SUPERFICIAL MYCOSIS AND DERMATOPHYTOSIS

I. Superficial Mycoses
 Colonize the keratinized outer layers of the skin, hair, and nails.
1. Pityriasis versicolor (Malassezia furfur)
A. Morphology
 clusters of spherical or oval, thick-walled yeastlike cells
 Butuh lipid --> kultur pakai olive oil

B. Clinical syndrome
 Small hypopigmented (in dark skinned) or hyperpigmented macules
C. Laboratory diagnosis
 Epidermal scale in 10% KOH
 Bisa dilihat pakai HE atau PAS
 Kultur pakai olive oil
D. Treatments
 Topical azoles or selenium sulfides shampoo
 Luas --> oral ketoconazole atau itraconazole

2. Tinea nigra
 Superficial phaeohypomycosis caused by Hortaea werneckii
 Contracted by traumatic inoculation of the fungus into the superficial
layers of the epidermis.
A. Morphology
 Producing annelloconidia (conidia possessing annelids or rings)
 B. Clinical syndrome
 Solitary, irregular, pigmented (brown to black) macule, usually on the
palms or soles
 No scaling or invasion of hair follicles, and the infection is not
contagious, little or no host reaction
 May resemble a malignant melanoma --> skin scrapping
C. Laboratory diagnosis
 Microscopic examination of skin scrapings placed in 10% to 20% KOH
 Hyphae and yeast forms are confined to the outer layers of the
stratum corneum and are easily detected on H&E-stained
D. Treatments
 Topical whitfield ointment, azole creams, and terbinafine.

3. White piedra
 caused by yeastlike fungi of the genus Trichosporon: T. ovoides(causes
scalp hair white piedra), T. inkin(causes most cases of pubic white piedra),
and T. asahii.
A. Morphology
 reveals hyphal elements, arthroconidia (rectangular cells resulting
from the fragmentation of hyphal cells), and blastoconidia (budding
yeast cells)
B. Clinical syndromes
 Affects the hairs of the groin and axillae.
 Surrounds the hair shaft and forms a white to brown swelling along
the hair strand
 Does not damage hair shaft
C. Laboratory diagnosis
 infected hair should be placed on mycologic media without
cycloheximide (cycloheximide will inhibit Trichosporonspp.).
 Formed cream-colored, dry, wrinkled colonies within 48 to 72 hours
upon incubation at room temperature.
D. Treatments
 Topical azoles
 Shaving the infected hair
 4. Black piedra
 Caused by Piedraia hortae
A. Morphology
 Grow as pigmented molds
 Asci and ascospores --> sexual phase of the fungus, produced within
rock hard hyphal mass
B. Clinical syndromes
 Presents as small dark nodules that surround the hair shafts.
C. Laboratory findings
 Reveals branched, pigmented, hyphae held together by a cement-like
substance
D. Treatments
 Hair cuts, proper regular hygiene

II. Cutaneous Mycosis

 Caused by dermatophytosis (dermatophytic fungi) and dermatomycosis (non
dermatophytic fungi)
1. Dermatophytosis
 Caused by Trichophyton, Epidermophyton, and Microsporum
 Keratinophilic and keratinolytic --> able to break down the keratin surfaces
of these structures.
 Only invades stratum corneum and keratinized layer
A. Classifications
 Tinea capitis = scalp, eyebrows, eyelashes
 Tinea barbae = beard
 Tinea corporis = body
 TInea cruris = groin
 Tinea unguium = nails (onychomycosis)
B. Morphology
 Microsporum = Characterized by macroconidia

Black arrow = macroconidia; red arrow = microconidia

 Trycophyton = Characterized by microconidia
 Epidermophyton = smooth walled macroconidia without
microconidia
C. Epidemiology and Ecology
 Zoophilic, geophilic, anthropophilic
 Anthropophilic mudah menular, sedikit menimbulkan reaksi inflamasi,
sulit disembuhkan
 Zoophilic dan geophilic menimbulkan reaksi inflamasi tapi lebih mudah
disembuhkan
 Penularan = transfer of arthroconidia or hyphae or keratinous
material; direct contact or indirect contact (vomites)

D. Clinical Syndromes
 Ring worm (ring of inflammatory scalling)
 Yellow - green fluorescence in wood lamp (M. canis, M. audouinii,
Trichophyton schoenleinii)
 Tinea unguium (onychomycosis) = thickened, discolored, raised,
deformed nails. Commonly caused by Trichophyton rubrum
E. Treatments
 Do not involve hair and nails = topical azoles, terbinafine
 Involve hair and nails = oral griseovulfin, terbinafine,
itraconazole, fluconazole