superficial mycosis maculaepapulevesiclebullapustulenodulefistulascale

Superficial mycosisSuperficial mycosis

MaculaeMaculaePapulePapuleVesicleVesicleBullaBullaPustulePustuleNodule Nodule FistulaFistulaScaleScale

Superficial mycosisSuperficial mycosis

DefinitionDefinition

FungiFungi Pityriasis versicolorPityriasis versicolor Tinea nigraTinea nigra PiedraPiedra

BacteriaBacteria ErythrasmaErythrasma Trichomycosis axillarisTrichomycosis axillaris

Superficial mycosisSuperficial mycosis

OtomycosisOtomycosis

KeratomycosisKeratomycosis

Pitted keratolysisPitted keratolysis

Dermatophylosis Dermatophylosis

Pityriasis versicolorPityriasis versicolor

Tinea versicolorTinea versicolorMaculaeMaculaeMalassezia sppMalassezia sppNormal floraNormal floraBoys & girlsBoys & girlsAfter maturationAfter maturationBeautyBeautyWarm & humidity Warm & humidity SeasonSeason

Pityriasis versicolorPityriasis versicolor

Conditions:Conditions: HealthHealth SweatSweat Greasy skinGreasy skin IC.IC. Chronic bacterial infectionsChronic bacterial infections SteroidsSteroids

Pityriasis versicolorPityriasis versicolor

Clinical manifestations:Clinical manifestations: MaculaeMaculae White, cream, pink, red, White, cream, pink, red,

brownbrown PositionPosition ScaleScale PainlessPainless Not itchingNot itching

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Superficial mycosisSuperficial mycosis

Pityriasis versicolorPityriasis versicolor

Pityriasis versicolorPityriasis versicolor

Differential diagnosis:Differential diagnosis: VitiligoVitiligo ChloasmaChloasma

Pityriasis versicolorPityriasis versicolor

Laboratory diagnosis:Laboratory diagnosis:

SamplingSampling ScalpelScalpel Scathe tapeScathe tape Wood 1s lampWood 1s lamp

DirectDirect

Culture Culture

Pityriasis versicolorPityriasis versicolor

TreatmentTreatment Selenium sulfide Selenium sulfide Clotrimazole Clotrimazole

Tinea nigraTinea nigra

Phaeoanellomyces werneckiiPhaeoanellomyces werneckii Exophiala werneckiiExophiala werneckii

EcologyEcology

PalmPalm

Tinea nigra palmarisTinea nigra palmaris

Tinea nigraTinea nigra

Clinical manifestation:Clinical manifestation:

Annular Annular CentrifugeCentrifuge

Regular or irregularRegular or irregular

PainlessPainless

No itching No itching

Tinea nigraTinea nigra

Differential diagnosis:Differential diagnosis: Malignant melanomaMalignant melanoma Silver nitrateSilver nitrate

Tinea nigraTinea nigra

Laboratory diagnosis:Laboratory diagnosis: Sampling:Sampling:

Scalpel & KOH10%Scalpel & KOH10% Direct:Direct:

HyphaeHyphae

ChlamydioconidiaChlamydioconidia Culture:Culture:

SS

Tinea nigraTinea nigra

TreatmentTreatment Keratolytic ointmentKeratolytic ointment

whitfieldwhitfield

PiedraPiedra

HairHair

Nodule Nodule

Bread, groin, axillarBread, groin, axillar

White & blackWhite & black

PiedraPiedra

Clinical manifestation:Clinical manifestation: White piedra:White piedra:

Trichosporon beigeliiTrichosporon beigelii BasidiomycetesBasidiomycetes

NoduleNodule Bread, head, pubisBread, head, pubis White, brown, yellow, White, brown, yellow, Soft Soft

PiedraPiedra

Clinical manifestation:Clinical manifestation: Black piedra:Black piedra:

Piedra hortaePiedra hortae AscomycetesAscomycetes

NoduleNodule HeadHead ThickThick Black to brown Black to brown

PiedraPiedra

Differential diagnosis:Differential diagnosis: Pediculosis Pediculosis

PiedraPiedra

Laboratory diagnosis:Laboratory diagnosis: Sampling:Sampling:

Sesser & KOH10%Sesser & KOH10% Direct:Direct:

White:White: hyphae & arthroconidia hyphae & arthroconidia

Black:Black: ascus & ascospore ascus & ascospore Culture:Culture:

