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Fungal Skin Infection

Irma Savitri

0806358022

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Presentation Outline

Superficial mycoses

Pityriasis versicolor

Candidiasis

Cutaneous mycoses

Dermatophytes

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Presentation outline

Aspects that will be discussed in each disease: Etiology

Risk factors

Epidemiology

Histopathology

Pathophysiology and Pathogenesis

Clinical manifestation

Laboratory examination

Diagnosis, Differential Diagnosis, and Prognosis

Management

Prevention

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Pityriasis versicolor

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Etiology: Malassezia furfur

GMS stained skin biopsy showingcharacteristic spherical yeast cellsand short pseudohyphal elementstypical ofM. furfur.

10% KOH with Parker ink mountshowing characteristic sphericalyeast cells and short pseudohyphalelements typical of the fungus.

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Risk Factors & Epidemiology

Risk factors: late teen and young adulthood

age, tropical and subtropical climate (and to a

lesser extent temperate climate),

immunosuppression, malnutrition, use of oral

contraceptives, hyperhidrosis, poor hygiene

Epidemiology: commonly found in tropical

areas

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Histopathology: Malassezia furfur

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Pathophysiology and Pathogenesis

Hypopigmentation: tyrosinase inhibitors

competitively inhibit an enzyme necessary for

melanocyte pigment formation

Hyperpigmentation: the organism induces

enlargement of melanosomes made by

melanocytes in the basal layer of the epidermis

In vitro, asparagine stimulates the growth of theorganism, while glycine induces hyphal formation

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Clinical Manifestations

Hypopigmentation Hyperpigmentation

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Laboratory Examination

Skin scraping

Cellophane stripping technique

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Diagnosis, Differential Diagnosis,

Prognosis, Management

Woods lamp: golden yellow fluorescence

Mainly cosmetic problem

Daily application of selenium sulfide, topicalor oral azole

Avoid excessive heat and sweating

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Woods lamp

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Woods lamp

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Candidiasis

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Etiology: Candida

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Risk Factors and Epidemiology

superficial candidiasis: AIDS, pregnancy,

diabetes, young or old age, birth control pills,

and trauma.

Systemic candidiasis: chronic administration of

corticosteroids or other immunosuppressive

agents as well as hematologic diseases.

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Histopathology

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Pathophysiology and Pathogenesis

increase in the local census ofCandida anddamage to the skin or epithelium localinvasion by the yeasts and pseudohyphae.

Systemic candidiasis bloodstream and thephagocytic host defenses are inadequate tocontain the growth and dissemination of theyeasts.

Important: Cell-mediated immune response,neutrophil

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Clinical Manifestation

Cutaneous and MuscosalCandidiasis

Candidiasis in theGastrointestinal mucosa

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Laboratory Examination, Diagnosis,

Differential Diagnosis, Prognosis

Swabs and scrapings

Culture, Gram stain

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Management and Prevention

Thrush and other mucocutaneous forms ofcandidiasis : topical nystatin or oralketoconazole or fluconazole

Systemic candidiasis: amphotericin B,sometimes in conjunction with oralflucytosine, fluconazole, or caspofungin

Prevention: avoid disturbing the normalbalance of microbial flora and intact hostdefense

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Dermatophytoses

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Etiology

Microsporum

Epidermophyton floccosum

Trichophyton

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Microsporum

Microsporum caninum Microsporum gypseum

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Risk Factors and Epidemiology

Moisture, warmth, etc.

The incidence is higher in hot, humid climates

and under crowded living conditions.

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Histopathology

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Pathophysiology and Pathogenesis

Dermatophytes synthesize keratinases

digest keratin and sustain existence of fungi in

keratinized structures.

Cell-mediated immunity and antimicrobial

activity of polymorphonuclear leukocytes

restrict dermatophyte pathogenicity

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Clinical Manifestations

Tinea pedis Tinea pedis

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Clinical Manifestations

Tinea cruris Tinea corporis

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Clinical Manifestations

Tinea manuum

Laboratory Examination Diagnosis

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Laboratory Examination, Diagnosis,

Differential Diagnosis, Prognosis,

Management, Prevention Scraping

Culture on Saboraud agar

Woods lamp

Therapy: throrough removal of infected and

dead epithelial structures and application of a

topical antifungal or antibiotic

Prevention: Avoid sources of infection