SUPERFICIAL MYCOSIS

Pepy Dwi Endraswari, dr., M.Si

Departemen Mikrobiologi Kedokteran
FK UNAIR
 1. Superfisial mycosis

 Fungal infection on superficial of the skin or

hair shaft (Stratum corneum)
 No living tissue is invaded
 No inflamation or cellular response
 Patients are often unaware of their condition
 Pityriasis versicolor
• Chronic mild superficial infection of the stratum
corneum
• Caused by: Malassezia furfur
• Host responses (scaling, inflammation, and
irritation) are minimal.
• Discrete, serpentine, hyper- or hypopigmented
maculae occur on the skin, usually on the chest,
upper back, arms, or abdomen.
• Species of Malassezia are considered part of
the microbial flora  can be isolated from
normal skin and scalp.
• They have been implicated as a cause of or
contributor to seborrheic dermatitis, or
dandruff.
 LABORATORY DIAGNOSIS
• 1. Clinical material: Skin scrapings from patients
with superficial lesions, blood from patients
with suspected fungaemia.
• 2. Direct Microscopy: 
• Skin scrapings  10% KOH, glycerol and Parker
ink solution  spagety and meat ball (yeat and
pseudohyphae)
• Culture preparations are usually not necessary.
M. furfur on skin scrapping specimen with GMS staining
(left) and KOH staining (right):
spagety and meatballs appearance
Culture
• only necessary in suspected fumgaemia
• M. furfur is a lipophilic yeastin vitro growth
must be stimulated by natural oils or other fatty
substances.
• Medium:
– Sabouraud's dextrose agar with olive oil
– or Dixon's agar (contains glycerol mono-oleate)
• Rapid growth, best growth 37 C, 3 days
M furfur on Dixon’s agar
• Therapy:
– Selenium sulfide
– Topical or oral azoles
 Tinea Nigra (Tinea Nigra Palmaris)
• A superficial chronic and asymptomatic
infection of the stratum corneum
• caused by: the dematiaceous fungus Hortaea
(Exophiala) werneckii.
• More prevalent in warm coastal regions and
among young women.
• The lesions appear as a dark (brown to black)
discoloration, often on the palm.
 Hortaea (Exophiala) werneckii
•  a common saprophytic fungus
• believed to occur in soil, compost, humus and
on wood in humid tropical and sub-tropical
regions.
 LABORATORY DIAGNOSIS
• Diagnosis:
– Specimen: Skin scrapings
– Staining KOH
– Branched, septate hyphae and budding yeast cells
with melaninized cell walls.
– Culture: not necessary
Skin scrapings mounted in 10% KOH showing pigmented brown
to dark dematiaceous septate hyphal elements and 2-celled
yeast cells
• Therapy:
– keratolytic solutions
– salicylic acid
– azole antifungal drugs.
 Black piedra
• Nodular infection of the hair shaft
• Caused by Piedraia hortai
• Axillary, pubic, beard, and scalp hair may be
infected.
• Treatment :
– removal of hair
– topical antifungal agent
 LABORATORY DIAGNOSIS
• Specimen: hair with hard black nodule
• Staining with 10%KOH
• Culture: hair shaftSabouraud’s dextrose
agar  2-3 weeks black to brown colony
microscopic : septate hyphae with
chlamydoconidia appearance.
 White piedra
• larger, softer, yellowish nodules on the hairs
• Caused by: Trichosporon species
 LABORATORY DIAGNOSIS
• Specimen: hair with soft white nodule
• Staining with 10%KOH
• Culture: hair shaftSabouraud’s dextrose
agar  2-3 weeks yellowish to deep cream
colored, smooth, wrinkled, velvety, dull
coloniesmicoscopic: hifa, pseudohypha,
arthroconidia, blastoconidia
 RANGKUMAN
Disease Causative organisms Incidence Clinical Manifestation
Pityriasis Malassezia furfur  Common Hipopigmented macule
versicolor
Tinea nigra Exophiala werneckii     Rare black macules
White piedra Trichosporon beigelii Rare Cream colored nodule on
hair shaft 
Black piedra Piedraia hortae   Rare Black nodules on hair shaft