SUPERFICIAL MYCOSES

SUPERFICIAL MYCOSES AND DERMATOPHYTOSIS

Hyperpigmentation
Predisposing factors:
 Humidity
 Immunosuppression
 Poor hygiene (usually what is affected is the epidermal
area with strong affinity with keratin)

 Treatment
o Oral antifungals (A Px may take in oral
antibiotics if the Px has secondary infection
brought about by fungal infection)
o Oral steroids for inflammation and itch Hypopigmentation
o Selenium sulphide or Itraconazole shampoo  lightening of skin color
o Duration of tx: 2-4 weeks

SUPERFICIAL FUNGI
 Piedra: hair infection with
nodular masses of fungal
elements surrounding the
shaft
 Tinea: infections of the skin
: Macular patches that
are non-scaly
Tinea Versicolor
Causative agents:
 Malasezzia furfur (s)
 Exophilia werneckii (s) – affects skin
 Trichosporon beigelii (h)
 Piedraia hortae (h) – causes infection to the hair

A. MALASEZZIA FURFUR
 Lipophilic yeast
 Found as a normal flora on the skin
Disease:
o Pityriasis versicolor DISEASE CAUSED BY MALASSEZIA FURFUR
1. POTYRIASIS FOLLICULITIS
o Pityriasis folliculitis
o Seborrhoeic dermatitis; Dandruff  Follicular Papule: small circumscribed elevation (no
o Systematic infection pus just slight swelling)
 Pustule: small inflammatory swelling containing pus
o Back, chest and upper arms
Major Clinical Manifestation:
o Sometimes the neck, seldom the face
 Hyper- or hypopigmented of the skin
 Itchy and often appear after sun exposure
 Lesion are well-demarcated (white, pink or brownish)
 Fawn-colored macules are the most common
presentation of the disease
o Trunk and upper arms
o Rarely on neck and face (damage
is cosmetic or superficial)
Note:
 Lipophilic yeast living on the skin as part of the normal
flora
Papule Pustule

CHARLES REY GATCHALIAN | SARAH ANGELA PABUSTAN | JERICK FERNANDEZ | ALLAN JAMES BACACO 1
 SUPERFICIAL MYCOSES

2. SEBORRHOEIC DERMATITIS
Malassezia furfur
 Seborrhoea (greasy
condition or the present of
grease or oil in the scalp
and on the face and the
external region and
elsewhere due to over
activity of sebaceous gland)
 May result to alopecia (causes hair to fall out), acne
 Genetic predisposition; emotional component
 Changes in quantity and composition of sebum Microscopic appearance:
 Increase in alkalinity of skin  The collarettes of the phialides appear as distinct dark
 External local factors such as occlusion rings separation the mother and daughter cells

Clinical manifestation: Macroscopic Characteristics

o Erythema and scaling in areas with a rich supply  1-2 weeks: bacteria-like
of sebaceous glands  Pasty white
o Lesions are covered with greasy scales  Grows at 37oC
o Itching is common in the scalp Microscopic Characteristics
 Resembles bowling pins, medicine capsules
3. SYSTEMIC INFECTION  Hyphae has hyaline septate (there are cross walls
 Common among infants as catheter acquired present)
 Intravenous infusion of lipid  Spaghetti and meatballs (conidia and hyphae)
 Pneumonia results from emboli from the infected IV  Phialoconidium
catheter o buds
Management and treatment
LABORATORY DIAGNOSIS 1. Topical agent:
 Clinical/material specimen o Ketoconazole shampoo
o Skin scrapping 2. Oral treatment
o Blood o Ketoconazole
o Indwelling catheter tips to determine fungemia o Itraconazole
Procedures: 3. Alternative
a. Direct Microscopy o Zinc pyrithione shampoo
 10% KOH (Glycerol with Parker ink or Calcoflour
white) Helpful features
o Observe short angular hyphal forms  White discoloration of skin (brown complexion) or
o Yeast cells (3-7 um) light brown discoloration (for white or light
 “Spaghetti and meatballs” complexion)
 Presence of spaghetti and meatballs
B. EXOPHIALA WERNECKII
 Phaeoannellomyces werneckii
 Cladosporum werneckii
o Common saprophytic fungus
o Soil, compost, humus and wood
DISEASE:
TINEA NIGRA
b. Culture  Discoloration (dark
 For systemic infection pigmentation) of the palms
 Stimulate growth by natural oils or other fatty and soles
substances  Well-defined dark patch
 Sabouraud’s dextrose agar or Sheep blood agar with irregular margin, 1-5
containing ACTi Dione cm in diameter on palm
 Dixon’s agar containing glycerol mono-oleate “stained appearance”
 Often misdiagnosed as
NOTE: Superficial infections rarely requires culture, but melanoma
culture is for systemic infection. Aside from the blood, we  Brown to black macules
can also obtain samples from intravenous catheter  Lesions: non – inflammatory and non – scaling
 Both tropics and temperate zones
 Usually < 20 y/o; females (3:1) ratio
 Predisposing factor is excessive sweating.

