dermatophytosis .ppt

dermatophytosis

1. .ا
ًريِثَك اًرْيَخ َيِتو
ُ
أ ْدَقَف
َ
ةَمْكِحْلا َتْؤُي نَم َو ُءآَشَي نَم
َ
ةَمْكِحْلا يِتْؤُي
[269 هرقب]
هب
ًاقيقحت ،تسا هدش هداد تمكح يو هب هك يسك و .دهديم دهاوخب هك سك ره هب ار تمكح دنوادخ«
».تسا هدش هداد يريثك ريخ وا

2. Cutaneous MycosesCutaneous Mycoses
(Dermatomycosis) (Dermatomycosis)

3. 1-Dermatophytosis1-Dermatophytosis
"ringworm""ringworm" disease of the nails, hair and skin caused by fungi disease of the nails, hair and skin caused by fungi
called called dermatophytesdermatophytes..
2-Candidiasis of skin, mocus membranes and nails2-Candidiasis of skin, mocus membranes and nails
Candida albicans and related species.
3- Dermatomycosis: rare3- Dermatomycosis: rare
•more general name for any skin disease caused by a fungus.
Non-dermatophyte moulds: Aspergillus, mucor, fusarium,
Hendersonula toruloidea, Scytalidium hyalinum,
Scopulariopsis brevicaulis …

4. DermatophytosisDermatophytosis
(Ringworm, Tinea)(Ringworm, Tinea)

5. DermatophytesDermatophytes
•Dermatophytosis (tinea or ringworm) of the scalp, glabrous skin,
hair and nails is caused by a closely related group of fungi
known as dermatophytes which have the ability to utilize keratin
as a nutrient source, i.e. they have a unique enzymatic capacity
[keratinase].
•Dermatophytes are Dermatophytes are keratinophilickeratinophilic - - "keratin loving""keratin loving".
 
.
 
Keratin is a major protein found in Keratin is a major protein found in hornshorns, , hooveshooves, , nailsnails, , hairhair, and , and
skinskin..
•Ringworm:Ringworm: circular lesions similar to worms circular lesions similar to worms
•Tinea: Tinea: lesions like to decay of clothes by mothlesions like to decay of clothes by moth

6. •ThreeThree important important anamorphicanamorphic genera are involved in genera are involved in
ringworm.ringworm.
1- Microsporum1- Microsporum
•infections on infections on skin skin and and hairhair ( (notnot the cause of tinea the cause of tinea
unguium or rarely) (M. persicolor does not attack to unguium or rarely) (M. persicolor does not attack to
hair).hair).
2- Epidermophyton2- Epidermophyton
•infections on infections on skinskin and and nailsnails ( (notnot the cause of tinea the cause of tinea
capitis).capitis).
3- Trichophyton3- Trichophyton
•infections on infections on skin, hair, skin, hair, and and nailsnails except of except of
T. concentricum T. concentricum (no hair).(no hair).

7. یسنج ر
یثکت
•مو
یشیتونمیج عون Xزا یاموکسآ ای پراکوکسآ
• ش
یبو مک تسس یافیاه هکبش زا نآ مویدیرپ هک یپراکوکسآ
.تسا هدش ل
یکشت هتفای زیامت
•.د
Xراد Xرارق نآ نورد یاسآ ای هسیک ای کسآ
• زا مویدیرپ ندش درخ زا لبق دنوش غلاب اه
Xروپساوکسآ یتقو
.دنوش یم جراخ نآ
• .دننک یم مو
یشیتونمیج دیلوت امردورتXرآ یاه هنوگ

8. Gymnothecium

9. یسنج ر
یغ ریثکت
•روپساورت
Xرآ دیلوت

10. Arthrospore ( Arthroconidia)Arthrospore ( Arthroconidia)

11. Dermatophytes classification basis on the Dermatophytes classification basis on the
ecologyecology
Geophilic speciesGeophilic species
•Keratin-utilizing soil saprophytes Keratin-utilizing soil saprophytes
(e.g., (e.g., M. gypseumM. gypseum, , T. ajelloiT. ajelloi).).
Zoophilic speciesZoophilic species
•keratin-utilizing on hosts - living animals keratin-utilizing on hosts - living animals
(e.g., (e.g., M. canisM. canis, , T. verrucosumT. verrucosum).).
Anthropophilic speciesAnthropophilic species
•keratin-utilizing on hosts - humans keratin-utilizing on hosts - humans
(e.g., (e.g., T. rubrumT. rubrum, , M. audouniiM. audounii, , T. tonsuransT. tonsurans).).
relationships between groups of living things and their environments

