41-42 C Growth at 37C (+) Partial Thiamine
Growth 37C (+) No Thiamine Required
(+) Thiamine Required Requirement
Tinea Corporis
Tinea Crucis Tinea Crucis
Tinea Corporis
Tinea Pedis Tinea Pedis
White Superficial
Pathology Tinea Manuum Tinea Manuum Tinae Barbae (I) Tinea Barbae (NI) Tinea Favosa Tinea Imbricata
Tinea Capitis Onychomycosis
Tinea Barbae (I) Tinea Barbae (NI)
(black dot)
Tinea Ungium Distal Subungual
Onychomycosis
Usually found on cattle
Most common to infect
No conidia if grown on
humans Onychomycosis of
SDA No conidia on SDA Causes favus
Other notes Causes Athlete’s Foot Onychomycosis of nail Causes scalp ringworm nail plate but no
Add thiamine to blood Conidia if grown on TA#4 Mousy odor
bed with no invasion of invasion of nail bed
agar for conidia to be
nail plate
produced
UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY

Trichophyton Pathology Microconidia Macroconidia

Trichophyton megninii Ringworm of the beard Teardrop-shaped Pencil-shaped
Trichophyton terrestre No infection in humans Large peg or club-shaped Thin-walled
Infects scalp and hair, to other parts
Trichophyton soudanense Teardrop-shaped None
Epidemic in Central and West Africa

Microsporum Microsporum audouinii Microsporum canis Microsporum gypseum

Classification Anthropophilic Zoophilic Geophilic
Growth rate Intermediate to slow-growing Rapid-growing Rapid
Areas Affected Hair shaft and follicles Scalp, skin, and nails Scalp and skin
Obverse: Glabrous to velvety, light pigment, wrinkled with
Surface : Fluffy to wooly/hairy white to pale yelloe Surface : Cinnabon-buff or fawn floccose to pwdery
Colony Morphology radiating edge
Reverse: Bright yellow to orange Reverse : Colorless to buff, deep mahogany-broen
Reverse: Rugose, reddish-brown , peach
Racquet and hyphae, nodular bodies (PECTINATE HYPHAE)
Vegetative hypha Racquet or Pectinate
Presence of chlamydoconidia
Microconidia Clavate or ovoid Clavate or pyriform (sparse) Single or in small clusters, if present
Distorted cylinders or spindles Large Spindle-shaped with thick rough walls 3-9 cells, broadly spindle-shaped clavate or cylindrical
Macroconidia
Thick-walled (spines) Asymmetrical beaked apex/knob Rough-walled
Wood’s Lamp Apple green fluorescence of ectothrix hairs Green yellow fluorescence of ectothrix hairs Does not fluoresce
Pathology Tinea Capitis (gray patch) Tinea Capitis (gray patch)
Ectothric Ectothric Ectorhix large spore
Hair Perforation Test (-) Hair Herforation Test (+) Hair Perforation Test (+)
Tests
Rice Grain Growth (-) Rice Grain Growth (+) with yellow pigment Rice Grain Growth (+) no pigment
Ureae (+/-) Urease (+) Urease (+)
Rarely infects adults
Other notes Prevalent in children Most common in lower animals than humans
Formerly caused ringworm in children

Microsporum gallinae Epidermophyton Epidermophyton floccosum

 Zoophilic Classification Anthropophilic
 More often seen as ringworm in chickens Growth rate Slow-growing
 Rare cause of ringworms in humans Area/s Affected Skin and nais
 “White comb” lesions Microconidia None
Snow shoe or paddle-shaped
Macroconidia
Microsporum nanum Pair or set of 3, smooth-walled
 More common in pigs Obverse: Greenish-brown or khaki or mustard, suede-like surface
Colony Morphology
 Rare cause of ringworms in humans May be raised, folded at the center
Pathology Tinea Crucis, Tinea Pedis, Tinea Manuum, Tinea Ungium
UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY

