YSMU Department of Dermatology, STI and CosmetologySkin Fungal InfectionsLecturer: Edgar Manukyan MD, MS

Pityriasis Versicolor Malassezia furfur (Pityrosporum ovale): KOH preparation Round yeast and elongated pseudohyphal forms, so-called spaghetti and meatballs.

Pityriasis versicolor (PV) is a chronic asymptomatic scaling dermatosis associated with the superficial overgrowth of the hyphal form of Pityrosporum ovale, characterized by well-demarcated scaling patches with variable pigmentation, occurring most commonly on the trunk.

Pityriasis Versicolor Flat, round lesions : white to red or brown.

Pityriasis Versicolor The lesions are found mainly on the shoulders, chest, back, and occasionally the upper arms and thighs.

Pityriasis Versicolor Follicular, hypopigmented macules on the upper chest of anindividual with black skin

Pityriasis Versicolor

Dermatophytes Dermatophytic genera includeTrichophytonMicrosporumEpidermophyton

Multiple, septated, tubelike structures (hyphae or mycelia) and spore formation in scales from an individual with epidermaldermatophytosis. In contrast, KOH preparation in candidiasis shows elongated yeast forms (pseudohyphae) without true septations.

Dermatophytes

Dermatophytes

Dermatophytes

Dermatophytes

Dermatophytes - Tinea Capitis

tinea capitis superficialistinea capitis profunda (Kerion Celsi)tinea capitis superficialis: round, coin-sized patches, occasionally coalesce into larger areas, fine lamellar scaling without inflammatory signs, stubs of broken hairtinea capitis profunda: marked inflammatory reaction, pustules, crusts, swelling of the regional lymph nodes, tinea barbae (T. verrucosum, T. mentagrophytes)

Dermatophytes - Tinea Capitis ClassificationEctothrix infection: invasion outside hair shaft, M. audouinii, M. canisEndothrix infection: within hair shaft, T. tonsurans, T. violaceumKerion: variant of endothrix with boggy inflammatory plaques

Dermatophytes - Tinea Capitis plaque of alopecia, due to breaking off of hair shafts close to the surface, scales exhibit a green fluorescence with a Woods lamp. Microsporum canis was isolated on culture.

Dermatophytes - Tinea Capitis patch of alopecia due to breaking off of hairs. sister presented with tinea corporis. Trichophyton tonsurans was isolated onculture.

Dermatophytes - Tinea Capitis painful, boggy, purulent inflammatory nodule, drains pus from multiple openings, tender lymphadenophathy. Infection was due to T. verrucosum contracted from an infected rabbit

Dermatophytes - Tinea Barbae Scattered, discrete follicular pustules and papules in the Differentiate from S. aureus folliculitis.

Dermatophytes - Tinea Barbae and FacialisConfluent, painful papules, nodules, and pustulestinea facialis - with sharply marginated erythema and scaling Trichophyton mentagrophytes was isolated on culture

Dermatophytes - Tinea Corporis

Dermatophytes - Tinea Corporis Multiple, bright red, sharply marginated lesions, minimal scaling Microsporum canis was isolated on fungal culture, which hadbeen contracted from a pet guinea pig.

Dermatophytes - Tinea Corporis Sharply marginated, hyperpigmented plaques, psoriasiform appearance.Associated tinea cruris and tinea pedis are usually present.

Dermatophytes - Tinea Pedis

Dermatophytes - Tinea Pedis interdigital dry type erythema and scaling; the toenail is thickened, indicative of associated distal subungual onychomycosis.

Dermatophytes - Tinea Pedis interdigital macerated type hyperkeratotic and macerated Erythrasma also occurs in the setting of moist intertriginous sites and may occur concomitantly with interdigital tinea pedis

Dermatophytes - Tinea Pedis moccasin

Dermatophytes - Tinea Pedis moccasin type sharply marginated erythema of the plantar foot with a mild keratoderma associated with distal/lateral subungual onychomycosis, typical of T. rubrum infection

Dermatophytes - Tinea Pedis moccasin type Hyperkeratosis, scaling, associated distal/lateralsubungual onychomycosis, typical of T. rubrum infection

Dermatophytes - Tinea Pedis bullous type Ruptured vesicles, bullae, erythema, and erosion on Hyphae were detected on KOH preparation obtained from the roof of the inner aspect of the bulla. T. mentagrophytes infection.

Dermatophytes - Tinea Manuum Tinea manuum Erythema, scaling of the right hand, which was associated with bilateral tinea pedum; the one hand, two feet, distal/lateral subungual onychomycosis occurs on the fingernails.

Dermatophytes - Tinea Cruris Tinea cruris Erythematous, scaling plaques on thighs, inguinal folds, pubic area; areas of clearing are apparent within the large plaques. The margins are raised and sharply marginated.

Dermatophytes - Treatment local

Dermatophytes - Treatment systemic

Candidiasis 100 speciesPolymorphism: yeast forms, budding, pseudohyphae, and true hyphaeC. albicans, C. krusei, C. glabrataHost Factors Diabetes mellitus, obesity, hyperhidrosis, heat, maceration, systemic and topical glucocorticoidsCandida albicans: KOH preparation Budding yeast formsand sausage-like pseudohyphal forms.

Dermatophytes - Tinea Cruris candidiasis: intertrigo Small peripheral satellite papules and pustules that have become confluent centrally, creating large eroded area in the submammary region.

Dermatophytes - Tinea Cruris candidiasis: intertrigo Erythematous papules with a few pustules, becoming confluent on the medial thigh

Dermatophytes - Tinea Cruris candidiasis: interdigital intertrigo Erythematous eroded webspace

Dermatophytes - Tinea Cruris Candidiasis: diaper dermatitis Confluent erosions, marginal scaling, and satellite pustules

Dermatophytes - Tinea Cruris Oral candidiasis: thrush White curd-like material the material can be abraded off with gauze revealing underlying erythema.

Dermatophytes - Tinea Cruris Oral candidiasis: thrush Extensive cottage cheese-like plaques, Patches of erythema (atrophic) candidiasis.

Dermatophytes - Tinea Cruris Oral candidiasis: balanoposthitis Multiple, discrete pustules on The umbilicated lesions can be mistaken for genital herpes, mollusca contagiosa, or condylomata acuminata.

Nail

Onychomycosis distal and lateral subungual type Distal subungualhyperkeratosis and onycholysis these findings are usually associated with tinea pedis.

Onychomycosis Onychomycosis of toenails: superficial white type chalky white. White nail dystrophy can easily be treated by curettage;

Onychomycosis Tinea unguium: proximal subungual onychomycosis type The proximal chalky white color due to invasion from the undersurface of the nail matrix. The patient had advanced HIV disease

Onychomycosis Figure 28-17 Candida onychomycosis: total dystrophic type thickened, dystrophic and is associated with a paronychial infection; both findings were caused by C. albicans HIV disease.

Onychomycosis Chronic paronychia The paronychial tissue is erythematous and edematous; Candida infection. The paronychia resolved with weekly dosing of fluconazole (150 mg) and a topical preparation containing clotrimazole