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Course of Dermatology

Diseases Resulting from


Fungi and Yeasts

Yujianbin( 于建斌 )
Dep. of Dermatology,First Teaching
Hospital of Zhengzhou University
The superficial mycoses(Ⅰ)
 The skin constitutes the main site of fungal
infections in humans
 These infections can be divided into
– superficial mycoses
– deep mycoses
 The fungi that usually cause only superficial
infection on the skin are called dermatophytes
 The skin appendages,namely,the hair and
nails,are also often involved in these infections
The superficial mycoses(Ⅱ)
 The mycoses caused by dermatophytes are
called dermatophytosis,tinea,or ringworm.
 On certain parts of the body tinea has
certain distinctive features
 For this reason the tineas are divided into :
tinea capitis (ringworm of the scalp and kerion)
tinea barbae (ringworm of the beard)
tinea facies
tinea corporis
tinea manus
tinea pedis
tinea cruris
onychomycosis (fungus infection of the nails)
susceptibility (Ⅰ)
 The dermatophytes are soil saprophytes that have
acquired the ability to digest keratinous debris in
soil
 Some of these organisms evolved to parasitize
keratinous tissues of animals frequently in contact
with soil
 Environmental conditions help promote the
propagation of many opportunistic fungi
Susceptibility (Ⅱ)
 However , host factors are also significant
– The best example of host factors that promote
dermatophytosis is the immunosuppressed patient
– Dermatophytes are eliminated from the skin by a cell-
mediated immune reaction
– The combination of an inflammatory response
coupled with increased proliferative activity of
keratinocytes helps to minimize progression and
remove the fungus from the skin surface
– Immunocompromised state,such as patient with AIDS
,may result in severe forms of dermatophyte infection
Tinea captis
 Ringworm of the scalp is an infectious disease
occurring chiefly in schoolchildren and less commonly
in infants and adults
 Boys have tinea captis more frequently than girls
 Clinical types of infection can be divided into
– Tinea alba: often noninflammatory lesions
– Tinea nigra: often noninflammatory,or light inflammatory
lesions
– Tinea favosa: inflammatory lesions
– Kerion: inflammatory lesions,may cause scarring
 Tinea capitis can be caused by all the
pathogenic dermatophytes except for
Epidermophyton floccosum ( 絮状表皮癣菌 )

 In china,most cases are caused by


Microsporum
ferrugineum ( 铁锈色小孢子菌 ), and
Microsporum canis ( 犬小孢子菌 )
( clinical type is tinea alba)
Tinea alba kerion

Tinea favosa Tinea nigra


Tinea alba
Clinical feature
Often caused by
Microsporum
ferrugineum, and
Microsporum canis
Stubs of broken hair
Scaly lesions
(gray-patch)
Minimal inflammtory
response
Less subjective
symptoms
Tinea favosa
Clinical features

Caused by
Trichophyton
schoenleinii

Infected hairs shedding


Inflammatory lession
purulent crust
Obviously Itching
Scarring after infection
Trichophyton schoenleinii
damages of the hairs Bubbles of air

Infected hair broken off The hole of infected hair

Hairs broken off Hairs shedding


Tinea nigra
Clinical features

Multiple areas of
alopecia
black dots
Infected hairs
broken off at or
below the surface
of scalp
Light inflammation
kerion
Diagnosis
 Clinical features
– Damage of hairs
 Shedding ,broken off
– Lesions of the scalp
 Scaly patchs
 Purulent crusts
 Microscope examination
– Diagnostic values,ectothrix type,endothrix type
 cultivation
– Obtaining fungal species
Differential diagnosis

Eczema of head Psoriasis of scalp


Tinea corporis
 Tinea corporis includes all superficial
dermatophyte infections of the skin, other than
those involving the scalp,beard,face,hand,feet,and
groin
 Sites of predilection are the neck,upper and lower
extremities,and trunk
 It can be caused by any of the dermatophytes
 This form of ringworm is characterized by one of
more circular,sharply circumscribed,slightly
erythematous,dry,scaly,usually hypopigmented
patches
Etiology

