CUTANEOUS MYCOSES

R.Varidianto Yudo T., dr.,MKes

Lab. Mikrobiologi
Fakultas Kedokteran Universitas Hang Tuah
 Dermatophytoses
► Dermatophytoses are caused by fungi
(dermatophytes) that infect only superficial
keratinized structures (skin, hair, and nails), not
deeper tissues.
► The most important dermatophytes are classified
in 3 genera:
1. Epidermophyton (Epidermophyton floccosum)
2. Trichophyton
3. Microsporum
► They are spread from infected persons by
direct contact.
► Microsporum is also spread from animals
such as dogs and cats. This indicates that to
prevent reinfection, the animal must be
treated also.
► Dermatophytoses (tinea, ringworm) are
chronic infections favored by heat and
humidity, eg, athlete's foot and jock itch
(also known as tinea pedis and tinea cruris,
respectively).
► They are characterized by pruritic papules
and vesicles, broken hairs, and thickened,
broken nails.
► In some infected persons, hypersensitivity
causes dermatophytid ("id") reactions,
eg, vesicles on the fingers.
► Id lesions are a response to circulating
fungal antigens; the lesions do not contain
hyphae.
► Patients with tinea infections show positive
skin tests with fungal extracts, eg,
trichophytin.
► Scrapings of skin or nail placed in 10% KOH
on a glass slide show hyphae under
microscopy.
► Cultures on Sabouraud's agar at room
temperature develop typical hyphae and
conidia.
► Treatment involves local antifungal creams
(undecylenic acid, miconazole, tolnaftate,
etc) or oral griseofulvin.
► Prevention centers on keeping skin dry and
cool.
Trichophyton - Macroconidium
Epidermophyton -
Macroconidium
Microsporum -
Macroconidium
Microsporum canis. Lactophenol blue preparation: large,
fusiform macroconidia.
Trichophyton mentagrophytes. Lactophenol blue preparation:
thin-walled, cylindrical macroconidia; numerous microconidia,
often in clumps; spiral hyphae.
 Tinea Versicolor
► Tinea versicolor (pityriasis versicolor), a
superficial skin infection of cosmetic
importance only, is caused by Malassezia
furfur.
► The lesions are usually noticed as
hypopigmented areas, especially on tanned
skin in the summer.
► There may be slight scaling or itching, but
usually the infection is asymptomatic.
► It occurs more frequently in hot, humid
weather.
► The lesions contain both budding yeast cells
and hyphae.
► Diagnosis is usually made by observing this
mixture in KOH preparations of skin
scrapings.
► Culture is not usually done.
► The treatment of choice is topical
miconazole, but the lesions have a tendency
to recur and a permanent cure is difficult to
achieve.
The characteristic short, cigar-butt hyphae that are present in
the diseased state. Spores with short mycelium has been
referred to as the spaghetti and meatballs or the bacon and
eggs sign of tinea versicolor.
GMS stained skin biopsy showing characteristic
spherical yeast cells and short pseudohyphal
elements typical of M. furfur.
 10% KOH with Parker ink mount showing
characteristic spherical yeast cells and short
pseudohyphal elements typical of the fungus
 Tinea Nigra
► Tinea nigra is an infection of the keratinized
layers of the skin.
► It appears as a brownish spot due to the
melanin-like pigment in the hyphae.
► The causative organism, Cladosporium
werneckii, is found in the soil and
transmitted during injury.
► Diagnosis is made by microscopic
examination and culture of skin scrapings.
► Microscopic examination of skin scrapings
from the periphery of the lesion will reveal
branched, septate hyphae and budding
yeast cells with melaninized cell walls.
► Culture of skin scrapings on Sabouraud agar at
25°C yields growth in approximately 1 week.
► Initially, yeastlike colonies that are shiny, black,
and mucoid are present.
► Subsequently, the colonies become olivaceous
brown and develop aerial mycelia in 2-3 weeks.
► Microscopic examination of the colonies reveals
dematiaceous 2-celled yeast that produce
annelloconidia in addition to dematiaceous,
septate hyphae with conidia on intercalary
annelides.
Tinea nigra, evident as a painless
cluster of brown-to-black macules
Typical brown to black, non-scaling macules on the palmar
aspect of the hands. Note there is no inflammatory reaction
Tinea nigra, with histologic section demonstrating
periodic acid-Schiff–positive septate hyphae within
the stratum corneum
 Skin scrapings mounted in 10% KOH showing pigmented
brown to dark olivaceous (dematiaceous) septate hyphal
elements and 2-celled yeast cells producing annelloconidia
typical of Hortaea werneckii.
► Theinfection is treated with a topical
keratolytic agent, eg, salicylic acid.
TERIMA KASIH