13. Major sources of ringworm infectionMajor sources of ringworm infection
1- Family, Schools, military camps, prisons, Gym (comb, towel, 1- Family, Schools, military camps, prisons, Gym (comb, towel,
hat, underwear, socks).hat, underwear, socks).
2- Warm damp areas (e.g., tropics, moisture accumulation in 2- Warm damp areas (e.g., tropics, moisture accumulation in
clothing and shoes). clothing and shoes). 
3- Animals (e.g., dogs, cats, cattle, poultry, etc.).3- Animals (e.g., dogs, cats, cattle, poultry, etc.).

14. Infections by DermatophytesInfections by Dermatophytes
•Severity of ringworm disease depends onSeverity of ringworm disease depends on
•(1)(1) strains or species of fungus involved strains or species of fungus involved
•(2)(2) sensitivity of the host to a particular pathogenic fungus. sensitivity of the host to a particular pathogenic fungus.
•More severe reactions occur when a dermatophyte crosses More severe reactions occur when a dermatophyte crosses
non-host lines (e.g., from an animal species to man). non-host lines (e.g., from an animal species to man). 
•Infections acquired from animals are usually Infections acquired from animals are usually inflammatoryinflammatory, ,
but are but are more likely to resolve spontaneously more likely to resolve spontaneously than are than are
infections caused by anthropophilic dermatophyte speciesinfections caused by anthropophilic dermatophyte species

15. Molecular taxonomy and phylogenetic relationships
In recent years, dermatophytes have been subject to extensive molecular
systematic study
all sexual and asexual dermatophytes are, indeed, closely related to one another,
and that all are members of the family Arthrodermataceae.
Trichophyton gourvilii, T. soudanense, and T. yaoundei have been suggested to be
synonyms of T. violaceum

16. rDNA ITS and partial LSU, the ribosomal 60S protein,
and fragments of b-tubulin and translation elongation
factor.
clade (A)
clade (B)
clade (C)
clade (D)
clade (E)
clade (F)
clade (G)
In the newly proposed
taxonomy, Trichophyton contains 16 species,
Epidermophyton one species ,
Nannizzia 9 species
Microsporum 3 species ,
Lophophyton 1 species ,
Arthroderma 21 species and
Ctenomyces 1 species
Nannizzia aenygmaticum
Nannizzia corniculata
Nannizzia duboisii
Nannizzia fulva
Nannizzia gypsea
Nannizzia incurvata
Nannizzia nana
Nannizzia persicolor
Nannizzia praecox
Paraphyton cookie
Paraphyton cookiellum
Paraphyton mirabile
Lophophyton gallinae
Arthroderma amazonicum Arthroderma thuringiensis
Arthroderma tuberculatum Arthroderma uncinatum
Arthroderma ciferrii Arthroderma vespertilii
Arthroderma cuniculi
Arthroderma curreyi
Arthroderma eboreum
Arthroderma flavescens
Arthroderma gertleri
Arthroderma gloriae
Arthroderma insingulare
Arthroderma lenticulare
Arthroderma melis
Arthroderma multifidum
Arthroderma onychocola
Arthroderma phaseoliforme
Arthroderma quadrifidum
Arthroderma redellii
Arthroderma silverae
Ctenomyces serratus

17. Clinical manifestationsClinical manifestations
1- 1- Tinea capitisTinea capitis: ringworm infection of the head, : ringworm infection of the head,
scalp, eyebrows, eyelashes. scalp, eyebrows, eyelashes.
2- 2- Tinea corporisTinea corporis: ringworm infection of the : ringworm infection of the
body (smooth or glabrous skin).body (smooth or glabrous skin).
3- 3- Tinea crurisTinea cruris: ringworm infection of the groin : ringworm infection of the groin
((jock itchjock itch).).
4- 4- Tinea unguiumTinea unguium: ringworm infection of the : ringworm infection of the
nails. nails.

18. 5- 5- Tinea barbaeTinea barbae: ringworm infection of the beard. : ringworm infection of the beard.
6- 6- Tinea manuumTinea manuum: ringworm infection of the : ringworm infection of the
hand. hand.
7- 7- Tinea pedisTinea pedis: ringworm infection of the foot : ringworm infection of the foot
((athlete's footathlete's foot).).