SS

PiedraPiedra

Treatment:Treatment: ScrapingScraping Clotrimazole Clotrimazole

ErythrasmaErythrasma

BacteriaBacteria

Corynebacterium minutissimumCorynebacterium minutissimum

ChronicChronic

IntertrigenousIntertrigenous

ErythrasmaErythrasma

Clinical manifestation:Clinical manifestation: MaculaeMaculae

Red or brownRed or brown

ScaleScale

ItchingItching

No inflammationNo inflammation

Superficial mycosisSuperficial mycosis

ErythrasmaErythrasma

Superficial mycosisSuperficial mycosis

ErythrasmaErythrasma

Superficial mycosisSuperficial mycosis

ErythrasmaErythrasma

Superficial mycosisSuperficial mycosis

ErythrasmaErythrasma

ErythrasmaErythrasma

Differential diagnosis:Differential diagnosis: Pityriasis versicolorPityriasis versicolor CandidiasisCandidiasis Tinea crurisTinea cruris

ErythrasmaErythrasma

Laboratory diagnosis:Laboratory diagnosis: Sampling:Sampling:

Scalpel & simple stainingScalpel & simple staining Direct:Direct:

StrandStrand Culture:Culture:

BHI, Blood agarBHI, Blood agar Wood 1s lampWood 1s lamp

ErythrasmaErythrasma

TreatmentTreatment Erythromycin Erythromycin

Trichomycosis axillarisTrichomycosis axillaris

BacteriaBacteria

Corynebacterium tenuisCorynebacterium tenuis

Nodule Nodule

HairHair Axillaries & pubisAxillaries & pubis RedRed YellowYellow blackblack

Trichomycosis axillarisTrichomycosis axillaris

Differential diagnosis:Differential diagnosis: PediculosisPediculosis

Trichomycosis axillarisTrichomycosis axillaris

Laboratory diagnosis:Laboratory diagnosis: Sampling:Sampling:

Sesser & KOH10%Sesser & KOH10% DirectDirect CultureCulture

Trichomycosis axillarisTrichomycosis axillaris

TreatmentTreatment Scraping and sulphur ointment 3%Scraping and sulphur ointment 3%

KeratomycosisKeratomycosis

INCIDENCE OF INCIDENCE OF FKFK

Developed worldDeveloped world

6 -35% of all microbial keratitis6 -35% of all microbial keratitis

Developing worldDeveloping world

22 - >50%22 - >50%

FUNGAL GROUPSFUNGAL GROUPS

FilamentousFilamentous

FusariumFusarium

AspergillusAspergillus

DematiaceousDematiaceous

YeastsYeasts

CandidaCandida

Fungal KeratitisFungal Keratitis

Risk factors:Risk factors: Topical corticosteroids ↓corneal resistance to Topical corticosteroids ↓corneal resistance to

infectioninfection Contact lens use Contact lens use Immunocomprised states Immunocomprised states

Fungal KeratitisFungal KeratitisRisk factorsRisk factors Injury, ocular surface compromiseInjury, ocular surface compromise TemperatureTemperature WindWind HumidityHumidity Urbanisation/employmentUrbanisation/employment

Fungal KeratitisFungal Keratitis

ExogenExogen

Endogen Endogen

Fungal KeratitisFungal Keratitis

Gray-white color, dry, and rough corneal Gray-white color, dry, and rough corneal surfacesurface

White ring in the cornea and satellite White ring in the cornea and satellite lesions near the edge of the primary lesions near the edge of the primary Most cases remain superficial Most cases remain superficial but deep invasion may but deep invasion may occuroccur

DIAGNOSISDIAGNOSIS

Clinical features (diff.diagnosis)Clinical features (diff.diagnosis)

MicrobiologyMicrobiology

HistopathologyHistopathology

DNA amplificationDNA amplification

HISTOPATHOLGYHISTOPATHOLGY

Haematoxylin and eosin (H&E)Haematoxylin and eosin (H&E)

Periodic acid-Schiff (PAS)Periodic acid-Schiff (PAS)

GrocottGrocott

Fungal KeratitisFungal Keratitis

Treatment: Treatment: Natamycin 5% drops (filamentous)Natamycin 5% drops (filamentous)

Works particularly well Fusarium sppWorks particularly well Fusarium spp Amphotercin B 0.15-0.30% (Candida)Amphotercin B 0.15-0.30% (Candida) Most effective for yeastMost effective for yeast

Otomycosis Otomycosis

OtomycosisOtomycosis

Bacterial, viral or fungal infection of Bacterial, viral or fungal infection of external auditory canalexternal auditory canal

