Lesson 2 Superficial Cutaneous Mycosis Handouts

Rikka Mae M.
Donasco 06/18/2022
LESSON 2: SUPERFICIAL & CUTANEOUS MYCOSIS
The least invasive of the pathogenic fungi are the dermatophytes and other superficial fungi that
are adapted to the keratinized outer layers of the skin.
DERMATOPHYTES
Fungi that require keratin for growth
SUPERFICIAL MYCOSES AGENT
1. Malassezia spp.
2. Hortaea weneckii
3. Trichosporon spp.
4. Piedraia hortae
CUTANEOUS MYCOSES AGENT
1. Microsporum spp.
2. Trichophyton spp.
3. Epidermophyton floccosum
Superficial mycosis – Malassezia spp.

Malassezia spp.
: appears as tight clusters of spherical yeast like cells “spaghetti with meatballs” microscopically
Mycosis caused
: Pytiriasis (tinea) versicolor is a very common superficial fungal infection of the skin. It is
characterized by discrete patches of either hypopigmentation or hyperpigmentation, especially
on the skin of the torso and upper arms.
: There are 14 currently recognized species of Malassezia, but the vast majority of cases of
pityriasis are caused by Malassezia globosa, Malassezia furfur, or Malassezia sympodialis.
Superficial mycosis – Hortaea werneckii
Hortaea werneckii
: brown to dark olivaceous, septate hyphal elements and numerous two-celled, pale brown,
cylindrical to spindle-shaped yeast-like cells that taper towards the ends to form an annellide
MYCOSIS CAUSED
: Tinea nigra (or tinea nigra palmaris) is a superficial chronic and asymptomatic infection of the
stratum corneum caused by the dematiaceous fungus Hortaea (Exophiala) werneckii. The
lesions appear as a dark (brown to black) discoloration, often on the palm.
Superficial mycosis – Hortaea werneckii

Hortaea werneckii
Appears as short, dark hyphae containing thick-walled resting cells. ascomata consist of
irregularly shaped pseudothecia that are black in color. Each ascoma contains a single ascus
containing eight ascopores
MYCOSIS CAUSED
: Causative agent of Black piedra which is a nodular infection of the hair shaft.
Superficial mycosis – Trichosporon
TRICHOSPORON CUTANEUM/ TRICHOSPORON BEIGELLI/ TRICHOSPORON ASAHII
: produces pleomorphic yeast cells, measuring 3–8 μm in diameter, separate hyphae, and
arthroconidia, either of which can predominate. The organism can readily be confused with
Candida spp
MYCOSIS CAUSED
White piedra – light brown soft nodules on the beard or mustache
CUTANEOUS MYCOSES
Cutaneous mycoses are caused by fungi that infect only the keratinized tissue (skin, hair, and
nails).
The most important of these are the dermatophytes, a group of about 40 related fungi that
belong to three genera:
Microsporum, Trycophyton, and Epidermophyton.
PATHOGENESIS
Dermatophytoses begin when the infecting fungus comes in contact with skin, especially if there
are minor breaks in the skin integrity.
Detached hair and skin scales containing dermatophytes can remain infectious for months in the
environment.
Once the stratum corneum is penetrated, the organism can proliferate in the keratinized layers
of the skin, with a variety of proteinases helping to establish infection. Most dermatophyte
infections are self-limited, spontaneously resolving with time.
CLINICAL MANIFESTATIONS
Dermatophyte infections range from inapparent colonization to chronic progressive eruptions
that last months or years, causing considerable discomfort and disfiguration.
Dermatologists often give each infection its own “disease” name based on the Latin name for
the anatomic site at which the infection is found. For example, these names include
Tinea capitis (scalp),
tinea pedis (feet, athlete’s foot),
tinea manuum (hands),
tinea cruris (groin),
tinea barbae (beard, hair),
tinea unguium (nail beds).
Skin infections otherwise not included in this anatomic list are called corporis (body). There are
certain clinical, etiologic, and epidemiologic differences among these syndromes, but they are
basically the same disease in different locations.
CUTANEOUS MYCOSES –Tinea pedis (ATHLETE’S FOOT)