19. Tinea pedis - Athletes' foot infectionTinea pedis - Athletes' foot infection
•toes or toe webs, soletoes or toe webs, sole
-4th and 5th toes are most common. 4th and 5th toes are most common.
•Soreness and Soreness and itchingitching of of any part any part of the foot. of the foot.

20. •Fungi probably transmitted host to host through Fungi probably transmitted host to host through
infected squamesinfected squames; flat, ; flat, keratinisedkeratinised, , dead cells dead cells shed shed
from the outermost layer of a stratified squamous from the outermost layer of a stratified squamous
epithelium. epithelium.
•Three causal agents, Three causal agents, T. rubrumT. rubrum (source of inoculum (source of inoculum
comes from people with comes from people with chronic infectionschronic infections, because , because
fungus not long-lived in squames), fungus not long-lived in squames),
T. interdigitaleT. interdigitale and and Epidermophyton floccosumEpidermophyton floccosum
(source of inoculum comes from long-lived (source of inoculum comes from long-lived
arthrospores that reside in squames deposited in rugs arthrospores that reside in squames deposited in rugs
and carpets (fomites).and carpets (fomites).

21. Three Clinical varieties of InfectionThree Clinical varieties of Infection
1- Intertriginous variety1- Intertriginous variety
•It is the It is the commonest form commonest form of tinea pedis.of tinea pedis.
•characterized by characterized by peelingpeeling, , macerationmaceration and and fissuring affecting fissuring affecting
the lateral toe cleftsthe lateral toe clefts, and sometimes spreading to involve , and sometimes spreading to involve
the the undersurface of the toesundersurface of the toes..
•Caused by Caused by Epidermophyton floccosumEpidermophyton floccosum..
•Peeling:Peeling: یزیر هتسوپیزیر هتسوپ
•Cleft: Cleft: کرتکرت

24. 2-2- Squamous hyperkeratotic (moccasin formSquamous hyperkeratotic (moccasin form((
((نمزم هدنوش هتسوپ هتسوپ :ینزوگ تسوپنمزم هدنوش هتسوپ هتسوپ :ینزوگ تسوپ))
•This variety is This variety is very chronic very chronic and and resistant to treatmentresistant to treatment. .
•characterized by characterized by erythemaerythema and and scalingscaling that may involve that may involve
the the entireentire solesole and and sides of the footsides of the foot..
•Caused by Caused by Trichophyton rubrum Trichophyton rubrum and and T. interdigitaleT. interdigitale..
•Hyperkeratosis is thickening of the stratum corneum, often associated with a quantitative
abnormality of the keratin
•تسوپ یسلف هیلاتسوپ یسلف هیلا

27. 3- Vesiculobullous variety3- Vesiculobullous variety ( (یلوات-یلوک
یزو
یلوات-یلوک
یزو
))
•It is characterized by It is characterized by acute vesicular acute vesicular or or bullousbullous eruptioneruption that that
maymay involve the involve the entire soleentire sole. .
•Caused by Caused by Trichophyton interdigitaleTrichophyton interdigitale..
•Id reaction Id reaction formation in formation in other sites other sites specially specially palm palm
((اپ فکاپ فک))..

29. TreatmentTreatment
•DryDry the feet thoroughly after bathing. the feet thoroughly after bathing.
•Topical antifungals Topical antifungals for mild cases for mild cases
(azoles, naftifine and terbinafine).(azoles, naftifine and terbinafine).
•Systemic antifungals for Systemic antifungals for severe and chronic cases severe and chronic cases
(itraconazole or terbinafine or griseofulvin).(itraconazole or terbinafine or griseofulvin).

30. Tinea manuumTinea manuum
•Occur in Occur in association with tinea pedis association with tinea pedis but affects the hands.but affects the hands.
•Primarily involves the Primarily involves the palmpalm and and interdigitalinterdigital ( (mostly one handmostly one hand) )
with with dry scale, small circular areas dry scale, small circular areas of scale.of scale.
•HandcraftHandcraft, , hyperhidrosishyperhidrosis, , cantact dermatitidiscantact dermatitidis, , frequentfrequent usage usage
of alkaline soapsof alkaline soaps
•1-Disseminated hyperkeratosis of hand 1-Disseminated hyperkeratosis of hand and 2-and 2-interdigital, interdigital,
vesicularvesicular 3- 3-reddish scales on hand back reddish scales on hand back ……

33. Tinea corporis (tinea circinata) - Tinea corporis (tinea circinata) -
body ringwormbody ringworm
•Disease found throughout the world.
•Tinea corporis is defined as dermatophytosis of the
glabrous skin of the face (excluding the beard), trunk,
and limbs (including the hands and feet).
•Tinea corporis is a very common disease that,
although present worldwide, is more prevalent in
persons living in warm, humid climates.

