Superficial Mycoses

SUPERFICIAL MYCOSES
 caused by fungi that invade only superficial

keratinized tissue (skin, hair and nails)
 do not invade deeper tissues
 dermatophytes – most important
Classified into 3 genera:

1. Epidermophyton
2. Microsporum
3. Trichophyton
Morphology and Identification
 Culture – Sabourauds agar

 Conidia formation observed in slide
A. Trichophyton (Arthroderma)
 Microconidia are the predominant spore form
 Smooth-walled, pencil shaped microconidia – rare
 Medium on which the fungi grow greatly

influences the characteristics of the fungi
♦Trichophyton mentagrophytes – granular to
powdery
- abundant grape-like clusters of subspherical
microconidia on terminal branches
- coiled hyphae are common
♦Trichophyton rubrum – some teardrop-shaped

microconidia along the sides of the
hyphae
- colonies often develop a red color on the
reverse
side
T. rubrum
♦Trichophyton tonsurans – larger microconidia
- usually numerous, maybe borne on short
branches
B. Microsporum (Nannizzia)
Macroconidia are the predominant clinical form
Large, rough-walled, multicellular and spindle
shaped – form on the ends of the hyphae
Usually infects skin and hair but rarely the nails
♦M. canis – forms numerous thick-walled 8-15

celled macroconidia that frequently have
curved or hooked spiny tips
-a yellow-orange pigment usually develops on

the reverse side of the colony
-infected hairs fluoresce bright green under
wood’s light
M. canis M. canis culture
♦M. gypseum – has abundant thinner-walled 4-6
celled macroconidia in buff to
brownish – colored colonies
M. gypseum M. Gypseum culture

♦M. audouini – rarely forms conidia in the
colony - many thick-walled
chlamydospores are present
- grows poorly on
sterile rice grains
- infected hair fluoresce
M. audouini
Epidermophyton (Floccosum)
only 1-5 celled, club-shaped macroconidia

greenish-yellow colony mutates to form a
sterile white overgrowth only invade skin and
nails
Epidermophyton
Clinical Findings
A. Tinea Pedis (Athletes Foot)
 most prevalent of all dermatophytoses

 infected with Trichophyton species or E. floccosum
 initially itchy between the toes and development of
small vesicles that rupture and discharge a thin fluid
 skin of toe becomes macerated and peels off – crack –
prone to secondary bacterial infection – lymphangitis
and lymphadenitis develop
 when fungal infections becomes chronic – peeling and
cracking of the skin are the principal manifestation
= found only in people who wear shoes
= infection spreads through the use of common
showers
and dressing rooms, where infected,
desquamated
skin serves as a source of infection
= no really effective control measures (other than
proper
hygiene and use of talc to keep interdigital
space
dry)
= chronic athletes foot – asymptomatic and
becomes
activated only in excessive heat or moisture
or with
Tinea Pedis
♦Tinea ungium; onychomycosis –follows prolonged tinea
pedis
- nails become yellow, brittle, thickened or crumbling
 in some instances, the individual may become

hypersensitive to constituents or products of the
fungus and may develop allergic manifestations called
dermatophytids (usually vesicles) elsewhere in the
body, most often on the hands
 trichophytin skin test – markedly (+)

B. Tinea Corporis (Tinea Glabrosa, Tinea cruris) (Ringworm)
dermatophytosis of the non hairy skin of the body
gives rise commonly to the annular lesions of
ringworm ,clearing, scaly center surrounded by a red
advancing border that often contains vesicles
T. corporis T. cruris T. Cruris jock itch