CLINICAL DISEASES
 Epidermis, hair, and nails
 Referred to as ringworm or tinea
o Clinical terminology: followed by the body part involved

TINEA CORPORIS
 Ringworm of the body
 Glabrous skin, trunk limb
 Clinical Features:
o Reddened, circular, scaly
o Patch with sharp demarcated margin

TINEA PEDIS
 Ringworm of the foot, Athlete’s foot
 Sole of the foot, interdiginating areas
Tinea Intertrigino
Moccasin Bullae
Pedis us
Entire sole.
Area Between skin Heel and Sides of the
affected folds sides of the foot
foot
Redness
Itching Clusters of
Peeling blisters or
Clinical Dry but not
Scaling pustules
Features inflamed
Maceration, Painful and
fissuring of pruritic
the skin

TINEA CRUCIS
 Synonyms:
o Ringworm of the groin
o Jock itch
o Eczema marginatum
o Dhobie itch
o Tinae inguinalis
o Groin dermatophytosis
o Junk rubbin
o Gym itch
o Crotch rot
o Camper rash
o The chaffin
 Groin
 Clinical Features:
o Pruritic
o Spreads symmetrically on both sides of inner thigh

TINEA MANUUM
 Fungal infection of the skin on hands
 Palm and between fingers
 Clinical Features:
o Erythema
o Mild scaling (dorsal aspect)
o Dry and scaly palms

TINEA BARBAE
 Synonyms
o Ringworm of the beard
o Barber’s itch
o Trichophytosis barbae
o Tinea sycosis
o Pseudofolliculitis barbae
 Bearded areas of face and neck, hair shaft

Tinea Barbae Non-inflammatory Inflammatory

Superficial Deeper
Clinical
Causes severe hair Deep kerion-like
Features
infection plaques

TINEA UNGIUM
 Synonyms
o Nail ringworm
UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY
o Onychomycosis
 Toenails or fingernails
 Clinical Features: Tinea Capitis Gray Patch Tinea Black Dot Capitis
Ectothrix pattern
o Thickening, brittleness, nail dystrophy
of hair invasion Chronic
Mosaic sheath Alopecia and kerion
TINEA CAPITIS
 Synonyms Cuticle may be No destruction
Clinical Features
o Scalp ringworm destroyed of cuticle
o Tinea of the scalp Scaling
o Pityriasis capitis Dull, brittle hair that
o Black dot ring worm Grayish, dull, can break off
brittle hair
 Scalp, eyebrows, eyelashes

TINEA FAVOSA
 Synonyms
o Tinea favosa capitis
o Favus honeycomb ringworm
 Scalp hair
 Clinical Features:
o Severe
o Yellow cup-shaped crust, “scutula”
o Mousy odor

TINEA IMBRITICA
 Synonyms
o Scaly ringworm
o Oriental ringworm
o Beauty ringworm
o Tokelau ringworm
o Trichophyta corporis superficialis
o Malabar itch
o Tinea circinata tropicalis
o Gugo
o Hepes desquaman
o Hepes farinosus
 Glabrous skin
 Clinical Features:
o Skin eruptions
o Concentric rings of overlapping scales forming papulosquamous patches

LABORATORY DIAGNOSIS
 KOH Mount
 Fungal Culture
o Sabouraud’s Dextrose Agar with cyloheximide and chloramphenicol
o Macroconidia – large and multicellular
o Microconidia – small and unicellular
 Dermatophyte Test Medium
o Yellow to red at Room Temperature
o (+) Presence of dermatophyte
 Growth on Rice Grain
o Differential: (+) M. canis; (–) M. audouinii
 Urease Test
o (+) T. mentagrophytes; (–) T. rubrum
 Hair Baiting
o (+) T. mentagrophytes after 7-10 days

TREATMENT
 Azoles
o Miconazole, clotrimazole, econazole
o Interferes with CP450-dependent enzyme system at the demethylation step
 Griseofulvin
o Fungistatic (microtubular system of fungi)
o Oral route