Fungal Skin Infection

Irma Savitri 0806358022

Presentation Outline
Superficial mycoses
Pityriasis versicolor Candidiasis

Cutaneous mycoses
Dermatophytes

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

Pityriasis versicolor

Etiology: Malassezia furfur

GMS stained skin biopsy showing characteristic spherical yeast cells and short pseudohyphal elements typical of M. furfur. 10% KOH with Parker ink mount showing characteristic spherical yeast cells and short pseudohyphal elements typical of the fungus.

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

Histopathology: Malassezia furfur

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 the organism, while glycine induces hyphal formation

Clinical Manifestations
Hypopigmentation Hyperpigmentation

Laboratory Examination
Skin scraping Cellophane stripping technique

Diagnosis, Differential Diagnosis, Prognosis, Management

Woods lamp: golden yellow fluorescence Mainly cosmetic problem Daily application of selenium sulfide, topical or oral azole Avoid excessive heat and sweating

Woods lamp

Woods lamp

Candidiasis

Etiology: Candida

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.

Histopathology

Pathophysiology and Pathogenesis

increase in the local census of Candida and damage to the skin or epithelium local invasion by the yeasts and pseudohyphae. Systemic candidiasis bloodstream and the phagocytic host defenses are inadequate to contain the growth and dissemination of the yeasts. Important: Cell-mediated immune response, neutrophil

Clinical Manifestation
Cutaneous and Muscosal Candidiasis Candidiasis in the Gastrointestinal mucosa

Laboratory Examination, Diagnosis, Differential Diagnosis, Prognosis

Swabs and scrapings Culture, Gram stain

Management and Prevention

Thrush and other mucocutaneous forms of candidiasis : topical nystatin or oral ketoconazole or fluconazole Systemic candidiasis: amphotericin B, sometimes in conjunction with oral flucytosine, fluconazole, or caspofungin Prevention: avoid disturbing the normal balance of microbial flora and intact host defense

Dermatophytoses

Etiology
Microsporum Epidermophyton floccosum Trichophyton

Microsporum
Microsporum caninum Microsporum gypseum

Risk Factors and Epidemiology

Moisture, warmth, etc. The incidence is higher in hot, humid climates and under crowded living conditions.

Histopathology

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

Clinical Manifestations
Tinea pedis Tinea pedis

Clinical Manifestations
Tinea cruris Tinea corporis

Clinical Manifestations
Tinea manuum

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

Laboratory Examination, Diagnosis, Differential Diagnosis, Prognosis, Management, Prevention