34. Tinea Corporis
•In our study, more in women and 21-30
•Patients with systemic diseases such as diabetes mellitus,
Cushing syndrome, or HIV infection, and those
immunocompromised for other reasons are predisposed to
tinea corporis

36. •The types of tinea corporis lesions:The types of tinea corporis lesions:
•All lesions of tinea corporis are usually pruritic.
1- annular form1- annular form
•The The commonestcommonest lesions. lesions.
•circinated circinated and and annularannular lesion with lesion with activeactive and and erythema erythema
marginmargin..
•Caused by Caused by T. rubrum T. rubrum and and E. flocossumE. flocossum..
2- vesicular form2- vesicular form
•Irregular vesicle Irregular vesicle in in lesions marginlesions margin..
•Caused by Caused by T. mentagrophytesT. mentagrophytes and and T. verrucosumT. verrucosum..

37. 3- severe infections3- severe infections
A) Tinea profundaA) Tinea profunda
Kerion-like infection with severe inflammation.Kerion-like infection with severe inflammation.
B) Majocchis granulomaB) Majocchis granuloma
**Ethiological agent in both infections is Ethiological agent in both infections is T. rubrumT. rubrum..
*the most common cause of dermatophytic pseudomycetoma is *the most common cause of dermatophytic pseudomycetoma is M. canisM. canis. Other . Other
species that have been reported are species that have been reported are M. ferrugineum M. ferrugineum and and M. audouiniiM. audouinii
(Kwon-Chung and Bennett 1992).(Kwon-Chung and Bennett 1992).
**Invasion of tissue by myceliumInvasion of tissue by mycelium
**Small granuloma around hair follicles.Small granuloma around hair follicles.
*Invasion of hair follicles results in perifollicular pustules that may resemble a
bacterial folliculitis.
*Majocchi’s granuloma is most often seen in women with onychomycosis or
tinea pedis who shave their legs

38. Kerion
It usually presents itself as raised, spongy lesions.
is the result of the host's response to a fungal ringworm infection of
the hair follicles of the scalp and beard accompanied by secondary
bacterial infection(s).
This honeycomb is severely painful inflammatory reaction with deep
suppurative lesion on the scalp.
There may be sinus formation and rarely mycetoma like grains are
produced.
It is usually caused by Zoophilic dermatophytes like Trichophyton
verrucosum and T. mentagrophytes.

41. •Granulomas form when the immune system
attempts to wall off substances that it perceives
as foreign but is unable to eliminate.

47. •Persons with frequent contact with animals, especially kittens,
puppies, horses, cattle, rodents, and fowl, may be exposed to
zoophilic organisms such as M. canis and T. mentagrophytes
var. mentagrophytes.
• Geophilic species, most often M. gypseum, are more likely to
infect gardeners or other persons in contact with the soil.
•The anthropophilic pathogens are more likely to produce the
classical annular plaque with advancing scale and central
clearing .
• Other noninflammatory lesions may be oval, circinate, and
may or may not have erythema. Geophilic and zoophilic
species are more apt to cause inflammatory lesions that can
range from vesicles and pustules to bulla.

48. •TreatmentTreatment
•All forms of tinea corporis caused by All forms of tinea corporis caused by T. rubrumT. rubrum, ,
T. mentagrophytesT. mentagrophytes, , T. tonsuransT. tonsurans, , M. canisM. canis and  and  M. audouiniiM. audouinii are are
treatable with topical agent treatable with topical agent containing containing tolnaftatetolnaftate, , ketoconazoleketoconazole, ,
miconazolemiconazole, etc..., etc...
•T. verrucosumT. verrucosum and and T. violaceumT. violaceum infections require infections require moremore vigorousvigorous
treatment treatment including cleaning of area to remove of scales and older including cleaning of area to remove of scales and older
fungicidal topical applications of ammoniated mercury ointment, 3 % fungicidal topical applications of ammoniated mercury ointment, 3 %
salicylic and sulfuric acid, or tincture of iodine for several weeks. salicylic and sulfuric acid, or tincture of iodine for several weeks.
•Widespread tinea corporis Widespread tinea corporis and and more severe types (lesions) more severe types (lesions) require require
systemic griseofulvin treatment systemic griseofulvin treatment (about 6 weeks for effective (about 6 weeks for effective
treatment).treatment).