Categorized by time courseCategorized by time course AcuteAcute ChronicChronic

Swimmer’s earSwimmer’s ear

OrganismsOrganisms

1.1. FungiFungi1.1. AspergillusAspergillus

2.2. CandidaCandida species species

2.2. PseudomonasPseudomonas species species

3.3. Staphylococci Staphylococci

4.4. StreptococciStreptococci

5.5. Gram negative rodsGram negative rods

Risk FactorsRisk Factors

High humidityHigh humidity

Water exposureWater exposure

High environmental temperatureHigh environmental temperature

Local traumaLocal trauma

AllergyAllergy

StressStress

Alkaline pH of canalAlkaline pH of canal

OtomycosisOtomycosis

Often indistinguishable from bacterial OEOften indistinguishable from bacterial OE

Dull painDull pain

Hearing loss (obstructive)Hearing loss (obstructive)

OtomycosisOtomycosis

TreatmentTreatment

Thorough cleaning and drying of canalThorough cleaning and drying of canal

Topical antifungals Topical antifungals ClotrimazoleClotrimazole

Acidifying of the EAC with drops likeAcidifying of the EAC with drops like 2% acetic acid2% acetic acid 3% boric acid3% boric acid

درماتوفیلوزیسدرماتوفیلوزیس

مترشحه، چرکمترشحه، چرکحیوانحیوانانسانانسانپوسته و دلمهپوسته و دلمهاسکار و آلوپسیاسکار و آلوپسیمسریمسری

درماتوفیلوزیسدرماتوفیلوزیس

Dermatophilus congolonsisDermatophilus congolonsisاکتینومایستاکتینومایستگوسفند و دامگوسفند و دامپارازیت پوستپارازیت پوستفصل بارانیفصل بارانیتماس مستقیمتماس مستقیمLumpy woolLumpy wool

عالئم بالینیعالئم بالینی

اپیدرماپیدرمزخم های کم عمقزخم های کم عمقاگزودااگزوداکدر شدن موکدر شدن موریزش دلمهریزش دلمهبهبودبهبودآلوپسیآلوپسی

تشخیص آزمایشگاهیتشخیص آزمایشگاهی

گیریگیری نمونهنمونهپوسته و ترشحاتپوسته و ترشحات

مستقیممستقیمرنگ آمیزیرنگ آمیزی

متیلن بلومتیلن بلوگیمساگیمسا ،میکرون میکرون55- - 22رشته های منشعب، رشته های منشعب

88 کوکسی کوکسی

کشتکشتبالد آگاربالد آگار3737درجه درجه

تشخیص آزمایشگاهیتشخیص آزمایشگاهی

کاتاالز مثبتکاتاالز مثبتاوره آز مثبتاوره آز مثبتاسید فست منفیاسید فست منفیهیدرولیز نشاسته مثبتهیدرولیز نشاسته مثبت

درماندرمان

سولفات مسسولفات مس درصد/ درصد55سولفات روی سولفات روی /پنی سیلینپنی سیلین

کراتولیز حفره ایکراتولیز حفره ای

Pitted keratolysisPitted keratolysisالیه شاخی کف پاالیه شاخی کف پاضایعات سطحی گردضایعات سطحی گرد

عامل بیماریعامل بیماری

اکتینومایستاکتینومایستنوکاردیانوکاردیادرماتوفیلوسدرماتوفیلوسکورینه باکتریومکورینه باکتریوم

عوامل مستعد کنندهعوامل مستعد کننده

رطوبترطوبتگرماگرمارعایت نکردن بهداشترعایت نکردن بهداشتچکمهچکمهپوتینپوتین

عالئم بیماریعالئم بیماری

الیه های سطحی کف پاالیه های سطحی کف پاانگشتان و پاشنه پاانگشتان و پاشنه پاتجزیه کراتینتجزیه کراتینضایعات سطحی گردضایعات سطحی گردبوی نامطبوعبوی نامطبوع

تشخیص آزمایشگاهیتشخیص آزمایشگاهی

نمونه گیرینمونه گیریپوستهپوسته

مستقیممستقیمپتاس و رنگ آمیزیپتاس و رنگ آمیزیرشته و کوکسیرشته و کوکسی

کشتکشتمشکل استمشکل است

درماندرمان

از بین بردن شرایط مستعد کنندهاز بین بردن شرایط مستعد کننده درصد درصد4040 تا تا 2020فرمالین فرمالین