C. Tinea capitis (Ringworm of the scalp)
 occurs in childhood and usually heals spontaneously

by puberty
 infection begins on skin of the scalp – subsequent
growth of the dermatophyte down to the keratinized
wall of the hair follicle
 infection takes place just above the hair root
 fungus continues to grow downward on the upward-
growing hair shaft
 Microsporum species grow primarily as a sheath
around the hair (ectothrix)
some invade the hair shaft (endothrix) –
making it fragile – breaks off within or at the
surface of hair follicle (black-dot ringworm)
 infections with other species – hair breaks a short
distance above the scalp – short stubs in a
balding, usually circular patch
= redness, edema, scaly and vesicle
formation maybe seen
= pronounced inflammation are seen in some
areas (kerion) – resemble pyogenic
infections
T. schoenleinii – forms cup-like crusts (scutula around infected
follicle)
D. Tinea barbae – infection with trichophyton species involving the

bearded region of humans only occur in
immunocompromised persons
Other Superficial Mycosis
Tinea Versicolor
 Growth within the stratum corneum of
clusters of spherical, thick walled budding
cells and short bent hyphae of Malassezia
furfur – usually causes no pathologic signs
except fine to browny scales
 Lesions appear on chest, back, abdomen,
neck and upper arms
 Lesions range from depigmented to
brownish – red and are only of cosmetic
importance
Tinea Nigra
 Light brown to blackish macular areas – palmar
or plantar stratum corneum
 Filled with brownish, branched, septate hyphae
and budding cells of Chladosporium
werneckii
 No scaling or other reaction develop
Piedra
Hard black nodules – around the scalp hair by Piedraia

hortae
- Softer, white to brown nodules –
caused by Trichosporon cutaneum
form on axillary, pubic, beard and
scalp hair
Diagnostic Laboratory Test
 scraping of both skin, nails and hairs plucked
from involved areas
A. Microscopic examination
 Specimen placed on a slide + drop of 10-20%
KOH – covered with cover slip – examined
immediately and then again after 20 minutes
 In skin and nails – branching hyphae or chains
of arthrospores are seen
 In hairs – microsporum species form dense
sheaths of spores around the hair
- trichophyton species form parallel rows of
spores out side. (ectothorix) or inside
(endothrix) the hair shaft
B. Culture
 for final identification of dermatophytes
 specimens are inoculated into sabourauds
agar – 1-3 weeks incubation at room
temperature
C. Treatment
 therapy consist of thorough removal of
infected and dead epithelial structures and
application of a typical antifungal chemical
 overtreatment causes dermatophytids
 attempts must be made to prevent reinfection
 in widespread infection – Griseofulvin 1-4
weeks
 nail infection – requires months of griseofulvin
treatment and sometimes surgical removal of
the nail
A. Scalp infections
 Griseofulvin = 0.125 – 0.5g/d orally for 1 – 2
weeks
 Frequent shampoos and Miconazole cream
2%
B. Body infections
 Miconazole cream 2%
 5% Undecylenic Acid Cream
 3% Salicylic Acid
 5% Benzoic Acid
 In tinea vesicolor – selenium sulfide also
effective
C. Foot Infections
• Acute phase = soak in potassium
permagerate
1: 5,000 until acute
Control
 infection arises from contact of uninfected skin

or hair with infected skin scales or hair
stubs – hyphae grow into stratum corneum
 sporadic cases of ringworm are acquired from
cats or dogs (M. canis)
 epidemics of tinea capitis – due to use of
shared barber shop clippers, transfer of
infected hairs on seats, person – person contact
 control depends on cleanliness, sterilization of
instruments (using hot mineral oil),
effective treatment of cases and reduced
contact with infectious materials

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SUPERFICIAL MYCOSES

 caused by fungi that invade only superficial

Classified into 3 genera:

 Culture – Sabourauds agar

 Microconidia are the predominant spore form

 Smooth-walled, pencil shaped microconidia – rare

 Medium on which the fungi grow greatly

♦Trichophyton rubrum – some teardrop-shaped

♦M. canis – forms numerous thick-walled 8-15

-a yellow-orange pigment usually develops on

M. gypseum M. Gypseum culture

only 1-5 celled, club-shaped macroconidia

A. Tinea Pedis (Athletes Foot)

 most prevalent of all dermatophytoses

 in some instances, the individual may become

 trichophytin skin test – markedly (+)

T. corporis T. cruris T. Cruris jock itch

 occurs in childhood and usually heals spontaneously

D. Tinea barbae – infection with trichophyton species involving the

Hard black nodules – around the scalp hair by Piedraia

 infection arises from contact of uninfected skin

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