49. Tinea cruris (ringworm of the groin Tinea cruris (ringworm of the groin
and surrounding region)and surrounding region)
•Sedentary peopleSedentary people disease. disease.
•More More common in common in menmen than women. than women.
•Infection seen on Infection seen on scrotumscrotum and and inner thighinner thigh, the penis is , the penis is
usually not infected.usually not infected.

50. •Several causes of tinea cruris include Several causes of tinea cruris include
•T. rubrumT. rubrum (does not normally survive long periods (does not normally survive long periods
outside of host) outside of host)
•E. flocossumE. flocossum (usually associate with epidemics because (usually associate with epidemics because
resistant arthroconidia in skin scales can survive for resistant arthroconidia in skin scales can survive for
years on rugs, shower stalls, locker room floors)years on rugs, shower stalls, locker room floors)
•T. mentagrophytesT. mentagrophytes (usually of animal origin, such as (usually of animal origin, such as
rodents), and rodents), and Microsporum gallinae Microsporum gallinae (rarely seen - (rarely seen -
usually found on gallinaceous birds like turkeys and usually found on gallinaceous birds like turkeys and
chickens). chickens).

51. •Predisposing factorsPredisposing factors include include persistent sweatingpersistent sweating, , high high
humidityhumidity, , irritation of skin from clothesirritation of skin from clothes, such as tight , such as tight
fitting underwear fitting underwear or or athletic supportersathletic supporters, pre-existing , pre-existing
disease, such as disease, such as diabetesdiabetes and and obesityobesity..

54. •TreatmentTreatment
–TolnaftateTolnaftate (Tinactin trademark) treatment (Tinactin trademark) treatment
protocol for tinea corporis. protocol for tinea corporis.
–Relief of symptoms occur within 3 days and Relief of symptoms occur within 3 days and
treatment continued until all signs of  disease treatment continued until all signs of  disease
are gone. are gone.
–Area is sensitive so the other care needs to be Area is sensitive so the other care needs to be
taken into to add to irritation of region.taken into to add to irritation of region.

55. What is Onychomycosis?
•A general term to denote any fungal nail infection.
•Fungal infection that causes fingernails or toenails to
thicken, discolor, disfigure, and split.
•Tinea unguium?Tinea unguium?

56. Risk Factors
•Increasing age
•Male > Female
•Diabetes
•Nail trauma
•Hyperhidrosis
•Peripheral vascular
diseases
•Poor hygiene
•Immunodeficiency

57. Anatomy of the Nail
▼▼▼

58. Classification
of Onychomycosis
•Distal subungual onychomycosis (DSO)
•Proximal subungual onychomycosis (PSO)
•White superficial onychomycosis (WSO)
•Total dystrophic onychomycosis (TDO)

59. Distal Subungual Onychomycossis
•The most common form of
onychomycosis
•Area of infection:
fingernails
toenails
•Common Etiology Agent:
Trichophyon rubrum
Trichophyton mentagrophytes
Epidermophyton floccosum

60. Distal subungual
onychomycosis
•Fungi invade the hyponychium
and grow in the substance of nail
bed and nail plate and
Hyperkeratotic debris resulted in:
•yellow or grey accumulation
causes nail to separate from the
bed and onycholysis (causing it
to crumble)

61. Proximal Subungual
Onychomycosis






















©©Current Medicine 1995Current Medicine 1995
•This results in subungual
hyperkeratosis, proximal
onycholysis, leukonychia,
and eventual destruction of the
proximal nail plate.
•Trichophyton rubrum is the
most common etiologic agent
and toenails are more often
infected than fingernails.
•Proximal subungual onychomycosis
(PSO) (and its variant, proximal white
subungual onychomycosis [PWSO]), is
the least common presentation in the
immunocompetent population.
•However, PSO is more frequent in AIDS
patients and in patients with peripheral
vascular disease.
•The pathogen invades the nail plate
through the proximal nail fold and
spreads distally from the lanula area.