CHARLES REY GATCHALIAN | SARAH ANGELA PABUSTAN | JERICK FERNANDEZ | ALLAN JAMES BACACO 2
 LABORATORY DIAGNOSIS C. PIEDRAIA HORTAE
a. Direct Microscopy
 Ascomycetous fungus
 10% KOH and Parker ink; calcofluor white
Disease:
b. Culture
BLACK PIEDRA
 Primary Isolation Media
o Chronic fungal infection of the hair shaft
o Sabouraud’s dextrose agar
o Mostly affects young adults
o Epidemics in families

Clinical Manifestations:
 Does not penetrate the hair
follicle
 Scalp hair: rough, sandy
Macroscopic characteristics  Infected hairs: hard black
nodules on the hair shaft
 7 days: off-white
 2-3 weeks: olive-black
LABORATORY DIAGNOSIS
 Velvety/wooly a. Direct Microscopy
Microscopic appearance  10% KOH w/ Parker ink; calcofluor white
 Olive-black o Darkly pigmented nodules: hair shaft
 2-celled o Nodules: pigmented center containing asci
 Anneloconidia: spores b. Culture
 Annellosphores: conidiosphore  Primary isolation media
o Colonies are dark, brown black
Exophiala werneckii
Macroscopic characteristics
 10 days
 Glabrous/ cerebriform
 Mature colonies: greenish to black with black
Microscopic appearance
 Spore/ Conidia:
 Hyphae:
Management and Treatment:
 Serology not required for diagnosis  shave or cut the hairs short
 Terbinafine
Management & Treatment: o Dose: 250 mg a day for 6 weeks
 Sulfur soap, SSA, azoles D. TRICHOSPORON BEIGELLI
 Topical treatment  More in temperate zones
o Whitfield’s ointment Disease:
o Imidazole agent twice a day for 3-4 weeks WHITE PIEDRA
 Superficial cosmetic fungal infection of the hair shaft
 Affects scalp, axilla, facial, and genital hair
Exophiala werneckii Malassezia furfur
Disease Tinea Nigra Tinea Versicolor Clinical Manifestations:
Morphology Mould Yeast  Common in young adults
 Nodules:
Tissue hands, feet Chest, arms, back
affected  Irregular, soft, white, or light brown nodules adhering
(skin) to the hairs
Geographical Tropical Temperate  1.0 – 1.5 mm in length
site
Appearance Dark, Macular Hypopigmented
of lesions
Others Slow growth Requires Fatty Acids
Features Annelloconidia Spaghetti and
meatballs
Bowling pins,
medicine capsule
LABORATORY DIAGNOSIS
1. Direct Microscopy
 10% KOH w/ Parker ink; calcofluor white
2. Culture
 Primary isolation media
 White or yellowish to deep cream colored

Management and Treatment

 Shave the hairs
 Topical: imidazole agent

Piedraia hortae Trichosporon beigelii

Disease Black piedra White piedra
Morphology Mould Yeast
Geographical Tropical Temperate
site
Tissue Scalp, eyebrows, Mustache, beard,
involved Eyelashes, pubic axillary, groin
(hair) hair
Texture of Black, hard White, soft
nodule
Features Barrel-shaped Sympodial blastoconidia
arthroconidia

REFERENCES
Notes from asynchronous session by Ms. Jaleh
Gacayan, RMT, MPH, LPT

University of Baguio PowerPoint presentation and

module