Various organisms may cause this type


of fungal infection

T. rubrum, common ( 红色毛癣菌 )


Microsporum canis ( 犬小孢子菌 )

 Epidermophyton floccosum( 须状表皮癣菌 )


Clinical features

One or more lesions


Circular
Sharply circumscribed
Slightly erythematous
Dry,scaly pathees
The lesions may slightly
elevated at the border ,
where they are more
inflamed and scaly than
at the central part
The name” ringworm”
was obtained
Tinea facies
Tinea corporis
in a child,
caused by
Microsporum
canis
Tinea corporis
Attention:
sharp margins and
central clearing

Tinea corporis
Tinea cruris
Occurs frequently in men
On the upper and inner
surface of the thighs
Begins as a small
erythematous,scaling
Spread peripherally
Well-defined border
Central clearing

Scrotum are seldom


involved
Tinea cruris
Tinea cruris
in a
Diagnosis
 Clinical features
– circular erythema
– well-difined border
– slightly elevated at the border,where they are more
inflamed and scaly than at the central part
– central clearing
 Microscope examination
– Fungal positive , diagnostic values
 cultivation
– Obtaining fungal species
Trichophyton
gypseum
( 须癣毛癣菌 )
Trichophyton gypseum
hypha under microscopy
( 菌丝 )

Trichophyton gypseum
Colony ( 菌落 )
Microsporum canis
( 犬小孢子菌 )
Microsporum canis
colony ( 菌落 )

Microsporum canis
spores under microscopy
( 孢子 )
Differential diagnosis

Pityriasis rosea Dermatitis


Tinea of hands & feet
 Dermatophytosis of the feet,long popularly called
athlete’s foot,is by far the most common fungal disease
 The primary lesions of tinea pedis often consist of
maceration,slight scaling,and vesiculation
 The primary lesions of tinea manusisthedry,scaly,

and erythematous
 However, the moist ,vesicular,and eczematous

type are often seen on the feet


Tinea pedis

Dry
Scaly
Erythema
Itching
Frequently only one
foot is affected
Tinea pedis

showing
Interdigital scaling
Frequently only
one foot is affected
Obvious itching
Tinea pedis

Showing
Maceration
Tinea pedis

Showing
Fissures
Thickening
Scaling
Tinea corporis and tinea pedis
Tinea manus

Showing
Scaly, coarse
Dry
Erythema
Fissures
Tinea manus
Vesicles are
usually about 2
or 3 mm in
diameter
Some times they
coalesce to form
bullae
They do not
rapture
spontaneousy but
dry up slowly
Tinea corporis and tinea manus
Diagnosis
 Clinical features
– Localized erythema,scales,coares ,vesicles
– Frequently only one hand or foot affected
 Microscope examination
– Fungal positive ,diagnostic value
 cultivation
– Obtaining fungal species
Onychomycosis
(discoloration 变色 )
Onychomycosis
Onychomycosis
Onychomycosis(part)
Onychomycosis(border)
Onychomycosis
Lesion near the root of nail
Onychomycosis
Onychomycosis
Histopathology test
Antifungal therapy (Ⅰ)

 When considering use of an oral antifungal


agent there are three considerations:
– the spectrum of activity of the antifungal agent
– the clinical type of infection
– the safety,compliance,and cost
Antifungal therapy (Ⅱ)
 The imidazoles comprise
– Clotrimazole
– Miconazole
– Econazole
– Ketoconazole
 They are used mostly for topical therapy
Antifungal therapy(Ⅲ)

 The triazoles include itraconazole and


fluconazole,they affect the cytochrome P450
– As such numerous drug interactions occur,some of
which may be life threatening
– A thorough knowledge of the patient’s drug levels is
required when prescribing these two agents
– The triazoles have the broadest in vitro spectrum of
activity,including dermatophytes,Candida species, and
Malassezia furfur
Antifungal therapy(Ⅳ)
 Terbinafine are allylamines
– Terbinafine is quite effective against dermatophytes
– Terbinafine is less active against Candida species in
in vitro studies;however,clinically it is usually
effective
– It has been shown ineffective in the oral treatment of
tinea versicolor but is effective topically

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