63. White Superficial Onychomycosis
©©Current Medicine 1995Current Medicine 1995
White superficial onychomycosis (WSO)
occurs less frequently than DLSO and is
caused by fungal invasion of the superficial
nail plate. Characteristically, well delineated
opaque “white islands” are seen on the nail.
These “white islands” grow radially and may coalesce to cover much of the nail.
The infection may also move through the plate into the cornified layers of the nail
bed and hyponychium.
Eventually, the nail becomes rough, soft, and may crumble.
As in DLSO, the toenails are more commonly involved.
The most common pathogen is T. mentagrophytes.
Non-dermatophyte moulds, including Aspergillus terreus, Acremonium potronii, and
Fusarium oxysporum have also been implicated

64. Total dystrophic onychomycosis
(TDO)
•Total dystrophic onychomycosis may
be the result of all three of these
primary presentations.
•The entire nail plate and bed are
involved and the nail becomes
thickened and dystrophic.
•These are “dermatophytomas,”
which are composed of
densely packed, somewhat
abnormal hyphae, and
relatively resistant to systemic
antifungal therapy.
Debridement of these lesions
•is necessary for optimal
management

67. •TreatmentTreatment Oral therapy:
•The most commonly used oral drugs for treatment of onychomycosis
is griseofulvin, terbinafine, itraconazole and ketoconazole.
•The disadvantages of oral antifungal agents are, they require a longer
treatment period and they have more side effects, e.g. terbinafine
(Lamisil®).
•This drug is taken daily for 8 weeks for fingernail fungus and for 12
weeks for toenail fungus.
•The most frequent side effects of Lamisil® are headache,
gastrointestinal disturbance (diarrhea and/or dyspepsia), rash and
elevated liver enzymes

68. Itraconazole (Sporanox®) this is often prescribed in “pulse doses” one
week per month for 2 or 3 months.
It can interact with some commonly used drugs such as the antibiotic
erythromycin or certain asthma medications.
The most frequent side effects of Sporanox® include increased liver
function tests, skin rash, high triglycerides, and gastrointestinal effects
(nausea, bloating, and diarrhea)
Ketoconazole (Diflucan®) may be given once a week for several
months.
The most common side effects are headache, skin rash, and/or
gastrointestinal (GI) disturbance (nausea, vomiting, diarrhea, and/or
abdominal pain)

69. Griseofulvin (Fulvicin®, Gifulvin®, Gris-Peg®) this drug has
been the main stay of oral antifungal therapy for many years.
Although this drug is safe, it is not very effective against
toenail fungus
Topical Therapy:
Creams and other topical medications are usually not effective against
nail fungus.
This is because nails are too hard for external applications to penetrate.
However, a new medicated nail lacquer has been approved to treat finger
or toenail fungus that does not involve the white portion of the nail
(lunula) in persons with normal immune systems.
The nail lacquers which are currently available are ciclopirox and
amorolfine nail lacquers, which are effective for the treatment or
prevention of fungal infections such as onychomycosis

70. Tinea capitis – ring worm of the Tinea capitis – ring worm of the
scalp, eyebrows and eyelashesscalp, eyebrows and eyelashes
•Caused by species of Caused by species of MicrosporumMicrosporum and and TrichophytonTrichophyton. .
•Fungus grows Fungus grows into hair follicleinto hair follicle. .
•Tinea capitis is most often a disease seen in children, with the
highest incidence occurring between the ages of 3 and 7
• In those persons with persistent infections, spontaneous cures
often occur shortly after puberty, probably because of chemical
changes in sebum.
• teenagers and adults may also be infected and develop a less
severe presentation.

71. Ectothrix infection Ectothrix infection
•spores formation around the hair shaft spores formation around the hair shaft with destroyed cuticle.with destroyed cuticle.
•This type of infection caused by This type of infection caused by M. audouniiM. audounii, , M. canisM. canis, ,
M. ferrugineumM. ferrugineum, , T. mentagrophytesT. mentagrophytes, , T. verrucosumT. verrucosum and and T. megniniiT. megninii..
M. gypseumM. gypseum and and M. fulvumM. fulvum (geophilic species). (geophilic species).
•1-"1-"Gray patch ringwormGray patch ringworm"" 
ectothrix common disease in children
 
ectothrix common disease in children
usually not associated with inflammationusually not associated with inflammation..
•Patches seldom exceed 6–8 centimeters in diameter.
•Several patches may coalesce to form extensive areas of hair loss.
•2-Kerion2-Kerion is inflammatory type of ectothrix infections that usually is inflammatory type of ectothrix infections that usually
caused by animal types of fungi and presented as caused by animal types of fungi and presented as swampy swellings swampy swellings
with crusting and loose hairswith crusting and loose hairs. Kerion may be followed by . Kerion may be followed by scarringscarring and and
permanent alopeciapermanent alopecia. .