Tinea pedis is the most prevalent of all dermatophytoses. It usually occurs as a chronic infection
of the toe webs. Initially, there is itching between the toes and the development of small vesicles
that rupture and discharge a thin fluid.
The skin of the toe webs becomes macerated and peels, whereupon cracks appear that are
prone to develop secondary bacterial infection. When the fungal infection becomes chronic,
peeling and cracking of the skin are the principal manifestations, accompanied by pain and
pruritus.
Caused by: TRICHOPHYTON RUBRUM , EPIDERMOPHYTON FLOCCOSUM and
TRICHOPHYTON MENTAGROPHYTES (micro scopores as small and globose arranged in
grapelike clusters)
CUTANEOUS MYCOSES – TINEA UNGUIUM (ONYCHOMYCOSIS)

Nail infection may follow prolonged tinea pedis. With hyphal invasion, the nails become yellow,
brittle, thickened, and crumbly. One or more nails of the feet or hands may be involved.
Can be caused by
TRICHOPHYTON MENTAGROPHYTES, TRICHOPHYTON RUBRUM AND
EPIDERMOPHYTON FLOCCOSUM
CUTANEOUS MYCOSES – TINEA CORPORIS (BUNI)

Superficial fungal infection of the skin that can affect any part of the body, excluding the hands
and feet, scalp, face and beard, groin, and nails.
It is commonly called “ringworm” as it presents with characteristic ring-shaped lesions.
Caused by TRICHOPHYTON RUBRUM
with tear shaped microconidia laterally on hyphae
CUTANEOUS MYCOSES – Tinea cruris (Jock ITCH/HADHAD)

Ringworm of the groin. red patches on the groin and scrotum
Caused by: EPIDERMOPHYTON FLOCCOSUM
produces only macroconidia, smooth walled 2-4 celled
CUTANEOUS MYCOSES –TINEA MANUUM
Ringworm of hands, palm, and between fingers. Associated with tinea pedis
Caused by: Trichophyton rubrum, followed by Trichophyton mentagrophytes and
Epidermophyton floccosum
CUTANEOUS MYCOSES – Tinea capitis

Infection of hair and scalp begins with an erythematous papule around the hair shaft, which
progresses to scaling of the scalp, and discoloration/fracture of the shaft.
Spread to adjacent hair follicles progresses in a ring-like fashion, leaving behind broken,
discolored hairs, and sometimes black dots where the hair is absent but the infection has
invaded the follicle.
CAN BE CAUSED BY
MICROSPORUM CANIS
macroconidia are thick-walled spindle shaped large multiseptated rough walled with curved tips
and knobby projections
TRICHOPHYTON TONSURANS
 2nd most common cause, abundant microconidia of various shapes “tear club or balloon
shaped”
CUTANEOUS MYCOSES – TINEA barbae
Ringworm of the beard and mustache
Caused by T mentagrophytes var granulosum and Trichophyton verrucosum
LABORATORY DIAGNOSIS
1. LACTOPHENOL COTTON BLUE STAIN
Microscopic appearance of Microscporum (Left), Trichophyton (Middle) and

Epidermophyton (Right)
2. Hair baiting technique

 V-shaped penetration of hair shaft
T. mentagrophytes – positive
T. rubrum – negative
3. Wood’s lamp
Some species of dermatophyte fluoresce when exposed to ultraviolet light
TREATMENT
Many local skin infections resolve spontaneously without therapy. Those that do not resolve
may be treated with topical terbinafine or azoles (miconazole, ketoconazole).
More extensive skin infections, especially those involving the scalp, often require systemic
therapy with griseofulyin, itraconazole, or oral terbinafine, often combined with topical therapy.
Nail infections are especially difficult to cure, likely due to the slow turnover of the infected nail
and poor penetration of antifungal agents.
Therapy for nail infections must be continued over weeks to months, and relapses may occur.
Keratolytic agents (Whitefield’s ointment) may be useful for reducing the size of hyperkeratotic
lesions.
Dermatophyte infections can usually be prevented simply by observing general hygiene
measures. No specific preventive measures such as vaccines exist.

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Rikka Mae M.

Superficial mycosis – Malassezia spp.

Superficial mycosis – Hortaea werneckii

CUTANEOUS MYCOSES –Tinea pedis (ATHLETE’S FOOT)

CUTANEOUS MYCOSES – TINEA UNGUIUM (ONYCHOMYCOSIS)

CUTANEOUS MYCOSES – TINEA CORPORIS (BUNI)

CUTANEOUS MYCOSES – Tinea cruris (Jock ITCH/HADHAD)

CUTANEOUS MYCOSES – Tinea capitis

Microscopic appearance of Microscporum (Left), Trichophyton (Middle) and

2. Hair baiting technique

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