Superficial mycosis

Superficial mycosisSuperficial mycosis

MaculaeMaculaePapulePapuleVesicleVesicleBullaBullaPustulePustuleNodule Nodule FistulaFistulaScaleScale

DefinitionDefinitionFungiFungi Pityriasis versicolorPityriasis versicolor Tinea nigraTinea nigra PiedraPiedra

BacteriaBacteria ErythrasmaErythrasma Trichomycosis axillarisTrichomycosis axillaris

OtomycosisOtomycosisKeratomycosisKeratomycosisPitted keratolysisPitted keratolysisDermatophylosis Dermatophylosis

Pityriasis versicolorPityriasis versicolor

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

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

Pityriasis versicolorPityriasis versicolorClinical manifestations:Clinical manifestations: MaculaeMaculae White, cream, pink, red, White, cream, pink, red,

brownbrown PositionPosition ScaleScale PainlessPainless Not itchingNot itching

Differential diagnosis:Differential diagnosis: VitiligoVitiligo ChloasmaChloasma

Laboratory diagnosis:Laboratory diagnosis:

SamplingSampling ScalpelScalpel Scathe tapeScathe tape Wood ́s lampWood ́s lamp

DirectDirect

Culture Culture

TreatmentTreatment Selenium sulfide Selenium sulfide Clotrimazole Clotrimazole

Tinea nigraTinea nigra

Phaeoanellomyces werneckiiPhaeoanellomyces werneckii Exophiala werneckiiExophiala werneckii

EcologyEcologyPalmPalmTinea nigra palmarisTinea nigra palmaris

Clinical manifestation:Clinical manifestation:

Annular Annular CentrifugeCentrifugeRegular or irregularRegular or irregular

PainlessPainless

No itching No itching

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

Laboratory diagnosis:Laboratory diagnosis: Sampling:Sampling:

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

HyphaeHyphaeChlamydioconidiaChlamydioconidia

Culture:Culture:SS

TreatmentTreatment Keratolytic ointmentKeratolytic ointment

whitfieldwhitfield

PiedraPiedra

HairHairNodule Nodule Bread, groin, axillarBread, groin, axillarWhite & 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

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

White:White: hyphae & arthroconidia hyphae & arthroconidiaBlack:Black: ascus & ascospore ascus & ascospore

Culture:Culture:SS

PiedraPiedra

Treatment:Treatment: ScrapingScraping Clotrimazole Clotrimazole

ErythrasmaErythrasma

BacteriaBacteriaCorynebacterium minutissimumCorynebacterium minutissimumChronicChronicIntertrigenousIntertrigenous

Clinical manifestation:Clinical manifestation: MaculaeMaculae

Red or brownRed or brown

ScaleScale

ItchingItching

No inflammationNo inflammation

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

Scalpel & simple stainingScalpel & simple staining Direct:Direct:

StrandStrand Culture:Culture:

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

TreatmentTreatment Erythromycin Erythromycin

Trichomycosis axillarisTrichomycosis axillaris

BacteriaBacteriaCorynebacterium tenuisCorynebacterium tenuisNodule Nodule HairHair Axillaries & pubisAxillaries & pubis RedRed YellowYellow blackblack

Differential diagnosis:Differential diagnosis: PediculosisPediculosis

Sesser & KOH10%Sesser & KOH10% DirectDirect CultureCulture

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

AspergillusAspergillusDematiaceousDematiaceous

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

ExogenExogenEndogen Endogen

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

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 canalCategorized by time courseCategorized by time course AcuteAcute ChronicChronic

Swimmer’s earSwimmer’s ear

OrganismsOrganisms

1.1. FungiFungi1.1. AspergillusAspergillus2.2. CandidaCandida species species

2.2. PseudomonasPseudomonas species species 3.3. Staphylococci Staphylococci 4.4. StreptococciStreptococci5.5. Gram negative rodsGram negative rods

Risk FactorsRisk Factors

High humidityHigh humidityWater exposureWater exposureHigh environmental temperatureHigh environmental temperatureLocal traumaLocal traumaAllergyAllergyStressStressAlkaline pH of canalAlkaline pH of canal

Often indistinguishable from bacterial OEOften indistinguishable from bacterial OEDull painDull painHearing loss (obstructive)Hearing loss (obstructive)

TreatmentTreatmentThorough cleaning and drying of canalThorough cleaning and drying of canalTopical 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

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

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

عالئم بالینیعالئم بالینیاپیدرماپیدرمزخم های کم عمقزخم های کم عمقاگزودااگزوداکدر شدن موکدر شدن موریزش دلمهریزش دلمهبهبودبهبودآلوپسیآلوپسی

تشخیص آزمایشگاهیتشخیص آزمایشگاهیگیریگیری نمونهنمونه

پوسته و ترشحاتپوسته و ترشحاتمستقیممستقیم

رنگ آمیزیرنگ آمیزیمتیلن بلومتیلن بلوگیمساگیمسا ،میکرون میکرون55- - 22رشته های منشعب، رشته های منشعب

88 کوکسی کوکسی کشتکشت

بالد آگاربالد آگار3737درجه درجه

تشخیص آزمایشگاهیتشخیص آزمایشگاهیکاتاالز مثبتکاتاالز مثبتاوره آز مثبتاوره آز مثبتاسید فست منفیاسید فست منفیهیدرولیز نشاسته مثبتهیدرولیز نشاسته مثبت

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

کراتولیز حفره ایکراتولیز حفره ایPitted keratolysisPitted keratolysisالیه شاخی کف پاالیه شاخی کف پاضایعات سطحی گردضایعات سطحی گرد

عامل بیماریعامل بیماریاکتینومایستاکتینومایستنوکاردیانوکاردیادرماتوفیلوسدرماتوفیلوسکورینه باکتریومکورینه باکتریوم

عوامل مستعد کنندهعوامل مستعد کنندهرطوبترطوبتگرماگرمارعایت نکردن بهداشترعایت نکردن بهداشتچکمهچکمهپوتینپوتین

عالئم بیماریعالئم بیماریالیه های سطحی کف پاالیه های سطحی کف پاانگشتان و پاشنه پاانگشتان و پاشنه پاتجزیه کراتینتجزیه کراتینضایعات سطحی گردضایعات سطحی گردبوی نامطبوعبوی نامطبوع

تشخیص آزمایشگاهیتشخیص آزمایشگاهینمونه گیرینمونه گیری

پوستهپوستهمستقیممستقیم

پتاس و رنگ آمیزیپتاس و رنگ آمیزیرشته و کوکسیرشته و کوکسی

کشتکشتمشکل استمشکل است

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

Superficial mycosis

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