72. EctothrixEctothrix

73. Gray- pach RingwotmGray- pach Ringwotm

74. kerionkerion

75. •2-Endothrix infection2-Endothrix infection
•spores formation within the hair shaft spores formation within the hair shaft with with intact intact
cuticle (cuticle (is the outermost part of the hair shaft)
•This type of infection caused This type of infection caused T. tonsuransT. tonsurans (the (the
commonest cause), commonest cause), T. violaceumT. violaceum, , T. rubrumT. rubrum, , and and T. T.
gourvilliigourvillii.  . 
•All these pathogen species are All these pathogen species are anthropophilicanthropophilic..
•Black dotsBlack dots and and chicken skinchicken skin are the endothrix are the endothrix
findings.findings.

76. EndothrixEndothrix
The shafts to break off at or below the surface of the scalp,
leaving only arthroconidia-laden stubs visible.
When the hairs are black, this results in the appearance of black dots.
Other hair colors produce dots of the same color.
black dots are not always seen in endothrix tinea capitis

78. Black dotsBlack dots

79. •3-Favus infection3-Favus infection
• fragmented hyphaefragmented hyphae and air spaces occur within the hair and air spaces occur within the hair
shaft. shaft.
•It is caused by It is caused by Trichophyton schoenleiniiTrichophyton schoenleinii..
•This infection is characterized by the presence of This infection is characterized by the presence of yellowishyellowish, ,
cup-shaped crusts cup-shaped crusts known as known as scutulascutula. .
•The scutula have a The scutula have a distinctive mousy odour.distinctive mousy odour.
•Cicatricial alopecia Cicatricial alopecia is usually found in long-standing cases.is usually found in long-standing cases.
• Tinea of deprivationTinea of deprivation (in (in malnutrished childrenmalnutrished children).).

81. FavusFavus

86. Treatment of Tinea CapitisTreatment of Tinea Capitis
•EctothrixEctothrix infections often resolve on their own. infections often resolve on their own.
•EndothrixEndothrix infections infections may become chronic may become chronic and may and may
continue into adulthood. continue into adulthood.
•Topical treatments Topical treatments are are ineffectiveineffective (don't bother using (don't bother using
tolnaftatetolnaftate or or topicaltopical griseofulvingriseofulvin). ).
•Fungistatic agents are Fungistatic agents are somewhat effective somewhat effective ((miconazolemiconazole, ,
clotrimazoleclotrimazole) in combination to systemic administration ) in combination to systemic administration
of of griseofulvin or Terbinafinegriseofulvin or Terbinafine. .
•Vigorous daily scrubs of scalp help removal of infectious Vigorous daily scrubs of scalp help removal of infectious
debris. debris. 

87. Diagnosis
These include (1) Wood’s light examination, (2) direct
microscopic examination of hair, and (3) fungal
cultures.
Wood’s light examination in a darkened room will
produce fluorescence in hairs infected with certain
dermatophyte species.

88. DIFFERENTIAL DIAGNOSIS
•Tinea capitis should be considered in the differential of any
scaling patch of alopecia on the scalp.
•
•Other conditions that may have similar clinical presentations
include: alopecia areata, discoid lupus erythematosus,
dissecting cellulitis, folliculitis decalvans, impetigo, lichen
planus, psoriasis, seborrheic dermatitis, and secondary syphilis

89. treatment

90. Tinea barbae – ringworm of the Tinea barbae – ringworm of the
beardbeard
•Tinea barbae is a disease of Tinea barbae is a disease of adultsadults especially those in especially those in
contact with contact with farm animalsfarm animals..
•as as tinea circinata tinea circinata and and mostly unilateral mostly unilateral
•Like tinea capitis, Like tinea capitis, oral and topical antifungals oral and topical antifungals are are
required to cure tinea barbae.required to cure tinea barbae.

91. •Anthropophilic dermatophytes that may cause this
disease include T. rubrum, T megninii, T violaceum,
and T. schoenleinii
•Zoophilic organisms, such as T. mentagrophytes and
T. verrucosum,
are more likely to produce the inflammatory pattern
characterized by kerion formation with boggy,
elevated nodules, draining pustules, and sinus tracts.

