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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 )
Caused by
Trichophyton
schoenleinii
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
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
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
and erythematous
However, the moist ,vesicular,and eczematous
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)