92. Hair in infected areas may be broken, loose, or
absent.
The chin and neck are usually first involved and
infection may spread to cover the entire beard
area.
However, the upper lip is rarely affected.

93. •This feature helps to distinguish tinea barbae from
bacterial pyodermas, as these infections commonly
involve the upper lip
•Other symptoms that may be seen with both conditions
include prominent adenopathy, fever, and malaise.
•The second clinical presentation of tinea barbae is the
noninflammatory or sycosiform type or circinata,
unilateral, the more uncommon of the two varieties.
•
•This non-inflammatory type often resembles bacterial
folliculitis in that follicular pustules may be discrete

96. Libratory diagnosisLibratory diagnosis
1- Specimen preparation1- Specimen preparation
•skin scrapings, nail scrapings and hair.skin scrapings, nail scrapings and hair.
2- Direct examination2- Direct examination
•Often tissue suspended in 10 % KOH solution to Often tissue suspended in 10 % KOH solution to
help clear tissue.help clear tissue.
•In skin and nail scrapingIn skin and nail scraping
•Branching and septate hyphae and arthroconidia.Branching and septate hyphae and arthroconidia.
•In hairIn hair
•Endothrix, ectothrix and favus.Endothrix, ectothrix and favus.

97. KOH preparation of skin scraping shows septate branching mycelium KOH preparation of skin scraping shows septate branching mycelium
with arthroconidiawith arthroconidia

98. Superficial dermatophytosis (PAS stains)Superficial dermatophytosis (PAS stains)

99. 3- Wood3- Wood
,,
s lights light
•Certain fungi fluoresce when infected hair Certain fungi fluoresce when infected hair
examined by Wood’s light.examined by Wood’s light.
•Greenish yellow fluorescenceGreenish yellow fluorescence: : M. audouinii, M. M. audouinii, M.
canis and T. menta var erinaceicanis and T. menta var erinacei..
•Blueish white fluorescenceBlueish white fluorescence: : T. schoenleiniiT. schoenleinii..

101. 4- Culture4- Culture
•There are three sets of observations generally There are three sets of observations generally
useful for the identification of most fungi:useful for the identification of most fungi:
•A) colony obverse:A) colony obverse: color (white, black,…), color (white, black,…),
consistency (cottony, fluffy, suedelike,…) and consistency (cottony, fluffy, suedelike,…) and
topography (flat, folded,…).topography (flat, folded,…).
•B) colony reverse:B) colony reverse: look for significant pigment look for significant pigment
and confirm with specific media.and confirm with specific media.
•C) microscopic morphology:C) microscopic morphology: look for look for
microconidia, macroconidia (their size, shape, microconidia, macroconidia (their size, shape,
arrangement) and hyphal structures.arrangement) and hyphal structures.

102. •S and SCCS and SCC (Sabouraud’s agar with cycloheximide (Sabouraud’s agar with cycloheximide
and chloramphenicol) is the standard medium for and chloramphenicol) is the standard medium for
isolation of dermatophytes.isolation of dermatophytes.
•Temprature: 30Temprature: 30
˚c˚c
•Time: 3 weekTime: 3 week

103. Infection is enhanced by damage to the skin surface.
For example, tinea cruris and interdigital tinea pedis
frequently occur in areas that have become macerated
secondary to occlusion.
Human genetics also appears to play a role in the
pathogenicity of some dermatophytes.
Tinea unguium (onychomycosis) may be an autosomal
dominant trait in some families.
Tinea imbricata, which is caused by Trichophyton
concentricum and thought to be inherited in an autosomal
recessive fashion, is a variant of tinea corporis.

104. •DermatophytidDermatophytid or or “Id" reaction“Id" reaction. .
•Allergic reactions Allergic reactions are sometimes associated with tinea are sometimes associated with tinea
pedis and other ringworm infections (pedis and other ringworm infections (allergic reaction allergic reaction
of tinea capitis occurs on bodyof tinea capitis occurs on body). ).
•toxinstoxins get get into blood stream into blood stream and and reaches a site other reaches a site other
than the site of infection. than the site of infection.
•blisteringblistering occurs on occurs on fingersfingers and and handshands..
•treat the primary site of infection where the antigen is treat the primary site of infection where the antigen is
being produced. being produced.
•treat secondary site - blisters.treat secondary site - blisters.

105. Dermatophytid ReactionDermatophytid Reaction